Main Article Content
COVID-19; suicide; mental health, meaning in life, demoralization, protective factor, risk factor
Consequences on mental health have been reported in general population, vulnerable individuals, psychiatric patients, and healthcare professionals. It is urgently necessary to study mental health issues in order to set priorities for public health policies and implement effective interventions. Suicidality is one of the most extreme outcomes of a mental health crisis. It is currently too early to know what the effect of COVID-19 will be on suicidality. However, authoritative commentary papers alert that most of the factors precipitating suicide are, and probably will be for a long time, present at several individual existence levels. A number of prevention measures and research considerations have been drawn up. A point of the latter, recommended by the International COVID-10 Suicide Prevention Research Collaboration, states that “the COVID-19 suicide research response should be truly multidisciplinary. This will foster research that addresses the different aspects and layers of risk and resilience.It will also foster research that informs prevention efforts by taking a range of perspectives” (Niederkrotenthaler et al., 2020). In this light, we would like to propose a reading perspective of suicidality that takes into account Meaning in Life (MiL) and demoralization. Both of the constructs were studied in heterogeneous populations with extreme life situations having led to a fracture between a “before” and an “after”, and play a role in affecting suicidality, respectively as resilience and risk factors. In clinical practice, during these unprecedent times, we wish that this more inclusive approach could: 1) contribute to prevention, by delineating more individualized suicidal risk profiles in persons conventionally non-considered at risk but here exposed to an extremely uncommon experience, 2) enrich supportive/psychotherapeutic interventions, by broadening the panel of means to some aspects constitutive of the existential condition of a person who is brutally confronted with something unexpected, incomprehensible and, in some ways, still unpredictable.
2. Xiang YT, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020; 7(3): 228-29.
3. Serafini G, Parmigiani B, Amerio A, et al. The psychological impact of COVID-19 on the mental health in the general population. QJM 2020; 113(8): 531-37.
4. Shi L, Lu ZA, Que JY, et al. Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Netw Open 2020; 3(7): e2014053.
5. Montemurro N. The emotional impact of COVID-19: From medical staff to common people. Brain Behav Immun 2020; 87: 23-24.
6. Amerio A, Aguglia A, Odone A, et al. COVID-19 pandemic impact on mental health of vulnerable populations. Acta bio-medica : Atenei Parmensis 2020; 91(9-S): 95-6.
7. Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM 2020; doi/10.1093/qjmed/hca202/5857612.
8. Yao H, Chen JH, Xu, Y. F. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry 2020; 7(4): e21.
9. Kang L, Ma S, Chen M, et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun 2020; 87: 11-17.
10. Que J, Shi L, Deng J, et al. Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. Gen Psychiatr 2020; 33(3): e100259.
11. Amerio A, Bianchi D, Santi F, et al. COVID-19 pandemic impact on mental health: a web based cross-sectional survey on a sample of Italian general practitioners. Acta bio-medica : Atenei Parmensis 2020; 91(2): 83-88.
12. Stuijfzand S, Deforges C, Sandoz V, et al. Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: a rapid review. BMC Public Health 2020; 20(1):1230. doi:10.1186/s12889-020-09322-z.
13. Niederkrotenthaler T, Gunnell D, Arensman E, et al. Suicide research, prevention, and COVID-19. Crisis 2020. https://doi.org/10.1027/0227-5910/a000731.
14. Wasserman IM. The impact of epidemic, war, prohibition and media on suicide: United States, 1910–1920. Suicide Life Threat Behav 1992; 22(2): 240-254.
15. Cheung YT, Chau PH, Yip PS. A revisit on older adults suicides and Severe Acute Respiratory Syndrome (SARS) epidemic in Hong Kong. Int J Geriatr Psychiatry. 2008;23(12):1231-1238. doi:10.1002/gps.2056
16. Gunnel D, Appleby L, Arensman E, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry 2020; 7(6): 468-71
17. Reger MA, Stanley IH, Joiner TE. Suicide Mortality and Coronavirus Disease 2019-A Perfect Storm? JAMA Psychiatry. 2020;10.1001/jamapsychiatry.2020.1060. doi:10.1001/jamapsychiatry.2020.1060
18. Kavukcu E, Akdeniz M. Tsunami after the novel coronavirus (COVID-19) pandemic: A global wave of suicide? Int J Soc Psychiatry 2020; https://doi.org/10.1177/0020764020946348.
