Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland.
Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy.
Int J Environ Res Public Health. 2020 Mar 26;17(7):2232. doi: 10.3390/ijerph17072232.
Emergency departments (EDs) play an increasingly crucial role in the management of patients with suicidal behavior (SB). Demoralization has been associated with SB in various populations and conditions, but little is known about the effect of this construct in SB patients who attend an ED. Therefore, a more inclusive SB assessment which considers the demoralization construct could be useful in clinical practice. The main aim of this study was to assess the presence and severity of demoralization in patients visiting EDs for SB. Secondly, the maintenance of the relationship between demoralization and SB after controlling for depression and the proportion of variance which accounted for hopelessness was investigated. A cross-sectional study of patients ( = 199) visiting an ED for SB was performed, which examined the role of demoralization, hopelessness, and depression on suicidal ideation (SI) and suicide attempts (SAs). Demoralization was strongly and positively correlated with SI. Demoralization was related to major depressive episodes, but it was confirmed to be a different and, probably, more sensitive construct for SB, validating its specificity in relation to depression. Hopelessness accounted for a small portion of the variance in SI, compared to demoralization. Formal support for the association of demoralization with SI was provided. Demoralization can improve SB assessment in EDs, particularly among patients whose suicide risk can be unnoticed. Furthermore, demoralization represents a clinically useful concept to increase comprehension of the suffering of the suicidal patient and a possible target for psychotherapeutic interventions.
急诊科（ED）在处理有自杀行为（SB）的患者管理中发挥着越来越重要的作用。在不同人群和情况下，绝望与 SB 有关，但对于在 ED 就诊的 SB 患者中，这一结构的影响知之甚少。因此，一种更全面的 SB 评估方法，考虑到绝望结构，可能对临床实践有用。本研究的主要目的是评估因 SB 而就诊于 ED 的患者中绝望的存在和严重程度。其次，在控制抑郁和无望感占比后，调查了绝望与 SB 之间的关系是否持续。对因 SB 而就诊于 ED 的患者（n=199）进行了一项横断面研究，考察了绝望、无望和抑郁对自杀意念（SI）和自杀企图（SA）的作用。绝望与 SI 呈强烈正相关。绝望与重度抑郁发作有关，但它被证实是 SB 的一个不同的、可能更敏感的结构，验证了其与抑郁的特异性。与绝望相比，无望感仅能解释 SI 变异的一小部分。提供了对绝望与 SI 之间关联的正式支持。在 ED 中，绝望可以改善 SB 评估，特别是对于自杀风险可能被忽视的患者。此外，绝望代表了一个有临床意义的概念，可以增加对自杀患者痛苦的理解，并且可能是心理治疗干预的目标。
