perfectionism, maladaptive self-presentation and...
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Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 1
Abstract
Perfectionism is a multifaceted trait that can be conceptualized by three distinguished dimensions:
Self-oriented Perfectionism, Other-oriented perfectionism and Socially Prescribed Perfectionism.
Perfectionists engage in maladaptive self-presentation styles, such as self-promotion, nondisplay and
nondisclosure to maintain their appeared perfection. Previous research has established the association
between trait perfectionism and suicide behaviors. I would suggest that perfectionistic male retirees would
be particularly vulnerable to suicide ideation due to stress brought by retirement and a lack of social
support caused by perfectionists’ nondisclosure tendencies. I investigated whether and how trait and self-
presentational components of perfectionism predict suicide ideation following retirement. A total of 92
mentally and physically healthy male retirees completed measures of perfectionism, self-worth and
suicide ideation at Time 1 before their retirement, and measures of nondisclosure, relationship specific
worry, perceived stress and suicide ideation at Time 2 five months later. The results showed that socially
prescribed perfectionism and all three perfectionistic self-presentational components were strongly
correlated with depression, hopelessness, subjective sense of alienation and perceived stress. Mediation
analysis suggested that the socially prescribed perfectionism indirectly led to suicide ideation through
nondisclosure then subjective social disconnection, d = .002 with CI.95 = [.0004, .01]. A moderated
mediation model revealed that the indirect pathway of suicide ideation was enhanced by contingence self-
worth from others’ approval and subjective stress, d = .0029 with CI.95 = [.0001, .01]. That is, for retirees
who felt that others demanded perfection from them, the more they based their self-worth on others’
approval, the more they tended to engage in nondisclosure, which led to subjective sense of alienation.
Consequentially, subjectively disconnected retirees with higher levels of stress are more likely to develop
suicide ideation compared to retirees with lower levels of stress. Interventions that promote help seeking
behaviors could be critical in suicide prevention among male retirees.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 2
Suicide is a significant problem in the United States. Heron et al. (2008) reported that
suicide was the 11th
leading cause of death in the United States in 2006, accounting for 33,300
deaths. The suicide rate among male seniors are exceptionally high: black men experience the
second suicide peak at old age whereas suicide rate of white men peaks at the oldest group over
45 per 100,000 per year, almost four times the nation's overall age adjusted rate of 11.5 per
100,000 per year (Conwell, Orden, & Caine, 2011). Case controlled studies have established
several significant suicide risk factors such as physical illness (Juurlink, Herrmann, Szalai, Kopp,
& Redelmeier, 2004), cognitive deficit (Dombrovski et al., 2008), mental illness (Waern,
Rubenowitz, & Wilhelmson, 2003), and especially mood disorder (Conwell et al., 2009).
Because of the somewhat slow progress in this area, researchers are urged to go beyond medical
models and consider integrative models that address interpersonal factors (Prinstein, 2008).
Past and present theorists have postulated the disruption in interpersonal relationship as a
suicide risk factor (Baumeister & Leary, 1995; Joiner, 2005; Van Orden et al., 2010). Studies
using psychological autopsy have demonstrated that impaired interpersonal relationship often
precedes suicide (e.g., Miller, 1977). Case controlled studies also provide support for the
relationship between impairment in interpersonal relationship and suicide behavior (Duberstein,
Conwell, Conner, Eberly, Evinger, & Caine, 2004; Rubenowitz, Waern, Wilhelmson, &
Allebeck, 2001). There is also evidence suggesting that a lack of interpersonal interaction
increases suicide risk beyond physical and mental risk factors (Beautrais, 2002).
Perfectionism has been linked to suicide because of its interpersonal nature. Baumeister
(1990) proposed that suicide is sought as a mean to escape overwhelming distress caused by a
perfectionist’s inability to fulfill extremely high standard that others seemingly demand. Hewitt
and Flett (1993a; 2002) proposed that perfectionism could create, enhance and prolong
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 3
interpersonal stressors that lead to severe maladjustment such as suicide potential. Most recently,
Hewitt and colleagues (2006) have established perfectionism as interpersonal risk factor of
suicide in a model that incorporates the interpersonal components of perfectionism, impairment
of social relationship and suicide behavior, known as the Perfectionism Social Disconnection
Model (PSDM).
