Serial multiple mediation of demoralization and depression in the relationship between hopelessness and suicidal ideation

Abstract

Objective: Suicidal ideation is common in cancer patients and may be associated with hopelessness, demoralization, and depression. This study aims to investigate the serial multiple mediation of demoralization and depression in the relationship between hopelessness and suicidal ideation in cancer patients. Methods: A total of 244 cancer patients were investigated by using the following standardized self-reported questionnaires: self-rating idea of suicide scale, Beck hopelessness scale, demoralization scale-Mandarin version, and patient health questionnaire depression scale-9. The mediation hypothesis was tested with a serial multiple mediation model (PROCESS model 6). An exploratory graph analysis was performed to detect the correlations among the dimensions of the mental conditions measured by these instruments. Results: Bootstrap analyzes indicate that there were direct and indirect effects of hopelessness on suicidal ideation mediated solely by demoralization (B = 2.3074, SE = 0.1724, P < .001) or by demoralization together with depression (B = 0.1605, SE = 0.0303, 95% confidence interval [CI] = 0.1102 to 0.2303). The mediation of depression alone in the relationship between hopelessness and suicidal ideation was insignificant (B = 0.1541, SE = 0.0519, 95% CI = −0.0565 to 0.0715). The exploratory graph analysis suggests that the strongest edge of dimensions between demoralization and suicidal ideation was desperation-disheartenment (0.62). Conclusions: The results of the study support the hypothesis that demoralization and depression mediate between hopelessness and suicidal ideation. The early identification of and interventions for hopelessness, demoralization, and depression may prevent cancer patients from developing suicidal ideation.

Demoralisation and its link with depression, psychological adjustment and suicidality among cancer patients: A network psychometrics approach

“…The results of the present study are consistent with a previous study 8 which identified a class reflecting poor coping without anhedonia and other classic depression symptoms, but linked to suicidal ideation. The present study is also consistent with studies showing that suicidality has stronger links with demoralisation than depression in cancer patients 4–7 . For people facing the existential threat of cancer, demoralisation symptoms with suicidal ideation, but without anhedonia, may indicate poor psychological adjustment to the stressors of their illness.…”

“…The present study is also consistent with studies showing that suicidality has stronger links with demoralisation than depression in cancer patients. 4 , 5 , 6 , 7 For people facing the existential threat of cancer, demoralisation symptoms with suicidal ideation, but without anhedonia, may indicate poor psychological adjustment to the stressors of their illness. Thus, demoralisation may be an important element of AD which contributes importantly to the independent link between AD and suicidality.…”

“…2 It is defined by difficulty in adjusting to a stressor, wherein the person feels they are trapped in their predicament and experience feelings of helplessness, hopelessness, loss of confidence and loss of meaning in life. 3 Demoralisation has a stronger link than depression with the desire for hastened death and suicidal ideation among the medically ill. [4][5][6][7] Demoralisation is closely related to depression, although evidence shows that it is distinct from anhedonia. 1 In its most severe form demoralisation is often comorbid with major depressive disorder (MDD).…”

“… 2 It is defined by difficulty in adjusting to a stressor, wherein the person feels they are trapped in their predicament and experience feelings of helplessness, hopelessness, loss of confidence and loss of meaning in life. 3 Demoralisation has a stronger link than depression with the desire for hastened death and suicidal ideation among the medically ill. 4 , 5 , 6 , 7 …”

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

“…Nevertheless, demoralization can occur independently of depression and the two conditions are not necessarily linked by a hierarchical connection [89,99,105,106]. In some cases, it has been demonstrated that demoralization had a predominant [89,97,98] or synergistic [99,100,107] effect with depression on the potentiation of SI and SB. In both cases described above, a depressive condition was suspected, and a psychopharmacological treatment was initiated.…”