Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-18T04:36:28.078Z Has data issue: false hasContentIssue false
  • English
  • Français

Personality disorder traits, risk factors, and suicide ideation among older adults

Published online by Cambridge University Press:  23 February 2015

Danielle R. Jahn ,
Erin K. Poindexter  and
Kelly C. Cukrowicz
Danielle R. Jahn
Affiliation:
Department of Psychological Sciences, Texas Tech University, Mail Stop 42051, Lubbock, TX 79409-2051, USA
Erin K. Poindexter
Affiliation:
Department of Psychological Sciences, Texas Tech University, Mail Stop 42051, Lubbock, TX 79409-2051, USA
Kelly C. Cukrowicz*
Affiliation:
Department of Psychological Sciences, Texas Tech University, Mail Stop 42051, Lubbock, TX 79409-2051, USA
*
Correspondence should be addressed to: Kelly C. Cukrowicz, Department of Psychological Sciences, Texas Tech University, Mail Stop 42051, Lubbock, TX 79409-2051, USA. Phone: +806-834-8485; Fax: +806-742-0818. Email: kelly.cukrowicz@ttu.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Personality disorder traits are relatively prevalent among older adults, and can be associated with complex and chronic difficulties, including suicide risk. However, there is a lack of research regarding personality disorders and suicide ideation in older adults. Depressive symptoms and hopelessness may be important to the relation between personality disorders and suicide risk. Additionally, variables from the interpersonal theory of suicide, perceived burdensomeness and thwarted belongingness, may be critical risk factors for suicide in this population. We hypothesized that perceived burdensomeness and thwarted belongingness, theory-based variables, would act as parallel mediators of the relation between personality disorder traits and suicide ideation, whereas depressive symptoms and hopelessness would not.

Methods:

The hypothesis was tested in a sample of 143 older adults recruited from a primary care setting. Participants completed self-report questionnaires of personality traits, suicide ideation, depressive symptoms, hopelessness, perceived burdensomeness, and thwarted belongingness.

Results:

Findings from a non-parametric bootstrapping procedure indicated that perceived burdensomeness, thwarted belongingness, and depressive symptoms mediated the relation between total personality disorder traits and suicide ideation. Hopelessness did not act as a mediator.

Conclusions:

These findings indicate that perceived burdensomeness, thwarted belongingness, and depressive symptoms are likely important risk factors for suicide ideation among older adults. Clinicians should be aware of these issues when assessing and treating suicide risk among older adults.