Perfectionism
There is general consensus that perfectionism is a multidimensional personality construct
and several models have been proposed to capture perfectionism (e.g., Frost, Marten,
Lahart, & Rosenblate, 1990; Hewitt & Flett, 1991b; Slaney, Rice, Mobley, Trippi, & Ashby,
2001). Our model emphasises on the interpersonal underpinning of perfectionism and we
describe perfectionism as dispositional traits (Hewitt & Flett, 1991b), interpersonal
presentational styles (Hewitt et al., 2003) and cognitive components (Flett, Hewitt, Blankstein, &
Gray, 1998). Perfectionism traits reflect the need to be perfect and consist of self-oriented
perfectionism (SOP, i.e., demand perfection of self), other-oriented perfectionism (OOP, i.e.,
demand perfection of others), and socially prescribed perfectionism (SPP, i.e., perceive that
others demand perfection of oneself). Since perfection cannot be achieved, perfectionists tend to
engage in Perfectionistic Self Presentation (PSP) in an attempt to appear perfect. PSP includes
three distinct interpersonal facets: perfectionistic self-promotion (i.e., actively promote one’s
supposed perfection), nondisplay of imperfection (i.e., avoid displaying one’s imperfection), and
nondisclosure of imperfection (i.e., avoid disclosing one’s imperfection; Hewitt et al., 2003).
Studies have shown that the trait perfectionism and self-presentational styles are
independent and differentially associated with various kinds of distress and disorders such as low
level of social self-esteem (Flett, Hewitt, & De Rosa, 1996), social anxiety (Nepon, Flett, Hewitt,
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 4
& Molnar, 2011), depressive symptoms (Sherry, Law, Hewitt, Flett, & Besser 2008), and eating
disorder symptoms (McGee, Hewitt, Sherry, Parkin, & Flett, 2005). The most severe outcome of
perfectionism is suicide and literature has shown strong association between SPP, but not SOP or
OOP, and suicide outcomes (O’Connor, 2007). For example, there is strong correlational
evidence that SPP is associated with suicide ideation (Dean & Range, 1996; Hewitt, Flett, &
Weber 1994; Hewitt, Newton, Flett, & Callender, 1997). Similarly, Klibert, Langhinrichsen-
Rohling, & Saito (2005) showed that SPP was positively correlated with suicidality irrespective
of method of assessment. Furthermore, SPP predicted unique variance of suicide threat and
suicide intention over and beyond hopelessness and depression (Hewitt, Flett, &
Turnbulldonovan, 1992; Dean, Range, & Goggin, 1996). In terms of suicide attempts, Hunter
and O'Connor (2003) found that SPP predicted parasuicides above and beyond the effects of
hopelessness, depression and anxiety. Finally, adult inpatients with alcoholism that made serious
suicide attempt were marked with elevated levels of SPP and low levels of OOP (Hewitt, Norton,
Flett, Callender, & Cowan, 1998).
The Perfectionism Social Disconnection Model
Although the evidence of maladaptive nature of trait and self-presentation perfectionism
has been accumulating, a comprehensive theory is needed to account for mechanisms by which
trait perfectionism manifests itself into maladaptive outcomes. Hewitt and Flett (2002) proposed
that perfectionism could interact with environmental stressors and lead to psychological distress
through stress enhancement, stress anticipation, stress generation and stress perpetuation. These
ideas were extended into the Perfectionism Social Disconnection Model (PSDM, Hewitt et al.,
2006). According to the PSDM, individuals with excessive interpersonal perfectionism are
motivated by excessive needs to be connected and belong with others. However, socially
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 5
prescribed perfectionists exhibit interpersonal hostility (Habke & Flynn, 2002; Hewitt et al.,
2003) and this interpersonal aggressiveness creates difficulties in establishing and maintaining
social relationships and leads to objective social disconnection (i.e., the perfectionistic individual
is not liked or cared for by others). In addition, socially prescribed perfectionists are
characterized by their interpersonal sensitivity (Hewitt & Flett, 1991). Because of their insecure
attachment (Chen et al., 2012), excessive neediness (Sherry et al., 2003) and sensitivity to
criticism; (Gilbert, Durrant, & McEwan, 2006), socially prescribed perfectionists could
misinterpret the environment and develop feelings of alienation and subjective social
disconnection (i.e., the perfectionistic individual feels rejected and excluded). As a result of both
objective and subjective interpersonal disconnection, perfectionistic individuals are likely to
experience psychological distress such as social anxiety, depressive symptoms, and suicidal
ideation (Baumeister & Leary, 1995).
