Abstract：
BACKGROUND: Clinical and subclinical forms of narcissism may increase suicide risk. However, little is known and there are controversies on this topic. This systematic review aims at providing an overview of studies investigating this association.
METHODS: We used PubMed, Scopus, and PsycInfo databases and followed PRISMA. We focused on cohort, case-control, cross-sectional and case series studies. We referred to both clinical (i.e., narcissistic personality disorder (NPD) and/or NPD criteria) and subclinical forms (i.e., grandiose and vulnerable narcissistic traits) of narcissism. Moreover, we considered: Suicidal Ideation (SI), Non-Suicidal Self-Injury(s) (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt(s) (SA), Suicide Risk (SR), and Capability for Suicide.
RESULTS: We included 47 studies. Lack of association between NPD diagnosis/criteria and suicide-related outcomes (SI) or mixed results (SA) were found. Higher homogeneity emerged when considering narcissistic traits. Vulnerable narcissism was associated with SI, less impulsive NSSI, and DSH. Grandiose narcissism was associated with severe NSSI and multiple SA with high intent to die, but it was protective against SI and SR. Vulnerable narcissism seemed to be associated with suicide-related outcomes characterized by low intent to die, while grandiose narcissism seemed to be a risk factor for outcomes with high planning and severity.
CONCLUSIONS: Between-study heterogeneity and lack of longitudinal studies.
CONCLUSIONS: Assessing suicide risk in subjects with clinical or subclinical forms of narcissism may be useful. Moreover, considering the most vulnerable form of narcissism, and not just the grandiose one, may contribute to a more nuanced risk stratification and to the identification of distinct therapeutic approaches.
METHODS: We used PubMed, Scopus, and PsycInfo databases and followed PRISMA. We focused on cohort, case-control, cross-sectional and case series studies. We referred to both clinical (i.e., narcissistic personality disorder (NPD) and/or NPD criteria) and subclinical forms (i.e., grandiose and vulnerable narcissistic traits) of narcissism. Moreover, we considered: Suicidal Ideation (SI), Non-Suicidal Self-Injury(s) (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt(s) (SA), Suicide Risk (SR), and Capability for Suicide.
RESULTS: We included 47 studies. Lack of association between NPD diagnosis/criteria and suicide-related outcomes (SI) or mixed results (SA) were found. Higher homogeneity emerged when considering narcissistic traits. Vulnerable narcissism was associated with SI, less impulsive NSSI, and DSH. Grandiose narcissism was associated with severe NSSI and multiple SA with high intent to die, but it was protective against SI and SR. Vulnerable narcissism seemed to be associated with suicide-related outcomes characterized by low intent to die, while grandiose narcissism seemed to be a risk factor for outcomes with high planning and severity.
CONCLUSIONS: Between-study heterogeneity and lack of longitudinal studies.
CONCLUSIONS: Assessing suicide risk in subjects with clinical or subclinical forms of narcissism may be useful. Moreover, considering the most vulnerable form of narcissism, and not just the grandiose one, may contribute to a more nuanced risk stratification and to the identification of distinct therapeutic approaches.
摘要：
背景：临床和亚临床形式的自恋可能会增加自杀风险。然而,鲜为人知，关于这个话题有争议。本系统综述旨在提供调查这种关联的研究概述。
方法：我们使用PubMed，Scopus,和PsycInfo数据库，并遵循PRISMA。我们专注于队列，病例控制，横断面和案例系列研究。我们提到了两种临床(即，自恋型人格障碍(NPD)和/或NPD标准)和亚临床形式(即，自恋的宏伟和脆弱的自恋特征）。此外，我们考虑：自杀意念(SI)，非自杀自我伤害（NSSI），故意自我伤害(DSH)，自杀企图（S）（SA），自杀风险（SR），自杀的能力。
结果：我们纳入了47项研究。发现NPD诊断/标准与自杀相关结果（SI）或混合结果（SA）之间缺乏关联。考虑自恋特征时，出现了更高的同质性。脆弱的自恋与SI有关，不那么冲动的NSSI，DSH。傲慢自恋与严重的NSSI和具有高死亡意图的多发性SA有关，但它对SI和SR有保护作用。脆弱的自恋似乎与自杀相关的结果有关，其特征是死亡意图低，而夸张的自恋似乎是高计划和严重程度结局的风险因素。
结论：研究之间的异质性和缺乏纵向研究。
结论：评估具有临床或亚临床形式自恋的受试者的自杀风险可能是有用的。此外，考虑到最脆弱的自恋形式，不仅仅是宏伟的，可能有助于更细致的风险分层和不同治疗方法的识别。
方法：我们使用PubMed，Scopus,和PsycInfo数据库，并遵循PRISMA。我们专注于队列，病例控制，横断面和案例系列研究。我们提到了两种临床(即，自恋型人格障碍(NPD)和/或NPD标准)和亚临床形式(即，自恋的宏伟和脆弱的自恋特征）。此外，我们考虑：自杀意念(SI)，非自杀自我伤害（NSSI），故意自我伤害(DSH)，自杀企图（S）（SA），自杀风险（SR），自杀的能力。
结果：我们纳入了47项研究。发现NPD诊断/标准与自杀相关结果（SI）或混合结果（SA）之间缺乏关联。考虑自恋特征时，出现了更高的同质性。脆弱的自恋与SI有关，不那么冲动的NSSI，DSH。傲慢自恋与严重的NSSI和具有高死亡意图的多发性SA有关，但它对SI和SR有保护作用。脆弱的自恋似乎与自杀相关的结果有关，其特征是死亡意图低，而夸张的自恋似乎是高计划和严重程度结局的风险因素。
结论：研究之间的异质性和缺乏纵向研究。
结论：评估具有临床或亚临床形式自恋的受试者的自杀风险可能是有用的。此外，考虑到最脆弱的自恋形式，不仅仅是宏伟的，可能有助于更细致的风险分层和不同治疗方法的识别。