Keywords

agingperceived burdensomenessthwarted belongingnessdepressive symptomshopelessnesssuicide ideation
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 11 , November 2015 , pp. 1785 - 1794
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abrams, R. C. and Horowitz, S. V. (1996). Personality disorders after age 50: a meta-analysis. Journal of Personality Disorders, 10, 271–281. doi:10.1521/pedi.1996.10.3.271.CrossRefGoogle Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, (DSM-IV-TR). Arlington, VA: American Psychiatric Publishing.Google Scholar
Balsis, S., Woods, C. M., Gleason, M. E. J. and Oltmanns, T. F. (2007). Overdiagnosis and underdiagnosis of personality disorders in older adults. American Journal of Geriatric Psychiatry, 15, 742–753. doi:10.1097/JGP.0b013e31813c6b4e.CrossRefGoogle ScholarPubMed
Beck, A. T. and Steer, R. A. (1988). Manual for the Beck Hopelessness Scale. San Antonio, TX: Psychological Corporation.Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Centers for Disease Control and Prevention (2014). WISQARS Leading Causes of Death Reports, National and Regional, 1999–2010. Retrieved from http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html.Google Scholar
Chapman, A. L., Lynch, T. R., Rosenthal, M. Z., Cheavens, J. S., Smoski, M. J. and Krishnan, K. R. R. (2007). Risk aversion among depressed older adults with obsessive compulsive personality disorder. Cognitive Therapy and Research, 31, 161–174. doi:10.1007/s10608-006-9114-x.CrossRefGoogle Scholar
Cukrowicz, K. C., Cheavens, J. S., Van Orden, K. A., Ragain, R. M. and Cook, R. L. (2011). Perceived burdensomeness and suicide ideation in older adults. Psychology and Aging, 26, 331–338. doi:10.1037/a0021836.CrossRefGoogle ScholarPubMed
Cukrowicz, K. C., Ekblad, A. G., Cheavens, J. S., Rosenthal, M. Z. and Lynch, T. R. (2008). Coping and thought suppression as predictors of suicidal ideation in depressed older adults with personality disorders. Aging & Mental Health, 12, 149–157. doi:10.1080/13607860801936714.CrossRefGoogle ScholarPubMed
Cukrowicz, K. C., Jahn, D. R., Graham, R. D., Poindexter, E. K. and Williams, R. B. (2013). Suicide risk in older adults: evaluating models of risk and predicting excess zeros in a primary care sample. Journal of Abnormal Psychology, 122, 1021–1030. doi:10.1037/a0034953.CrossRefGoogle Scholar
Davidson, C. L., Wingate, L. R., Grant, D. M., Judah, M. R. and Mills, A. C. (2011). Interpersonal suicide risk and ideation: the influence of depression and social anxiety. Journal of Social and Clinical Psychology, 30, 842–855. doi:10.1521/jscp.2011.30.8.842.CrossRefGoogle Scholar
De Leo, D., Cerin, E., Spathonis, K. and Burgis, S. (2005). Lifetime risk of suicide ideation and attempts in an Australian community: prevalence, suicidal process, and help-seeking behaviour. Journal of Affective Disorders, 86, 215–224. doi:10.1016/j.jad.2005.02.001.CrossRefGoogle Scholar
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W. and Benjamin, L. S. (1997). User's guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press.Google Scholar
Harwood, D., Hawton, K., Hope, T. and Jacoby, R. (2001). Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study. International Journal of Geriatric Psychiatry, 15, 155–165. doi:10.1002/1099-1166(200102)16:2<155::AID-GPS289>3.0.CO;2-0.3.0.CO;2-0>CrossRefGoogle Scholar
Hayes, A. F. and Preacher, K. J. (2014). Statistical mediation analysis with a multicategorical independent variable. British Journal of Mathematical and Statistical Psychology, 67, 451–470. doi:10.1111/bmsp.12028.CrossRefGoogle ScholarPubMed
Heisel, M. J., Conwell, Y., Pisani, A. R. and Duberstein, P. R. (2011). Concordance of self and proxy reported suicide ideation in depression adults 50 years of age or older. The Canadian Journal of Psychiatry, 56, 219–226.CrossRefGoogle ScholarPubMed
Heisel, M. J. and Flett, G. L. (2006). The development and initial validation of the geriatric suicide ideation scale. American Journal of Geriatric Psychiatry, 14, 742–751. doi:10.1097/01.JGP.0000218699.27899.f9.CrossRefGoogle ScholarPubMed
Jahn, D. R., Cukrowicz, K. C., Linton, K. and Prabhu, F. (2011). The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults. Aging & Mental Health, 15, 214–220. doi:10.1080/13607863.2010.501064.CrossRefGoogle Scholar
Jo, S. A., Park, M. H., Jo, I., Ryu, S.-H. and Han, C. (2007). Usefulness of beck depression inventory (BDI) in the Korean elderly population. International Journal of Geriatric Psychiatry, 22, 218–233. doi:10.1002/gps.1664.CrossRefGoogle ScholarPubMed
Joiner, T. E. Jr. (2005). Why People Die by Suicide. Cambridge, MA: Harvard University Press.Google Scholar
Joiner, T. E. Jr., Van Orden, K. A., Witte, T. K. and Rudd, M. D. (2009). The Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Joiner, T. E., Ribeiro, J. D. and Silva, C. (2012). Nonsuicidal self-injury, suicidal behavior, and their co-occurrence as viewed through the lens of the interpersonal theory of suicide. Current Directions in Psychological Science, 21, 342–347. doi:10.1177/0963721412454873.CrossRefGoogle Scholar
Klap, R., Unroe, K. T. and Unutzer, J. (2003). Caring for mental illness in the United States: a focus on older adults. American Journal of Geriatric Psychiatry, 11, 517–524. doi:10.1097/00019442-200309000-00006.CrossRefGoogle ScholarPubMed
Kunik, M. E. et al. (1993). Personality disorders in elderly inpatients with major depression. American Journal of Geriatric Psychiatry, 1, 38–45. doi:10.1097/00019442-199300110-00006.CrossRefGoogle ScholarPubMed
Luoma, J. B., Martin, C. E. and Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry, 159, 909–916. doi:10.1176/appi.ajp.159.6.909.CrossRefGoogle ScholarPubMed
Molinari, V., Ames, A. and Essa, M. (1994). Prevalence of personality disorders in two geropsychiatric inpatient units. Journal of Geriatric Psychiatry and Neurology, 7, 209–215.CrossRefGoogle ScholarPubMed
Molinari, V. and Marmion, J. (1995). Relationship between affective disorders and Axis II diagnoses in geropsychiatric patients. Journal of Geriatric Psychiatry and Neurology, 8, 61–64.Google ScholarPubMed
Ricarte, J. J., Latorre, J. M., Ros, L., Navarro, B., Aguilar, M. J. and Serrano, J. P. (2011). Overgeneral autobiographical memory effect in older depressed adults. Aging & Mental Health, 15, 1028–1037. doi:10.1080/13607863.2011.573468.CrossRefGoogle ScholarPubMed
Segal, D. L., Marty, M. A., Meyer, W. J. and Coolidge, F. L. (2012). Personality, suicidal ideation, and reasons for living among older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 67, 159–166. doi:10.1093/geronb/gbr080.CrossRefGoogle ScholarPubMed
Sirey, J. A. et al. (2008). Depressive symptoms and suicidal ideation among older adults receiving home delivered meals. International Journal of Geriatric Psychiatry, 23, 1306–1311. doi:10.1002/gps.2070.CrossRefGoogle ScholarPubMed
Stevenson, J., Datyner, A., Boyce, P. and Brodaty, H. (2011). The effect of age on prevalence, type and diagnosis of personality disorder in psychiatric inpatients. International Journal of Geriatric Psychiatry, 26, 981–987. doi:10.1002/gps.2645.CrossRefGoogle ScholarPubMed
Suija, K. et al. (2012). Validation of the Whooley questions and the beck depression inventory in older adults. Scandinavian Journal of Primary Health Care, 30, 259–264. doi:10.3109/02813432.2012.732473.CrossRefGoogle ScholarPubMed
van Alphen, S. P. J., Derksen, J. J. L., Sadavoy, J. and Rosowsky, E. (2012). Features and challenges of personality disorders in late life. Aging & Mental Health, 16, 805–810. doi:10.1080/13607863.2012.667781.CrossRefGoogle ScholarPubMed
Van Orden, K. A., Cukrowicz, K. C., Witte, T. K. and Joiner, T. E. Jr. (2012). Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the interpersonal needs questionnaire. Psychological Assessment, 24, 197–215. doi:10.1037/a0025358.CrossRefGoogle ScholarPubMed
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A. and Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. doi:10.1037/a0018697.CrossRefGoogle ScholarPubMed