There have not been many direct test of this relatively new model, though there is some
indirect evidence. For example, socially prescribed perfectionism and the three PSP facets, but
not self-oriented perfectionism, are associated with fear of negative evaluation (Flett et al., 1996),
excessive sensitivity to criticism (Gilbert, Durrant, & McEwan, 2006), and dependent attitudes,
such as need for admiration and desire to please others (Hewitt et al., 2003; Sherry, Hewitt, Flett,
& Harvey, 2003). In addition, there is evidence that interpersonal components of perfectionism
are associated with interpersonal problems and problematic relationships that affects social
connection. For example, Habke and Flynn (2002) showed that students with elevated SPP fall
in the hostile dominant quadrant of the interpersonal circumplex as do the PSP facets for men.
Women high in PSP tend to fall in the hostile submissive quadrant (Hewitt et al., 2001). Also,
Flett, Hewitt, Garshowitz, & Martin (1997) showed that SPP was associated with negative social
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 6
interactions including overt criticisms, lack of recognition and betrayal of others. More directly,
Hewitt et al. (2008) showed that clinicians who had conducted initial clinical interviews with
patients, disliked patients with higher levels of the PSP facets more than patients with lower
levels of PSP. Lastly, there is certainly long standing support for the link between social
disconnection and suicide tendency (see Heinrich & Gullone, 2006). For example, Joiner (2005)
proposed that social disconnection and a lack of belongingness are important in producing
suicidal behavior. Also, Levi-Bes et al., (2008) demonstrated that subjective social disconnection
caused by a lack of self-disclosure to intimate others is associated with compromised coping
capacity, and seriousness of the suicide attempts. Moreover, Levi-Bes et al., (in press) utilized
path analysis to show that subjective sense of social disconnection such as loneliness and sense
of alienation mediated the paths between both anxious and avoidant attachment patterns and
suicide lethality.
In a more direct test of the objective social disconnection part of the PSDM, Nepon et al.,
(2011) found that the relationship between nondisplay of imperfection and depressive symptoms
were mediated by negative social feedback suggesting that nondisplay of imperfection may have
led to objective social animosity which then produced depressive symptoms. Similarly, there is
evidence that although SPP and PSP facets are motivated by excessive need to belong and fear of
rejection, others seem to be able to see through the façade and as a result, dislike the
perfectionists (Hewitt et al., 2008). Moreover, Roxborough et al., (2012) showed that a marker of
objective social disconnection (i.e., being bullied) mediated the relationship between nondisplay
of imperfection and suicide potential. In terms of subjective social disconnection part of the
model, Sherry et al., (2008) showed that the relationship between SPP and depression symptoms
in a university student sample was mediated by perceived social support suggesting that
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 7
individuals high in SPP believed they received less social support resulting in increased
depression symptoms. Similarly, Roxborough et al., (2012) found in a sample of adolescent
psychiatric patients that a marker of subject social disconnection (i.e., social hopelessness)
mediated the relationship between all facets of PSP and suicide ideation suggesting that, in
adolescents, PSP may have led to subjective social disconnection which then produced suicide
ideation.
Present Study
The purpose of current study is two-fold: first, we wish to test and expand the validity of
the PSDM in relation to suicide ideation with a community sample consists of recent male
retirees. Second, we hope to take a closer look within the PSDM and study detailed pathways
through which SPP leads to suicide ideation. Most research of the PSDM utilized either college
students sample or psychiatric sample. Such samples are adequate in model testing but have
several drawbacks. For example, the effect size derived from student samples tend to differ from
non-student sample and the relatively low risk of the student sample could make the findings less
generalizable (Peterson, 2001). The psychiatric sample offers insights in the high risk population,
but relationship between suicide ideation and social factors cannot be studied in isolation since
mental illness is also a major compounding risk factor (Juurlink et al., 2004; Waern et al., 2003).
