Demoralization and Its Relationship with Depression and Hopelessness in Suicidal Patients Attending an Emergency Department

Abstract

Emergency departments (EDs) play an increasingly crucial role in the management of patients with suicidal behavior (SB). Demoralization has been associated with SB in various populations and conditions, but little is known about the effect of this construct in SB patients who attend an ED. Therefore, a more inclusive SB assessment which considers the demoralization construct could be useful in clinical practice. The main aim of this study was to assess the presence and severity of demoralization in patients visiting EDs for SB. Secondly, the maintenance of the relationship between demoralization and SB after controlling for depression and the proportion of variance which accounted for hopelessness was investigated. A cross-sectional study of patients (N = 199) visiting an ED for SB was performed, which examined the role of demoralization, hopelessness, and depression on suicidal ideation (SI) and suicide attempts (SAs). Demoralization was strongly and positively correlated with SI. Demoralization was related to major depressive episodes, but it was confirmed to be a different and, probably, more sensitive construct for SB, validating its specificity in relation to depression. Hopelessness accounted for a small portion of the variance in SI, compared to demoralization. Formal support for the association of demoralization with SI was provided. Demoralization can improve SB assessment in EDs, particularly among patients whose suicide risk can be unnoticed. Furthermore, demoralization represents a clinically useful concept to increase comprehension of the suffering of the suicidal patient and a possible target for psychotherapeutic interventions.

The Presence and the Search Constructs of Meaning in Life in Suicidal Patients Attending a Psychiatric Emergency Department

“…P a r t i c i p a n t s a n s w e r e d i n q u i r i e s r e g a r d i n g t h e i r sociodemographic situations as well as a series of questionnaires, some administered by the psychiatrist in charge of the study inclusion and some self-reported. Other aspects of this global project on suicide, not relevant to the present study, have resulted in five publications (28)(29)(30)(31)(32). This study was approved by the local Research Ethics Committee under the registration number 14-168.…”

When Sick Brain and Hopelessness Meet: Some Aspects of Suicidality in the Neurological Patient

“…And does this type of reasonableness lead to a certain resistance, resulting in the generalization of this population and banalization of the suicidal risk? Most of the data and reflections reported so far may indicate a highly deterministic conceptualization of the evolution of certain neurological diseases, in which the patient and his clinician may feel impotent and imprisoned [ 52 ]. Could one think that having SI is a way for the patient, on the contrary, to control what little he can do?…”

Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms

“…After its introduction into the psychiatric literature [81], MiL was recently described as one's perception of their own coherence, purpose, and significance [82] while demoralization was defined "a persistent failure to cope with stresses" [83], of which constitutive components are loss of MiL, hopelessness or disheartenment, helplessness, sense of failure, and dysphoria [84,85]. These two constructs are intimately and opposingly connected and have been investigated in our institutions among suicidal individuals who were confronted with extreme life situations that have led to an often-incomprehensible fracture between a "before" and an "after" living experience [84][85][86][87][88][89][90][91][92][93]. In the context of CTE in contact sports, retired athletes experience profound changes in their lives, worsening the outlook and the quality of their living condition.…”

“…The majority of the studies have suggested that demoralization is distinguishable from depression [84,85,92]. However, in patients with cancer [94][95][96][97][98][99][100], Parkinson's disease [101], as well as other psychiatric and medical conditions [89,[102][103][104][105], there may be frequent overlaps between demoralization and depression. Nevertheless, demoralization can occur independently of depression and the two conditions are not necessarily linked by a hierarchical connection [89,99,105,106].…”