The results of a meta-analysis published in Depression and Anxiety demonstrate a significant association between anhedonia and current suicidal ideation independent of symptoms of depression.
Deborah Ducasse, MD, from the Department of Psychiatric Emergency & Acute Crisis at Lapeyronie Hospital, Montpellier, France, and colleagues identified 15 observational case-control studies that investigated difference in anhedonia in individuals with (n=657) and without (n=6690) current suicidal ideation.
The level of anhedonia was higher in the group with current suicidal ideation than in the group without (P <.001). Even after controlling for depression and other psychiatric disorders, the association between anhedonia and current suicidal ideation remained significant. In studies reporting no between-group differences for depressive test score, the level of anhedonia was higher in the current suicidal ideation group than in the nonsuicidal ideation group (P <.001). Thus, depression per se does not explain the association between a high level of anhedonia and suicidal ideation. This remains true even in the absence of psychiatric disorders. However, anhedonia levels were higher in those with current suicidal ideation only for individuals older than 30 years.
The authors suggested that the association between anhedonia and suicidal ideation may be the result of a maladaptive coping strategy, or the tendency to avoid unpleasant emotions. By using such a strategy, the individual distances him or herself from noticing and appreciating pleasant events and experiences in the present (consummatory anhedonia), as well as from engaging in value-oriented actions (motivational anhedonia). Experiential avoidance can dampen pleasant emotions and exacerbate unpleasant ones. Furthermore, the researchers noted that the association between current suicidal ideation and anhedonia has been related to the interaction between the social component of anhedonia (ie, the loss of interest in people) and lack of belongingness.
Study limitations include those inherent to a retrospective analysis and the heterogeneity of the study population.
Dr Ducasse and colleagues called for future studies to assess whether suicidal thoughts are associated with deficits in wanting (motivational anhedonia) or liking (consummatory anhedonia).
Ducasse D, Loas G, Dassa D, et al. Anhedonia is associated with suicidal ideation independently of depression: a meta-analysis [published online December 12, 2017]. Depression and Anxiety. doi: 10.1002/da.22709.