Such methodological difficulties could be resolved by using a sample of high-risk, non-
clinical sample. To study the relationship between perfectionism, social stressors and suicide
ideation, we recruited recent retirees because retirement process could be potentially stressful
(Solinge, 2008). We restricted participation to males due to their elevated suicide risk compared
to their female counterpart (Conwell et al., 2011; Coren & Hewitt, 1999). Retirees with other
major suicide risks, such as mental or physical illness, were excluded so the interpersonal factors
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 8
could be isolated and tested in relation with perfectionism and suicide ideation. This use of male
retiree sample not only could expand the validity and generalizability of the PSDM, but also has
potential to shed some light on the exceptional high suicide rate of male seniors. In order to test
the subjective portion of the PSDM, we utilized a two-wave design to assess the relationships
concurrently and longitudinally and the latter will allow detection of change in the outcomes as
well as an appropriate temporal test of the meditational model (Baron & Kenny, 1986). We
hypothesized that SPP at time 1 will lead to subjective feeling of social disconnection at time 2,
which then leads to concurrent suicide ideation (Figure 1).
The overall model places emphasis on individual trait (i.e., SPP) and cognitive
characteristic (i.e., interpersonal sensitivity) in leading to subjective social disconnection (Hewitt
et al., 2006). We wanted to take a closer look at the pathway between SPP and subjective social
disconnection because it is not entirely clear how individuals’ characteristics might lead to
subjective feeling of disconnection. In an effort to emphasize the interaction between individual
and his or her surrounding environment, we propose that PSP-nondisclosure, an interpersonal
behaviour style, as the mediating step between SPP and subjective social disconnection (Figure
2). By definition, failure to disclose to intimate others could be considered as a self-initiated
action of social disconnection between the individual and his or her environment. Such model
also enjoys support from literature. For example, there is a strong correlational evidence
suggesting SPP is associated with PSP-nondisclosure (Hewitt et al., 2003) and failure to disclose
is closely associated with social alienation and feeling of loneliness (Levi et al., in press). Chen
and her colleagues (2012) directly showed that nondisclosure mediated the relationship between
insecure attachment style, which is closely associated with SPP (Rice & Mirzadeh, 2000), and
subjective social disconnection.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 9
Contingence self-worth from others’ approval was proposed as the moderator for the
relationship between SPP and nondisclosure. In the PSDM, both SPP and nondisclosure are
theorized to be motivated by powerful and excessive interpersonal need to be accepted and
approved of (Hewitt et al., 2006). Empirical study showed that dependent attitude, such as basing
self-worth on others’ approval, was positively correlated with SPP in psychiatric patients and
university students (Sherry, Hewitt, Flett, & Harvey, 2003). Since SPP is related to interpersonal
sensitivity such as heightened reaction to criticism (Gilbert et al., 2006) and evaluative concerns
perfectionism is strongly associated with contingent self-worth (Sturman, Flett, Hewitt, &
Rudolph, 2008), we speculated that contingent self-worth from others’ approval moderate the
relationship between SPP and nondisclosure (Figure 3, a path). That is, for perfectionists who
perceive others demand perfection of themselves, the more they based their self-worth on others’
opinion, the less they will disclose their shortcomings in an attempt to protect the sensitive and
fragile self.
Subjective stress was proposed as the moderator for the relationship between subjective
social disconnection and suicide ideation. Adjustment to the loss of the work role and the social
ties during retirement process is stressful (Solinge, 2008), and retirees who feel lonely and sense
of alienation could be especially vulnerable to these social stressors due to diminished social
support (Levi et al., 2008), passive coping strategies (Cacioppo et al., 2000a) and heightened
stress reactivity (Cacioppo et al., 2002a). Thus, stress could interact with subjective feelings of
social disconnection in leading to suicide ideation (Figure 3, b2 path). That is, subjectively
social-disconnected people who experience high levels of stress are more likely to develop
suicide ideation compared to the same people with low levels of stress.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 10
To recap, the theoretical model predicts that:
1) Subjective social disconnection mediates the relationship between SPP at time1 and
suicide ideation at time2 (Figure1).
2) The relationship between SPP and suicide ideation is theorized to be mediated through
nondisclosure then subjective social disconnection (Figure 2).
3) The relationship between socially prescribed perfectionism and nondisclosure is
hypothesized to depend on contingence of self-worth from others’ approval whereas the
relationship between subjective social disconnection and suicide ideation is hypothesized to
depend on the level of perceived stress (Figure 3). Thus the indirect effect of SPP on suicide
ideation is conditional on the level of contingence self-worth and perceived stress.