19. Thakur V, Jain A. COVID 2019-suicides: A global psychological pandemic. Brain Behav Immun 2020; 88: 952-53.
20. Frankl VE. Man’s Search for Meaning. From Death Camp to Existentialism. New York, NY, USA: Beacon Press 1959.
21. Frank JD. Psychotherapy: the restoration of morale. The American Journal of Psychiatry 1974; 131(3): 271-4.
22. Park CL. Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychol Bull 2010; 136(2): 257–301.
23. Steger MF. Meaning in Life. The Oxford Handbook of Positive Psychology. Oxford, UK: Oxford University Press 2009; pp. 679–88.
24. Martela F, Steger MF. The three meanings of meaning in life: Distinguishing coherence, purpose, and significance. J. Posit. Psychol. 2016; 11: 531–545.
25. Reker GT. Theoretical perspective, dimensions, and measurement of existential meaning. In: Recker GT, Chamberlain K, editors. Exploring Existential Meaning: Optimizing Human Development Across the Life Span. New York: SAGE Publications Inc; 2000:39–55.
26. Wong PTP. The Human Quest for Meaning: Theories, Research, and Applications. Wong P, editor. New York: Routledge; 2012; xxvii–xliv.
27. de Figueiredo JM, Frank JD. Subjective incompetence, the clinical hallmark of demoralization. Compr Psychiatry 1982; 23(4): 353-63.
28. Kissane DW, Clarke DM, Street AF. Demoralization syndrome--a relevant psychiatric diagnosis for palliative care. J Palliat Care 2001; 17(1): 12-21.
29. Clarke DM, Kissane DW. Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 2002; 36(6): 733-42.
30. Fava G, Fabbri S, Sirri L et al. (2007). Psychological factors affecting medical condition: a new proposal for DSM-V. Psychosomatics 2007; 48(2): 103–111
31. Tecuta L, Tomba E, Grandi S, Fava GA. Demoralization: a systematic review on its clinical characterization. Psychol Med 2015; 45(4): 673-91.
32. Costanza A, Prelati M, Pompili M. The meaning in life in suicidal patients: The presence and the search for constructs. A systematic review. Medicina (Kaunas, Lithuania) 2019; 55(8): 465.
33. Costanza A, Baertschi M, Richard-Lepouriel H et al. The presence and the search constructs of meaning in life in suicidal patients attending a psychiatric emergency department. Frontiers in Psychiatry 2020; 11: 327.
34. Costanza A, Amerio A, Odone A, et al. Suicide prevention from a public health perspective. What makes life meaningful? The opinion of some suicidal patients. Acta bio-medica : Atenei Parmensis 2020; 91(3-s): 128-34.
35. Costanza A, Baertschi M, Richard-Lepouriel H, et al. Demoralization and its relationship with depression and hopelessness in suicidal patients attending an emergency department. International Journal of Environmental Research and Public Health 2020; 17(7): 2232.
36. Hawton K, van Heeringen K. Suicide. Lancet 2009; 373(9672): 1372-81.
37. Turecki G, Ernst C, Jollant F et al. The neurodevelopmental origins of suicidal behavior. Trends Neurosci 2012; 35(1): 14-23.
38. Van Heeringen K, Mann JJ. The neurobiology of suicide. Lancet Psychiatry 2014; 1(1), 63–72.
39. Costanza A, D'Orta I, Perroud N, et al. Neurobiology of suicide: do biomarkers exist? International Journal of Legal Medicine 2014; 128(1): 73-82.
40. Costanza A, Rothen S, Achab S, et al. Impulsivity and impulsivity-related endophenotypes in suicidal patients with substance use disorders: an exploratory study. International Journal of Mental Health and Addiction 2020; https://doi.org/10.1007/s11469-020-00259-3.
41. Chytas V, Costanza A, Piguet V, et al. Démoralisation et sens dans la vie dans l’idéation suicidaire: un role chez les patients douloureux chroniques? [Demoralization and meaning in life in suicidal ideation : a role for patients suffering from chronic pain?]. Revue Medicale Suisse 2019; 15(656): 1282-85.
42. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry 2020; 7(4): 300-02.
43. Costanza A, Baertschi M, Weber K et al. Maladies neurologiques et suicide: de la neurobiologie au manque d’espoir [Neurological diseases and suicide: from neurobiology to hopelessness]. Revue Medicale Suisse 2015; 11(461): 402-5.
44. Costanza A, Amerio A, Aguglia A, et al. When sick brain and hopelessness meet: Some matters on suicidality in the neurological patient. CNS & Neurological Disorders Drug Targets 2020; DOI: 10.2174/1871527319666200611130804.
45. Costanza A, Amerio A, Radomska M et al. Suicidality Assessment of the Elderly with Physical Illness in the Emergency Department. Frontiers in Psychiatry, august 2020, in press.