Department of Psychiatry, University of Connecticut Health Center, Farmington, CT.
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT.
Am J Geriatr Psychiatry. 2021 Jan;29(1):66-77. doi: 10.1016/j.jagp.2020.03.018. Epub 2020 Apr 13.
Evidence suggests a cross-sectional association between personality traits and suicidal ideation in LLD. Yet, it is unclear how personality may influence suicidal ideation over time in LLD, or whether such an association would be moderated by psychosocial and biological individual differences. The present study had three aims: 1) to examine whether personality traits increase suicidal ideation in LLD over time, 2) to understand whether this relationship is influenced by subjective social support, and 3) to determine whether the potential relationship between social support, personality, and suicidal ideation is different for men and women.
Participants were enrolled in the Duke University Neurocognitive Outcomes of Depression in the Elderly (NCODE), a longitudinal investigation of the predictors of poor illness course in LLD. Patients were initially enrolled in the NCODE study between December 1994 and June 2000 and were followed for an average of six years.
NCODE operates in a naturalistic treatment milieu.
One hundred twelve participants aged 60 and older with a current diagnosis of major depressive disorder.
Annual assessments of depression, suicidal ideation, and social support (measured with the Duke Social Support Index). Participants also completed the NEO Personality Inventory-Revised (NEO-PI-R) providing measures of the five major personality dimensions (neuroticism, extraversion, openness, conscientiousness, and agreeableness).
Univariate logistic generalized linear mixed modeling (GLMM) analyses revealed that higher levels of depression at baseline, less subjective social support, higher neuroticism, and lower extraversion were significantly associated with an increased likelihood of suicidal ideation over time. While the relationship between these dimensions and suicidal ideation were no longer significant in multivariate analyses, there was a significant moderating effect of social support on the association between suicidal ideation and certain neuroticism and extraversion personality facets. Decreased subjective social support was associated with an increased likelihood of suicidal ideation in LLD patients with high (but not low) impulsiveness and low (but not high) gregariousness and positive emotions. Across all models, social support was beneficial to women, but not men, in decreasing the likelihood of future suicidal ideation.
Changes in social support may contribute to suicidal ideation in older depressed adults with certain personality traits. Irrespective of personality traits, changes in social support had a significant effect on the suicidal ideation of women but not men. These relationships were apparent even when controlling for depression severity, age, and history of suicide attempt.
有证据表明，个性特征与 LLD 中的自杀意念存在横断面关联。然而，目前尚不清楚个性特征如何随时间影响 LLD 中的自杀意念，或者这种关联是否会受到心理社会和生物学个体差异的调节。本研究有三个目的：1）研究个性特征是否会随时间增加 LLD 中的自杀意念；2）了解这种关系是否受到主观社会支持的影响；3）确定社会支持、个性特征与自杀意念之间的潜在关系是否因男性和女性而有所不同。
参与者参加了杜克大学老年人抑郁的神经认知结局（NCODE）研究，这是一项对 LLD 不良病程预测因素的纵向研究。患者最初于 1994 年 12 月至 2000 年 6 月期间被纳入 NCODE 研究，并平均随访了六年。
NCODE 在自然治疗环境中运作。
112 名年龄在 60 岁及以上、目前患有重度抑郁症的患者。
每年评估一次抑郁、自杀意念和社会支持（采用杜克社会支持指数测量）。参与者还完成了 NEO 人格量表修订版（NEO-PI-R），提供了五个主要人格维度（神经质、外向性、开放性、尽责性和宜人性）的测量。
单变量逻辑广义线性混合模型（GLMM）分析显示，基线时抑郁程度较高、主观社会支持较少、神经质程度较高和外向性程度较低与随时间增加自杀意念的可能性显著相关。虽然这些维度与自杀意念的关系在多变量分析中不再显著，但社会支持对自杀意念与某些神经质和外向性人格特征之间关联的调节作用具有显著意义。主观社会支持减少与 LLD 患者中高（但非低）冲动性和低（但非高）合群性和积极情绪相关的自杀意念发生可能性增加有关。在所有模型中，社会支持对女性降低未来自杀意念的可能性有益，但对男性无益。
社会支持的变化可能导致具有某些人格特征的老年抑郁成年人出现自杀意念。无论人格特征如何，社会支持的变化对女性自杀意念的影响显著，而对男性则没有。即使控制抑郁严重程度、年龄和自杀未遂史，这些关系仍然明显。
