Demoralization in suicide: A systematic review.

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.