The Type of Feelings of Worthlessness That Poses a High Risk for Suicide in Depression and Why
A Phenomenological Account and Criteria for Clinicians
DOI:
https://doi.org/10.5195/pom.2025.211Keywords:
Suicidality, Mood disorder, Self-esteem, ExistentialismAbstract
There is large consensus across clinical research that feelings of worthlessness (FOW) are one of the highest risk factors for a patient’s depression becoming suicidal. In this paper, I attempt to make sense of this empirical relationship from a phenomenological perspective. I propose that there are purely reactive and pervasive forms of FOW. Subsequently, I present a phenomenological demonstration for how and why it is pervasive FOW that pose a direct suicidal threat. I then outline criteria, contingent upon empirical verification, by which clinicians can more confidently identify when a patient’s FOW place them at high risk of suicide.
References
Allan, J., and A. Dixon. 2009. “Older Women’s Experiences of Depression: A Hermeneutic Phenomenological Study.” Journal of Psychiatric and Mental Health Nursing 16, no. 10: 865–873. https://doi.org/10.1111/j.1365-2850.2009.01465.x.
APA (American Psychiatric Association). 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Washington, DC: American Psychiatric Publishing. https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596.
Beck, Aaron T. and Brad A. Alford. 2009. Depression: Causes and Treatment. Philadelphia: University of Pennsylvania Press.
Beck, Aaron T. and Alice Beamesderfer. 1974. Assessment of Depression: The Depression Inventory. Basel: S. Karger.
Beck, Aaron T., and Robert A. Steer. 1989. “Clinical Predictors of Eventual Suicide: A 5- to 10-Year Prospective Study of Suicide Attempters.” Journal of Affective Disorders 17, no. 3: 203–209. https://doi.org/10.1016/0165-0327(89)90001-3.
Beck, Aaron T., Robert A. Steer, and Gregory K. Brown. 1987. Beck Depression Inventory. New York: Harcourt Brace Jovanovich.
Beck, Aaron T., Robert A. Steer, and William F. Ranieri. 1988. “Scale for Suicide Ideation: Psychometric Properties of a Self‐Report Version.” Journal of Clinical Psychology 44, no. 4: 499–505. https://doi.org/10.1002/1097-4679(198807)44:4%3C499::aid-jclp2270440404%3E3.0.co;2-6.
Bedrosian, Richard C., and Aaron T. Beck. 1979. “Cognitive Aspects of Suicidal Behavior.” Suicide and Life‐Threatening Behavior 9, no. 2: 87–96. https://doi.org/10.1111/j.1943-278X.1979.tb00433.x.
Blanchard, Matt, and Barry A. Farber. 2020. “‘It Is Never Okay to Talk About Suicide’: Patients’ Reasons for Concealing Suicidal Ideation in Psychotherapy.” Psychotherapy Research 30, no. 1: 124–136. https://doi.org/10.1080/10503307.2018.1543977.
Curtis-Wendlandt, Lisa, and Jack Reynolds. 2021. “Why Tourette Syndrome Research Needs Philosophical Phenomenology.” Phenomenology and the Cognitive Sciences 20, no. 4: 573–600. https://doi.org/10.1007/s11097-020-09688-w.
Everall, Robin D., Katherine E. Bostik, and Barbara L. Paulson. 2006. “Being in the Safety Zone: Emotional Experiences of Suicidal Adolescents and Emerging Adults.” Journal of Adolescent Research 21, no. 4: 370–392. https://doi.org/10.1177/0743558406289753.
Fergusson , D.M., L.J. Woodward, and L.J. Horwood. 2000. “Risk Factors and Life Processes Associated with the Onset of Suicidal Behaviour During Adolescence and Early Adulthood.” Psychological Medicine 30, no. 1: 23–39. https://doi.org/10.1017/S003329179900135X.
Fernandez, Anthony V. 2014a. “Depression as Existential Feeling or De-situatedness? Distinguishing Structure from Mode in Psychopathology.” Phenomenology and the Cognitive Sciences 13, no. 4: 595–612. https://doi.org/10.1007/s11097-014-9374-y.
———. 2014b. “Reconsidering the Affective Dimension of Depression and Mania: Towards a Phenomenological Dissolution of the Paradox of Mixed States.” Journal of Psychopathology 20, no. 4: 414–422. https://portal.findresearcher.sdu.dk/en/publications/reconsidering-the-affective-dimension-of-depression-and-mania-tow.
