Are Demoralization and Insight Involved in Suicide Risk? An Observational Study on Psychiatric Inpatients

Abstract

<b><i>Introduction:</i></b> Several features contribute to determining suicide risk. This study was designed with the aim of evaluating whether insight into illness and demoralization are involved in suicide risk (active suicidal ideation or behavior). <b><i>Methods:</i></b> For this purpose, in a sample of 100 adult psychiatric inpatients, we used the Columbia Suicide Severity Rating Scale to assess suicide risk, the Demoralization Scale for demoralization symptoms, and the Insight Scale to assess illness insight. We also investigated several demographic and clinical features, including gender, age, duration of untreated illness, previous suicide attempts, and nonsuicidal self-injurious behavior. <b><i>Results:</i></b> The results demonstrated that patients with higher scores on the insight-high dimension had 1.35 greater odds of having a higher suicide risk, and those with lifetime suicide attempts had 7.45 greater odds of having a higher suicide risk. Among the various clinical factors, the study indicated that only nonsuicidal self-harm behaviors in the last 3 months was a risk factor for suicide risk. <b><i>Conclusions:</i></b> The results indicated that greater illness insight is involved in suicide risk regardless of demoralization.

The Importance of Suicide Risk Formulation in Schizophrenia

“…Several studies have demonstrated that illness awareness is associated with increased suicide risk in patients with schizophrenia ( 95 – 97 ). In a recent study of 100 psychiatric inpatients, Berardelli et al ( 98 ) reported that patients with higher scores on the insight-high dimension had a 1.35 greater odds of having a higher suicide risk, indicating that greater illness insight is involved in suicide risk.…”

Suicidality in a psychiatric inpatient unit: a 2-year retrospective study in Umbria, central Italy

“…The relevance of psychache in the development of suicidality has progressively been established in studies conducted in both clinical and nonclinical settings (Pompili et al, 2008;Cáceda et al, 2014;Berardelli et al, 2019). Another construct that needs to be mentioned when considering suicidality is hopelessness, a symptom that can be included in the broader syndrome of demoralization, along with feelings of impotence and loss of the meaning of life (Costanza et al, 2020;Berardelli et al, 2021a).…”