Neuroticismo y suicidioun estudio meta-analítico

Abstract

JUSTIFICATION: Neuroticism is a trait of importance when developing suicidal behavior. Nevertheless, a range of heterogeneous results regarding this connection can be found. OBJECTIVE: To analyze the direction and magnitude of the existing connection between neuroticism and suicide and to evaluate the influence of the possible moderating variables. METHODOLOGY: The design used was a systematic review and meta-analysis. The studies were identified through: PubMed / MEDLINE, IME, Lilacs, CINAHL and EMBASE using the search terms: [Neuroticism OR Character OR Temperament] AND [Suicide], present in the title or in the abstract. The selection criteria: (a) studies that relate neuroticism with suicidal ideation or suicide attempts, (b) neuroticism measured directly in cases, (c) observational studies or descriptive type, (d) samples from any population group, region or geographical area, (e) written in the English, Spanish, French, Portuguese or Italian languages, (f) referred to adult population and (g) available until January 2015.With the obtained studies, a complete review is carried out by two independent evaluators. A Registration Protocol followed in which the characteristics of the studies are registered, including a list with criteria to measure the methodological quality. A descriptive analysis of the characteristics of the studies is carried out initially and later the size of the average effect is calculated assuming a random effects model. The heterogeneity of the effect magnitude was assessed, the publication bias and the influence of qualitative and quantitative moderating variables was examined. Finally, a multiple meta-regression model was applied. RESULTS: Two different meta-analyzes were carried out with the 29 studies selected. For the meta-analysis of neuroticism-suicidal ideas, the size of the mean effect (r + = 0.446, 95% CI 0.266-0.595) reflected a positive relationship of high magnitude, although a high level of heterogeneity in the results. No potential publication bias was detected. The analysis of the moderating variables resulted in a predictive model with gender moderating variables and type of self-report to measure neuroticism. Regarding the meta-analysis neuroticism-suicide attempts, an average effect size was obtained (r + = 0.340, 95% CI 0.243-0.430), which also reflected a positive relationship between neuroticism and suicide attempts of medium magnitude. In this case, there was also high heterogeneity and no publication bias was detected. The analysis of the moderating variables resulted in a predictive model with two variables: standard deviation of the age and type of sample. DISCUSSION: Neuroticism presents a statistically significant association with both ideas and suicide attempts. The association is stronger with suicidal ideas than with suicide attempts. In women, the connection between neuroticism and suicidal ideas is stronger than in men. The greater the variability in the ages of the sample, the less association between neuroticism and suicide attempts. In clinical samples a stronger correlation is observed than in the community ones, for both relationships. Some of the limitations of the presented study were that it has not been possible to study the suicidal phenomenon in its full spectrum and also that some of the moderating variables can not be dismissed as moderating the neuroticism-suicide relationship due to the low number of studies. The studied connections could be mediated by other variables not taken into account. Among the strengths: the exhaustive and systematic review of the studies, the revision and codification by two independent evaluators and the accomplishment of statistical analyzes taking into account random and mixed effects, as well as the analysis of the publication bias. CONCLUSIONS: It is hereby confirmed the existence of a statistically and clinically significant link between neuroticism suicidal ideas and suicide attempts. This is highly important in terms of clinical interventions, as well as preventive in relation to the suicidal phenomenon.