School of Psychology, Cardiff University, Cardiff, UK.
Psychology, Cwm Taf Morgannwg University Health Board, Abercynon, UK.
Clin Psychol Psychother. 2024 Jul-Aug;31(4):e3029. doi: 10.1002/cpp.3029.
Suicide rates in older adults are often the highest of any age group, particularly among high income countries. However, there is a limited understanding of the factors that could protect against suicidality in older age. This systematic review aimed to identify and evaluate the psychological factors that protect against suicidality in older age.
An a priori protocol was established and registered on PROSPERO (CRD42022343694). EMBASE, MEDLINE, PsycINFO, Web of Science and Scopus were searched. Papers were quality assessed using the Quality Assessment with Diverse Studies (QuADSs) tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seventeen papers were included and narratively synthesised.
The initial searches identified 10,673 records, resulting in the screening of 5441 records after the removal of duplicates. The protective factors identified were (1) meaning/purpose in life, (2) reasons for living, (3) coping styles, (4) psychological wellbeing, (5) life satisfaction, (6) personality factors, (7) cognitive functioning, and (8) sense of belonging. The factors with the most empirical support were meaning in life, followed by psychological wellbeing and coping responses, such as primary control strategies, and personality traits, such as positive affect and agency. There was also evidence to suggest that the influence of some protective factors, for example meaning in life, may depend upon stage in older life and gender.
This review identified several psychological factors that have been found to protect against suicidal ideation in older adults, representing potential treatment targets for reducing suicide in older adults. Recommendations for future research includes greater use of longitudinal and case-control designs, measuring outcomes across the continuum of suicidality and using samples that allow comparison between younger and older adults and within the spectrum of old age.
老年人的自杀率往往是所有年龄段中最高的，尤其是在高收入国家。然而，人们对可能预防老年人自杀的因素知之甚少。本系统评价旨在确定和评估预防老年人自杀的心理因素。
制定了一个事先的方案，并在 PROSPERO（CRD42022343694）上进行了注册。对 EMBASE、MEDLINE、PsycINFO、Web of Science 和 Scopus 进行了检索。使用多样性研究质量评估工具（QuADSs）评估论文的质量。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。纳入了 17 篇论文并进行了叙述性综合。
最初的搜索确定了 10673 条记录，在去除重复项后，筛选出 5441 条记录。确定的保护因素包括（1）生活的意义/目的，（2）生存理由，（3）应对方式，（4）心理健康，（5）生活满意度，（6）人格因素，（7）认知功能，和（8）归属感。具有最多实证支持的因素是生活意义，其次是心理健康和应对反应，如主要控制策略，以及人格特质，如积极情绪和能动性。也有证据表明，一些保护因素的影响，例如生活的意义，可能取决于老年人生命阶段和性别。
本综述确定了一些心理因素，这些因素已被发现可预防老年人出现自杀意念，代表了降低老年人自杀率的潜在治疗目标。对未来研究的建议包括更多地使用纵向和病例对照设计，测量贯穿自杀连续性的结果，并使用允许在年轻人和老年人之间以及在老年范围内进行比较的样本。