Method
Participants
The initial sample was composed of 90 male retirees recruited from metro Vancouver
area. The age of the participants ranged from 43 to 80 (M = 59.65, SD = 5.17). The sample was
composed of 71Whites (78.8%), 6 Asians (6.6%), and 13 people (14.4%) who did not specify
their ethnicity. Seventy-two (82.2%) participants were married; five (5.6%) were single; seven
(7.8%) were separated or divorced; two (2.2%) were widowed, and two (2.2%) did not report
their marital status. The highest education levels of participants are high school (14%),
technology school (17%), university (45%), and graduate or professional school (24%). The
majority of the participants reported voluntary retirement (73%). There were no significant
differences between retirees who voluntarily retired and retirees who were forced into retirement
in terms of age, education level, perfectionism, and suicide ideation.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 11
Measures
Multidimensional Perfectionism Scale (MPS; Hewitt & Flett, 1991b). The MPS is a 45-
item instrument that contains three subscales that measure self-oriented, other-oriented, and
socially prescribed perfectionism. Each subscale contains 15 items, which are scored on a 7-
point Likert scale ranging from 1 “strongly disagree” to 7 “strongly agree”. The scores of
individual subscale range from 15 to 105 and high scores indicate elevated perfectionism. The
reliability, validity and multidimensionality of the MPS have been demonstrated in both clinical
and non-clinical samples (Enns & Cox, 2002; Hewitt & Flett, 2004).
Perfectionistic Self-Presentation Scale (PSPS; Hewitt et al., 2003). The PSPS is a 27-
item instrument that contains three subscales measuring self-promotion, nondisplay of
imperfection, and nondisclosure of imperfection. The self-promotion and nondisplay subscale
each contains 10 items and the nondisclosure subscale contains 7 items. All items are scored on
a 7-point Likert scale ranging from 1 “strongly disagree” to 7 “strongly agree”. The scores of
self-promotion and nondisplay subscale range from 10 to 70 and the score of nondisclosure
subscale range from 7 to 49. In general, high scores indicate elevated levels of perfectionistic
self-presentation. The reliability and validity of PSPS has been documented (Hewitt et al., 2003).
Worry Domains Questionnaire (WDQ; Tallis, Eysenck, & Mathews, 1992). The WDQ is
a 25-item scale that measures domain specific worries (e.g. relationship, work incompetence, and
lack of confidence etc.).The relationship sub-scale is used as an indicator for subjective social
disconnection since the subscale taps into feelings of loneliness and subjective worry about
interpersonal relationship. The scale was designed for use on a nonclinical adult population and
the reliability and validity of the subscale has been documented (Rijsoort, Emmelkamp, &
Vervaeke, 1999).
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 12
Scale for Suicide Ideation (SSI; Beck, Steer, & Ranieri, 1988). The SSI is a 19-item scale
that measures themes such as wish to die, thought of active and passive attempt, frequency and
attitude toward ideation, capacity and planning, and final acts. Total score is the sum of all 19
items and can range from 0 (low ideation) to 38 (high ideation). SSI is a widely used suicide
measurement and several studies have documented its reliability and validity (Beck, Kovacs, &
Weissman, 1979; Clum & Curtin, 1993).
Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983). The PSS is a 14-
item self-report measure of nonspecific perceived stress. All items are scored on a 5-point Likert
scale ranging from 0 “never” to 4 “very often”. Seven items are reverse scored and individual
items are summed to calculate final score with higher scores reflecting greater perceived stress.
PSS is a widely used measure and several studies have supported its reliability and validity
(Cohen et al, 1983; Hewitt, Flett, & Mosher, 1992).
Contingencies of Self-Worth (CSW; Crocker, Luhtanen, Cooper, & Bouvrette, 2003). The
CSW is a 35-item self-report measure that contains seven domain specific sub-scales such as
“others’ approval”, “appearance”, “competition”, “academic competence”, “family support”,
“virtue”, and “god’s love”. Others’ approval subscale is used to measure self-worth derived from
approval and acceptance of others. All five items within the subscale are scored on a 7-point
Likert scale ranging from 1 “strongly disagree” to 7 “strongly agree”. Three items are reverse
scored and individual items are summed to calculate final score with higher scores reflecting
greater contingency of self-worth based on others’ view of the self. The reliability and validity of
the subscale has been demonstrated (Crocker et al., 2003).
