Coping and thought suppression as predictors of suicidal ideation in depressed older adults with personality disorders

Abstract

Suicide rates are higher among older adults than any other age group and suicidal ideation is one of the best predictors of completed suicide in older adults. Despite this, few studies have evaluated predictors of suicidal ideation and other correlates of death by suicide (e.g. hopelessness) among older adults. Even fewer studies on this topic have been conducted among samples characterized as poor responders to treatments (e.g. depressed individuals with co-occurring personality disorder). The purpose of this study was to examine coping styles and thought suppression as predictors of a suicide risk composite score in a sample of depressed older adults with co-occurring personality disorders. Based on the extant literature, it was hypothesized that maladaptive coping (i.e. emotional and avoidance coping) and chronic thought suppression would significantly predict suicide risk. The results of this study indicated that elevated emotional coping and thought suppression were associated with increased suicide risk. Contrary to hypotheses, lower avoidance coping was associated with increased risk, although this finding is moderated by Axis II diagnosis Thus, treatments that focus on decreasing emotional coping and chronic thought suppression may result in decreased suicidal ideation and hopelessness for older adults with depression and Axis II pathology.

Acknowledgements

This research was partially supported by Grant AG00029 from the National Institute of Aging and Grant MH01614 from the National Institute of Mental Health.

Notes

Note

[1]  To ascertain whether the prediction of suicide risk by CSQ subscale scores and WBSI scores was consistent across different personality disorders, post-hoc partial correlations were computed separately for participants meeting criteria for each personality disorder. The authors decided to conduct partial correlations rather than multiple regression analyses by group due to the small n for each group, which would have resulted in underpowered regression models. Further, we remained concerned regarding the representativeness of the relatively small groups of participants with each personality disorder. Finally, many participants were diagnosed with more than one personality disorder, rendering by-group analysis problematic. The partial correlations controlled for the influence of depressive symptoms on the relations between the suicide composite score, self-reported coping styles and thought suppression. These analyses indicated that emotional coping was positively related to suicide risk. The magnitude of this relation was 0.53 for BPD (n = 9); 0.49 for Avoidant Personality Disorder (n = 19); 0.45 for Paranoid Personality Disorder (n = 11); and 0.21 for Obsessive-Compulsive Personality Disorder (n = 33). Partial correlations were not computed for the other personality disorders due to limited sample size (i.e. degrees of freedom of one or zero). Partial correlations indicated that avoidance coping was negatively associated with suicide risk for many of the personality disorders. The magnitude of this relation was 0.41 for BPD; −0.21 for Avoidant Personality Disorder; −0.48 for Paranoid Personality Disorder; and −0.28 for Obsessive-Compulsive Personality Disorder. A similar pattern of positive and negative relations was found for detached coping (0.26 for BPD, −0.33 for Avoidant Personality Disorder; −0.38 for Paranoid Personality Disorder; and −0.23 for Obsessive-Compulsive Personality Disorder). Partial correlations also indicated that rational coping was negatively associated with suicide risk for all personality disorders. The magnitude of this relation was −0.34 for BPD; −0.28 for Avoidant Personality Disorder; −0.18 for Paranoid Personality Disorder; and −0.08 for Obsessive-Compulsive Personality Disorder. Finally, thought suppression was positively correlated with most personality disorders. The magnitude of this relation was −0.21 for BPD; 0.22 for Avoidant Personality Disorder; 0.33 for Paranoid Personality Disorder; and 0.46 for Obsessive-Compulsive Personality Disorder. Taken together, these post-hoc analyses indicate that while emotional coping is consistently positively correlated with suicide risk; the influence of avoidance and thought suppression may depend somewhat on the personality disorder experienced by the participant. In particular, the negative relation between avoidance coping and suicide risk appears to hold for Avoidant, Paranoid and Obsessive-Compulsive personality disorders, but not for BPD. Similarly, the association between thought suppression and suicide risk was consistently positive for Avoidant, Paranoid and Obsessive-Compulsive personality disorders.