Demoralization in Schizophrenia: A Pathway to Suicidal Ideation?

Arch Suicide Res. 2024 Apr-Jun;28(2):554-568. doi: 10.1080/13811118.2023.2195454. Epub 2023 Apr 4.


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.

MeSH terms

  • Adult
  • Demoralization*
  • Depression / psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Schizophrenia*
  • Schizophrenic Psychology*
  • Suicidal Ideation*
  • Surveys and Questionnaires