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 13
Procedure
Based on power analysis, 71 participants are needed to achieve power of 0.8 with 5%
type I error rate if bias corrected bootstrapping is used to carry out mediational analysis with
medium effect size for both a path and b path (Fritz & MacKinnon, 2007; Preacher & Hayes,
2008). Therefore, assuming it is possible to retain 70% of the sample recruited at Time 1, at least
101 participants are needed at Time 1 to achieve reasonable statistical power for the mediational
analysis with longitudinal data.
118 recently retired male retirees were initially recruited through newspaper
advertisement; Participants were mailed the MPS and SSI, and a consent form indicating that
retirees who retired due to physical or mental illness were not eligible for the study. A total of 94
packages were returned; 4 participants later decided not to participate, leaving a total of 90
participants. Five months later, the participants were sent the PSPS, WDQ, CSW, PSS and SSI.
A total of 75 packages were returned and four packages were dropped due to excessive missing
data, leaving a total of 71 participants for both time1 and time21. Participants who completed
both Time1 and Time2 packages received $15.00 honorarium for their participation.
Data Analysis Strategies
Missing data was handled by conservative list-wise deletion since the missing at random
(MAR) requirement for multiple imputations (MI) was not fully met (Sterne et. al., 2009). In
order to test the moderation effects of perceived stress and self-worth derived from others’
approval, regression analyses were used to calculate the standardized simple slope and t statistics.
Bootstrapping procedures were used to construct confidence intervals of standardized effect size
1 The 15 participants who didn’t complete Time 2 measures did not differ from the 71 participants who completed
the Time 2 measures in terms of demographic variables, perfectionism traits or suicide ideation.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 14
since standardized regression coefficients are not normally distributed (Kelley, 2005).
Bootstrapping resamples the original data with replacement to create 19999 bootstrap samples;
statistics of interest were computed for each bootstrap sample and an empirical confidence
interval was constructed based on all available resamples. The ratio of the obtained indirect
effect to the maximum possible indirect effect was computed following procedure listed by
Preacher and Kelley (2011). This effect size was only calculated for simple mediation in Figure
1since no viable procedure is available for chain mediation or moderated mediation.
To examine the conditioned mediation model, we followed the path analysis procedures
outlined in Preacher, Rucker, and Hayes (2007; note that the present model conforms to Model 4
in Figure 2). This method was chosen in an attempt to estimate effect size of mediational
relationship beyond qualitative description (Rucker, Preacher, Tormala, & Petty, 2011). The
point estimates of conditional effect sizes were calculated by multiplying standardized
coefficients of both a path, b1path, and b2 path under all possible conditions. Confidence
intervals were constructed by bootstrapping with accelerated bias correction method (Cheung,
2009). Suicide ideation at Time1 was controlled for all analysis for suicide ideation at Time 2.
Age was statistically controlled in b path since longitudinal study with large sample size
suggested that age was related to suicide ideation (Kuo, Gallo, & Tien, 2001). R is used for all
statistical computations.
Results
Means, standard deviations, coefficients alpha, and zero-order correlations are presented
in Table 1. Means and standard deviations approximated past studies that utilized the MPS
(Hewitt & Flett, 1991b), PSPS (Hewitt et al., 2003), and CSW (Crocker et al., 2003). However,
the mean of PSS (M = 16.94, SD = 9.61) was lower than reported by Cohen et al. (1983) for two
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 15
college student samples (M = 23.18 and 23.67) and for a community sample (M = 25.0). The
mean SSI at Time 1 and Time 2 were 0 and 0.1 respectively, which were substantially lower than
other community sample (M = 2.43) consisted of older adults (e.g., Miller, Segal, & Coolidge,
2001). Coefficients alpha ranged from .53 to .93. Both SSI at Time 1 and Time 2 had lower
coefficients alpha than in previous research (Beck et al., 1988). Finally, after adjusting
significance level for multiple comparisons (Holm, 1979), SPP was significantly correlated with
nondisclosure, perceived stress, and relationship specific worry. In addition, Perceived stress and
relationship specific worry were significantly correlated with suicide ideation at Time 2 (r = .41,
p < .01; r = .50, p < .01 respectively).