Fernandez, Anthony Vincent. 2019. “Phenomenology and Dimensional Approaches to Psychiatric Research and Classification.” Philosophy, Psychiatry, & Psychology 26, no. 1: 65–75. https://dx.doi.org/10.1353/ppp.2019.0004.
Fernandez, Anthony Vincent, and Steven Crowell. 2021. “Introduction: The Phenomenological Method Today.” Continental Philosophy Review 54, no. 2: 119–121. https://doi.org/10.1007/s11007-021-09539-8.
Franck, Erik, Rudi De Raedt, Mieke Dereu, and Dirk Van den Abbeele. 2007. “Implicit and Explicit Self-Esteem in Currently Depressed Individuals with and Without Suicidal Ideation.” Journal of Behavior Therapy and Experimental Psychiatry 38, no. 1: 75–85. https://doi.org/10.1016/j.jbtep.2006.05.003.
Freud, Sigmund. 1989 (1923). “The Ego and the Id.” TACD Journal 17, no. 1: 5–22. https://doi.org/10.1080/1046171X.1989.12034344.
Fuchs, Thomas. 2001. “Melancholia as a Desynchronization: Towards a Psychopathology of Interpersonal Time.” Psychopathology 34, no. 4: 179–186. https://doi.org/10.1159/000049304.
———. 2003. “The Phenomenology of Shame, Guilt and the Body in Body Dysmorphic Disorder and Depression.” Journal of Phenomenological Psychology 33, no. 2: 223–243. https://doi.org/10.1163/15691620260622903.
———. 2010. “Phenomenology and Psychopathology.” In Handbook of Phenomenology and Cognitive Science, edited by Daniel Schmicking and Shaun Gallagher, 546–573. Dordrecht: Springer. https://doi.org/10.1007/978-90-481-2646-0_28.
———. 2012. “The Feeling of Being Alive: Organic Foundations of Self-Awareness.” In Feelings of Being Alive, edited by Joerg Fingerhut and Sabine Marienberg, 149–166. Berlin: De Gruyter. https://doi.org/10.1515/9783110246599.149.
———. 2014. “Psychopathology of Depression and Mania: Symptoms, Phenomena and Syndromes.” Journal of Psychopathology 20: 404–413. https://www.uni-heidelberg.de/md/philsem/phaenomenologie/psychopathology_of_depression_and_mania.pdf.
Fuchs, Thomas, and Jann E. Schlimme. 2009. “Embodiment and Psychopathology: A Phenomenological Perspective.” Current Opinion in Psychiatry 22, no. 6: 570–575. https://doi.org/10.1097/yco.0b013e3283318e5c.
Hall, R.C., Dennis E. Platt, and Ryan C.W. Hall. 1999. “Suicide Risk Assessment: A Review of Risk Factors for Suicide in 100 Patients Who Made Severe Suicide Attempts—Evaluation of Suicide Risk in a Time of Managed Care.” Psychosomatics 40, no. 1: 18–27. https://doi.org/10.1016/s0033-3182(99)71267-3.
Hawton, Keith, Carolina Casañas I. Comabella, Camilla Haw, and Kate Saunders. 2013. “Risk Factors for Suicide in Individuals with Depression: A Systematic Review.” Journal of Affective Disorders 147, no. 1–3: 17–28. https://doi.org/10.1016/j.jad.2013.01.004.
Heidegger, Martin. 1962 (1927). Being and Time. Translated by John Macquarrie and Edward Robinson. Oxford: Blackwell Publishing.
Henden, John. 2008. Preventing Suicide: The Solution Focused Approach. Hoboken: Wiley Publishing.
Hines, Kevin. 2013. Cracked, Not Broken: Surviving and Thriving After a Suicide Attempt. Lanham: Rowman & Littlefield. Accessed digitally.
Jang, Jin-Mahn, Jong-Il Park, Keun-Young Oh, Keon-Hak Lee, Myung Sig Kim, Myeong-Sook Yoon, Sung-Hee Ko, Hye-Chung Cho, and Young-Chul Chung. 2014. “Predictors of Suicidal Ideation in a Community Sample: Roles of Anger, Self-Esteem, and Depression.” Psychiatry Research 216, no. 1: 74–81. https://doi.org/10.1016/j.psychres.2013.12.054.
