A new study has found that middle-aged and older adults with high levels of conscientiousness may be at a greater risk of engaging in suicidal behaviour, challenging the traditional view that this personality trait is solely protective against negative health outcomes.
The research, published in the journal Comprehensive Psychiatry, used data from the University of Pittsburgh’s Longitudinal Research Program in Late-Life Suicide, focusing on adults aged 40 and above who suffer from depression. The study investigated whether conscientiousness, a personality trait characterised by being organised, diligent, and goal-orientated, could be associated with an increased likelihood of recent suicidal behaviour and the severity of suicidal intent.
The study involved 313 participants, with an average age of 62, who were part of a larger ongoing research programme on late-life suicide. The participants were assessed for their levels of conscientiousness and other health indicators, such as cognitive functioning and physical health. Researchers aimed to understand whether conscientiousness might influence the likelihood of attempting suicide and the intensity of the intent behind such actions.
Anna Szücs, MD, a researcher from Vrije Universiteit Amsterdam and the National University of Singapore, said: “Suicide prevention remains difficult in the second half of life, with researchers and clinicians struggling to obtain a clear clinical picture of who may be at risk of attempting suicide. It is clear that midlife and late life often bring a different set of challenges than younger life, such as declining health, which may require individuals to rely more on others and let go of some amount of agency over their life and performance. This may be particularly difficult for individuals who tend to exercise a high level of control and precision over their activities, such as those who are highly conscientious.”
The findings revealed a complex relationship between conscientiousness and suicide risk. Overall, participants with higher levels of conscientiousness were more likely to have recently attempted suicide and demonstrated a higher severity of intent during these attempts. This suggests that the traits associated with conscientiousness, such as being meticulous and disciplined, might drive individuals to take decisive and potentially harmful actions when faced with distressing life circumstances, particularly when struggling with depression.
Szücs added: “We investigated the association between conscientiousness and suicidal behaviour in depressed middle-aged and older adults and found that conscientiousness was associated with a higher likelihood of having attempted suicide within the past two years as well as with higher intent (determination and planning) related to the attempt in those who engaged in suicidal behaviour.”
But the study also noted that this association did not hold for participants who were severely physically ill. In these instances, the presence of a serious illness appeared to lessen the risk that conscientiousness would otherwise increase.
Szücs commented on this aspect: “Although having a severe physical health condition was also linked to a higher likelihood of having attempted suicide, having both a severe physical illness and a more conscientious personality was not related to a higher likelihood of attempting suicide than having one of these two characteristics separately. The acute life stressors contributing to a suicidal crisis in ageing, highly conscientious individuals remain to be understood. These findings nonetheless hint to a darker side of high conscientiousness and warn clinicians against being falsely reassured by their depressed middle-aged and older patients or clients’ dependable, well-organised presentation when assessing suicide risk.”
The study further explored how different aspects of health influenced the relationship between conscientiousness and suicidal behaviour. Cognitive functioning and severe physical illness emerged as significant factors. Participants with lower cognitive functioning were more likely to have attempted suicide recently, and severe physical illness also independently increased the likelihood of suicidal behaviour.
Interestingly, when severe physical illness was present, the previously observed positive association between conscientiousness and suicide risk diminished. This finding suggests that while conscientiousness might generally increase the risk of suicidal behaviour, the presence of a severe physical health condition could alter this dynamic, possibly by shifting the focus of these individuals towards managing their illness rather than engaging in self-harm.
These findings have important implications for how clinicians assess and manage suicide risk in middle-aged and older adults. Conscientiousness is typically viewed as a positive trait that contributes to healthy behaviours and longevity. But this study suggests that in the context of depression and other mental health challenges, high levels of conscientiousness might paradoxically increase the risk of suicide, particularly among those who are otherwise healthy.
Szücs also mentioned ongoing research in this area: “Building on these findings, we are working on projects that will help understand how single vulnerability traits of mid- and late-life suicidal behaviour, such as conscientiousness, present in combination with one another to outline more comprehensive risk profiles. We are also planning more research to understand links between personality vulnerability, acute risk factors for late suicidal crises, and the life trajectories of middle-aged and older suicide attempters.”
Clinicians should be aware that highly conscientious patients may not always display overt signs of suicidal ideation but might still be at risk due to their tendency to plan and execute decisions meticulously. This underscores the importance of comprehensive mental health assessments that consider personality traits alongside traditional risk factors such as physical health and cognitive function.
The study also highlights the need for tailored interventions that account for an individual’s personality profile. For instance, patients with high conscientiousness might benefit from therapies that focus on flexibility and adaptive coping strategies, helping them manage their need for control in healthier ways. As Szücs noted: “We think that gaining a more holistic understanding of at-risk individuals can help shift preventive efforts to primary prevention, making it possible to prevent the onset of a suicidal crisis or even that of depression through early intervention tailored to individual profiles.”