Mediational Analyses
Consistent with our hypothesis, the relationship between SPP and suicide ideation was
mediated by relationship specific worry, standardized indirect effect size d = .01 with CI.95 =
[.002, .022]. In other words, one standard unit change in SPP led to an average .01 standard
deviation increase in suicide ideation through relationship specific worries. The ratio of the
obtained indirect effect to the maximum possible indirect effect was calculated, = .221 (Figure
4) with 95% CI [.092, .440].2 Since the confidence interval excluded .09, a medium indirect
effect size was achieved (Preacher & Kelley, 2011). In addition, the indirect effect of SPP on
suicide ideation through nondisclosure then relationship specific worry was significant, d = 0.002
with CI.95 = [.0004, .01]. That is, one standard unit change in SPP led to an average .002 standard
deviation increase in suicide ideation through nondisclosure then relationship specific worries.
Moderated Mediation Analyses
2 500 bootstrap re-samples were used to construct the confidence interval via percentile bootstrapping.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 16
Consistent with the expectation, the relationship between socially prescribed
perfectionism and none-disclosure was significantly moderated by amount of self-worth derived
from others’ approval, interaction b* = .31 with CI.95 = [.07, .48], t(66) = 3.81, p < .001. For
participants one standard deviation above the mean of contingency of self-worth, there was a
strong relationship between socially prescribed perfectionism and nondisclosure, b* = .69 with
CI.95 = [.51, .89], t(66) = 5.82, p < .001. For participants on the mean level of contingency of
self-worth, there was a moderate relationship between socially prescribed perfectionism and
nondisclosure, b* = .38 with CI.95 = [.19, .60], t(66) = 3.90, p < .001. In contrast, for participants
one standard deviation below the mean of contingency of self-worth there was a non-significant
relationship between socially prescribed perfectionism and nondisclosure, b* = .07 with CI.95 = [-
.21, .50], t(66) = .54, p > .05. Figure 5 provides a graphical representation of this interaction.
The association between relationship specific worry and suicide ideation was
significantly moderated by perceived stress while controlling for SPP and nondisclosure,
interaction b* = .23 with CI.95 = [-.06, .91], t(64) = 2.36 p < .05. For participants one standard
deviation above the mean of perceived stress, there was a significant relationship between
relationship specific worry and suicide ideation, b* = .41, with CI.95 = [.01, 1.11], t(64) = 2.87, p
<.01. In contrast, for participants on average level of perceived stress there was a non-significant
relationship between nondisclosure and suicide ideation, b* = .18 with CI.95 = [-.06, .99], t(64) =
1.08, p > .05. For participants one standard deviation below the mean of perceived stress there
was a non-significant relationship between nondisclosure and suicide ideation, b* = -.05 with
CI.95 = [-.66, 1.14], t(64) = -.02, p > .05. Regression diagnosis discovered the existence of
moderate multicollinearity, 5 < , <10. This multicollinearity could explain the
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 17
discrepancy between t statistics and empirically constructed confidence intervals. Figure 6
provides a graphical representation of this interaction.
Since self-worth moderates the relationship between SPP and nondisclosure (path a in
Figure 3) and perceived stress moderates the association between relationship specific worry and
suicide ideation while controlling for SPP and nondisclosure (path b2 in Figure 3), the magnitude
of the indirect effect depends on the levels of both self-worth and perceived stress. For
participants one standard deviation above the mean level of contingency of self-worth and one
standard deviation above the mean level of perceived stress, the indirect effect of SPP on suicide
ideation through nondisclosure then relationship specific worry was significant, d = .003 with
CI.95 = [.001, .01]. For participants on the mean level of contingency of self-worth and one
standard deviation above the mean level of perceived stress, the indirect effect was also
significant, d =.0016 with CI.95 = [.001, .006]. In contrast, the indirect effects were not
significant in all other conditions (Table 2). In sum, indirect effect was only significant when
perceived stress is one standard deviation above the mean. As contingence self-worth from
others’ approval increases, the magnitude of the indirect effect increases significantly. None of
the other PSP facets mediated this relationship in all conditions.
Discussion
The results provided strong support for the Perfectionism Social Disconnection Model.
The standardized indirect effect size in the chain mediation model is relatively small but
significant. The small effect size has to be interpreted in the content of small sample size and
inherited multicollinearity caused by strongly correlated predictor variables. By employing path
analysis, we demonstrated that trait perfectionism indirectly led to suicide ideation through
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 18
perfectionistic self-presentation and subjective sense of social disconnection. That is, by
concealing shortcomings, perfectionists’ attempt to connect with others ironically leads to a
subjective sense of disconnection. This disconnection, especially when combined with external
stress, in turn leads to suicide ideation.
