The Interaction of Personality and Social Support on Prospective Suicidal Ideation in Men and Women With Late-Life Depression

摘要

Objective: 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. Design: 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. Setting: NCODE operates in a naturalistic treatment milieu. Participants: One hundred twelve participants aged 60 and older with a current diagnosis of major depressive disorder. Measurements: 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). Results: 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. Conclusion: 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.