Moral objections to suicide: Can they counteract suicidality in patients with cluster B psychopathology?

Objective: Patients with cluster B personality disorder (CBPD) are particularly prone to suicidal behavior, yet possible protective mechanisms are not often studied. The present study investigated a possible protective role of moral objections to suicide (MOS) against suicidal behavior in patients with CBPD and current depression. The effect of MOS was then examined in relation to other mechanisms affecting suicide risk including trait aggressivity and the presence of effective coping strategies. Method: 147 depressed patients with comorbid CBPD (DSM-III-R) were compared with 210 depressed patients without CBPD in terms of their history of suicide attempts and clinical and demographic characteristics. The relationship of MOS to suicide attempt was examined by logistic regression controlling for demographic and clinical differences between the groups as well as presence of comorbid CBPD. Data were collected from 1990 to 2003. Results: Subjects with comorbid CBPD had fewer MOS and reported more previous suicide attempts. In logistic regression, fewer MOS/religious beliefs, lower coping potential, and higher aggression level were associated with suicide attempt. A CBPD diagnosis did not affect the relationship between MOS and suicide attempts. Conclusions: The results of this study suggest that the presence of MOS/religious beliefs may have a protective effect against suicidal behavior in depressed patients with comorbid CBPD and may be a target for therapeutic intervention.