The retirees in our sample were mentally and physically healthy, and they scored low on
distress measures compared to other community sample. However, perfectionism elevated their
suicide ideation significantly in merely five months. The increased stress and distress level also
makes the retirement process challenging. If resource allows, interventions need to focus on the
cause of retirement maladjustment, namely trait perfectionism, instead of symptoms. The
community could also establish outreach programs to encourage help seeking behaviours among
stressed male retirees, especially retirees who are reluctant to seek help due to their
perfectionism tendencies.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 19
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Table 1
Means, Standard Deviations, Coefficients Alpha, and Zero-Order Correlations
Variable SOP OOP SPP SP DSPY DISC WDQ CSW PSS SSI1 SSI2
SOP -- 0.77** 0.69** 0.67** 0.48** 0.50** 0.30 0.19 0.26 -- 0.16
OOP -- 0.54** 0.55** 0.38* 0.38* 0.31 0.19 0.24 -- 0.26
SPP -- 0.52** 0.52** 0.48** 0.44** 0.20 0.41* -- 0.18
SP -- 0.79** 0.79** 0.40* 0.35** 0.36* -- 0.18
DSPY -- 0.78** 0.50** 0.50** 0.59** -- 0.22
DISC -- 0.45** 0.29 0.49** -- 0.23
WDQ -- 0.26 0.63** -- 0.50**
CSW -- 0.35* -- 0.03
PSS -- -- 0.41**
SSI2 -- --
M 60.17 51.14 44.08 35.76 35.37 21.65 7.32 4.33 16.94 0 0.1
SD 16.99 11.75 12.88 12.96 12.19 7.64 3.09 1.18 9.61 0 0.45
α 0.91 0.80 0.85 0.91 0.89 0.84 0.85 0.74 0.93 N/A 0.56
Note. * p < .05. ** p < .01. Significance levels are adjusted for multiple testing (Holm, 1979).
SOP = self-oriented perfectionism; OOP = other-oriented perfectionism; SPP = socially
prescribed perfectionism; SP = self-promotion; DSPY = nondisplay; DISC = nondisclosure; SSI
=suicide ideation; WDQ= worry domain questionnaire, relationship; CSW= contingency of self-
worth, others’ approval; PSS = perceived stress. M = means; SD = standard deviations; α =
coefficients alpha.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 28
Table 2
Moderated Mediation Analysis and Confidence Interval
CSW (a path) PSS (b2 path) Estimate Standard Error .95 CI
High High .0029 .0027 [.0001, .0104]*
Medium High .0013 .0016 [-.0003, .0084]
Low High .0003 .0030 [-.0061, .0066]
High Medium .0015 .0016 [.0001, .0060]*
Medium Medium .0007 .0009 [-.0002, .0048]
Low Medium .0002 .0018 [-.0036, .0037]
High Low .0003 .0011 [-.0009, .0041]
Medium Low .0001 .0005 [-.0002, .0029]
Low Low .0000 .0001 [-.0025, .0012]
Note. * Confidence interval does not cross zero. The estimates are standardized indirect effect
size. High = +1 SD, Medium = mean, Low= -1 SD.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 29
Figure 1. Theoretical Model for Subjective Social Disconnection
Figure 2. Theoretical Model for Two-Step Mediation
Subjective Disconnection
Socially Prescribed Perfectionism
Suicide Ideation
Figure 1. Subjective Social Disconnection Mediating Relationship between Social
Prescribed Perfectionism and Suicide Ideation.
Subjective
Disconnection
Socially Prescribed
Perfectionism Suicide Ideation
Nondisclosure
Figure 2. The Chain Mediation Model Being Tested. The Link Between Socially Prescribed
Perfectionism and Suicide Ideation Is Mediated through Nondisclosure then Subjective Social
Disconnection.
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 31
Figure 4. Effect Size for Mediation Analysis
Figure 4. Ratio between achieved indirect effect and maximum indirect effect.
Graph generated by R syntax developed by Kelly 2011
Perfectionism, Maladaptive Self-presentation and Suicide Ideation in Male Retirees 32
Figure 5. Simple Slope Analysis for Path a
Figure 5. Simple Slopes for the Interaction between Socially Prescribed Perfectionism and
Contingence Self-Worth in Predicting Nondisclosure.