Demoralization in Schizophrenia: A Pathway to Suicidal Ideation?

Abstract

Introduction

Individuals with schizophrenia are at increased risk for suicide, and the Demoralization Hypothesis states that non-delusional awareness of one’s social, cognitive, or occupational deterioration elicits depression and hopelessness. Both depression and hopelessness are established risk factors for suicide and are features of schizophrenia. The present study investigated whether insight into one’s schizophrenia yields suicidal ideation, specifically by way of thwarted belongingness and perceived burdensomeness, which are constructs related to demoralization and measured by the Interpersonal Needs Questionnaire (INQ).

Methods

Three separate models explored the mediating role of INQ scores on suicidal ideation in 99 participants with schizophrenia. With suicidal ideation entered as the dependent variable and INQ scores entered as the mediator, the first model included insight as the independent variable, the second included cognitive functioning, and the third included cognitive deterioration post-illness-onset.

Results

Consistent with our hypothesis, INQ scores related to suicidal ideation (B = .03, SE = .01, p < .001). However, neither insight, cognitive functioning, nor cognitive deterioration predicted INQ scores or suicidal ideation. Additionally, INQ scores did not mediate relationships with suicidal, ideation.

Conclusion

Although INQ scores led to increased suicidal ideation, neither insight into illness, current cognitive functioning, nor shift in functioning led to increased INQ scores. Implications are discussed, and future directions are proposed.

Keywords:

• Cognition
• hopelessness
• insight
• perceived burdensomeness
• thwarted belongingness

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

AUTHOR CONTRIBUTIONS

Amy Lieberman: Conceptualization; formal analysis; methodology; project administration; writing- original draft

Emma M. Parrish: Data curation; writing- review & editing

Colin A. Depp: Conceptualization; data curation; supervision; writing- review & editing

Phillip D. Harvey: Data curation

Amy E. Pinkham: Data curation

Thomas E. Joiner: Conceptualization; supervision; writing- review & editing

Notes

1 Incidentally, meta-analytic results from 37 studies comprising 1,961 participants with schizophrenia and 1,444 controls found that the digit symbol coding task, alone, can expose an information processing inefficiency that is a central feature of the cognitive deficit in schizophrenia (Dickinson et al., 2007).

2 Post-hoc, exploratory analyses sought to investigate the effects of controlling for race in addition to age and gender. Our initial results remained.

3 Post-hoc analyses sought to investigate the effects of splitting TB and PB in the mediation analyses. All confidence intervals passed through zero, corroborating our original analyses.

Additional information

Funding

This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Department of Defense [Grant No. W81XWH-16-20003]. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Military Suicide Research Consortium, the Department of Defense, or the National Science Foundation.

Notes on contributors

Amy Lieberman

Amy Lieberman, MS, Department of Psychology, Florida State University, Tallahassee, Florida, USA;

Emma M. Parrish

Emma M. Parrish, MS, Clinical Psychology, San Diego State University/University of California, San Diego, California, USA;

Colin A. Depp

Colin A. Depp, PhD, Department of Psychiatry, University of California-San Diego, San Diego, California, USA;

Phillip D. Harvey

Phillip D. Harvey, PhD, University of Miami Health System, Miami, Florida, USA;

Amy E. Pinkham

Amy E. Pinkham, PhD, Dallas School of Behavioral and Brain Sciences, University of Texas, Richardson, Texas, USA;

Thomas E. Joiner

Thomas E. Joiner, PhD, Department of Psychology, Florida State University, Tallahassee, Florida, USA