For a study, researchers hoped to find original studies on suicidal ideation (SI)/suicidal behavior (SB) and demoralization in community-dwellers and patients with somatic or psychiatric disorders in this review. They used a PRISMA-compliant systematic approach to search 4 major electronic databases (PubMed/MEDLINE, Scopus, Science Direct, and PsychINFO) for relevant titles/abstracts published between January 1980 and June 2021. Investigators included original studies that explicitly stated that they were looking into a possible link between SI/SB and demoralization. A total of 18 studies met their inclusion criteria. Their findings revealed that demoralization was associated with SI/SB in a variety of populations (community dwellers, patients with somatic or psychiatric disorders) and significantly increased suicide risk (odds ratios of >6 were observed in community dwellers experiencing financial hardship or isolation). Furthermore, demoralization, either alone (about half of the demoralized patients did not meet the criteria for an affective disorder nor were they clinically depressed) or in combination with depression, had been identified as a major risk factor for SI/SB. In the context of the “ideation-to-action” frame, some authors discovered that the interaction of demoralization and over-arousal could be a useful predictor of this progression. In contrast, others discovered that depression alone was sufficient to differentiate attempts from non-attempts or the interaction with shutdown (helplessness and low positive emotions). These findings highlighted the possibility of identifying demoralization as a separate risk factor for suicide. The relationship between demoralization and SI/SB in patients with psychiatric disorders may be transnosographic. Overall, their findings highlighted the following clinical implications: Demoralization assessment may contribute to more comprehensive suicide risk detection. It was especially relevant in emergency departments (EDs), where a diverse population typology was typically admitted, and a clinical diagnosis of depression was frequently difficult to define. Furthermore, because meaninglessness is 1 of the demoralization subcomponents, meaning-centered psychotherapeutic approaches were indicated and can be initiated at the EDs upon first contact with the patient. More research was needed to confirm these findings.
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