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A New Method for Inducing a Depression-Like Behavior in Rats
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Demoralization in suicide: A systematic review.

Alessandra Costanza1, Chytas Vasileios2, Julia Ambrosetti3

  • 1Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.

Journal of Psychosomatic Research
|March 25, 2022
PubMed
Summary

Demoralization is an independent risk factor for suicidal ideation and behavior, even without depression. Assessing demoralization aids suicide risk detection, especially in emergency settings, and suggests meaning-centered therapies.

Keywords:
Community-dwellersDemoralizationDepressionHopelessnessPsychiatric disorder, Meaning in life, Meaning-centered psychotherapiesRisk factorSomatic disorderSuicidal behaviorSuicidal ideationSuicideSuicide attempt

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Area of Science:

  • Psychiatry
  • Psychology
  • Public Health

Background:

  • Limited original studies exist on demoralization in suicide.
  • Demoralization is a state of hopelessness and meaninglessness.
  • Suicidal ideation (SI) and suicidal behavior (SB) are significant public health concerns.

Purpose of the Study:

  • To systematically review original studies investigating the association between SI/SB and demoralization.
  • To explore this association across diverse populations including community dwellers and patients with somatic or psychiatric disorders.

Main Methods:

  • Systematic literature search following PRISMA guidelines across four major databases (PubMed/MEDLINE, Scopus, Science Direct, PsychINFO).
  • Inclusion of original studies published from January 1980 to June 2021 that explicitly examined the SI/SB-demoralization link.
  • Synthesis of findings from 18 included studies.

Main Results:

  • Demoralization is significantly associated with increased suicide risk (OR >6 in certain populations).
  • Demoralization is a major risk factor for SI/SB, both independently and in conjunction with depression.
  • Demoralization can be present in individuals without a formal diagnosis of affective disorder or clinical depression.
  • The interaction of demoralization with over-arousal or shutdown (helplessness, low positive emotions) may predict progression from SI to action.

Conclusions:

  • Demoralization should be recognized as an independent risk factor for suicide.
  • The association between demoralization and SI/SB appears transnosographic in psychiatric patients.
  • Assessing demoralization enhances suicide risk detection, particularly in emergency departments.
  • Meaning-centered psychotherapeutic approaches are indicated for demoralization and can be initiated early in treatment.