Janse van Vuuren, Danica. Forthcoming a. Feelings of Worthlessness and Suicidality in Major Depression: A Phenomenological Exegesis. Cambridge: Cambridge University Press.
———. Forthcoming b. “What It Is Like for Many with Depression to Feel Pervasively Worthless: Disruptions in Sense of World, Intentionality, Selfhood, Others, Temporality, and Situatedness.” Journal of Phenomenological Psychology.
Jeon, Hong Jin, Jong-Ik Park, Maurizio Fava, David Mischoulon, Jee Hoon Sohn, Sujeong Seong, Jee Eun Park, Ikki Yoo, and Maeng Je Cho. 2014. “Feelings of Worthlessness, Traumatic Experience, and Their Comorbidity in Relation to Lifetime Suicide Attempt in Community Adults with Major Depressive Disorder.” Journal of Affective Disorders 166: 206–212. https://doi.org/10.1016/j.jad.2014.05.010.
Katzenmajer-Pump, Luca, Dániel Komáromy, and Judit Balázs. 2022. “The Importance of Recognizing Worthlessness for Suicide Prevention in Adolescents with Attention-Deficit/ Hyperactivity Disorder.” Frontiers in Psychiatry 13, article 969164. https://doi.org/10.3389/fpsyt.2022.969164.
Luft, Sebastian, and Søren Overgaard. 2011. “Introduction.” In The Routledge Companion to Phenomenology, edited by Sebastian Luft and Søren Overgaard, 1–14. London: Routledge.
McClelland, Heather, Jonathan J. Evans, Rebecca Nowland, Eamonn Ferguson, and Rory C. O’Connor. 2020. “Loneliness as a Predictor of Suicidal Ideation and Behaviour: A Systematic Review and Meta-analysis of Prospective Studies.” Journal of Affective Disorders 274: 880–896. https://doi.org/10.1016/j.jad.2020.05.004.
McGirr, Alexander, Johanne Renaud, Monique Seguin, Martin Alda, Chawki Benkelfat, Alain Lesage, and Gustavo Turecki. 2007. “An Examination of DSM-IV Depressive Symptoms and Risk for Suicide Completion in Major Depressive Disorder: A Psychological Autopsy Study.” Journal of Affective Disorders 97, no. 1–3: 203–209. https://doi.org/10.1016/j.jad.2006.06.016.
Mehlum, Lars. 1992. “Prodromal Signs and Precipitating Factors in Attempted Suicide.” Military Medicine 157, no. 11: 574–577. https://doi.org/10.1093/milmed/157.11.574.
Melhem, Nadine M., Giovanna Porta, Maria A. Oquendo, Jamie Zelazny, John G. Keilp, Satish Iyengar, Ainsley Burke, et al. 2019. “Severity and Variability of Depression Symptoms Predicting Suicide Attempt in High-Risk Individuals.” JAMA Psychiatry 76, no. 6: 603–613. https://doi.org/10.1001/jamapsychiatry.2018.4513.
Merkin, Daphne. 2017. This Close to Happy: A Reckoning with Depression. New York: Farrar, Straus and Giroux. Accessed digitally.
Núñez, Daniel, Pía Monjes, Susana Campos, and Johanna T.W. Wigman. 2021. “Evidence for Specific Associations Between Depressive Symptoms, Psychotic Experiences, and Suicidal Ideation in Chilean Adolescents from the General Population.” Frontiers in Psychiatry 11, article 552343. https://doi.org/10.3389/fpsyt.2020.552343.
Pompili, Maurizio. 2010. “Exploring the Phenomenology of Suicide.” Suicide and Life-Threatening Behavior 40, no. 3: 234–244. https://doi.org/10.1521/suli.2010.40.3.234.
———. 2018. “Reflections of a Committed Suicidologist.” In Phenomenology of Suicide: Unlocking the Suicidal Mind, edited by Maurizio Pompili, 13–30. Cham: Springer.
Ramprasad, Gayathri. 2014. Shadows in the Sun: Healing from Depression and Finding the Light Within. Center City, MN: Hazelden Publishing. Accessed digitally.
Ratcliffe, Matthew. 2002. “Heidegger’s Attunement and the Neuropsychology of Emotion.” Phenomenology and the Cognitive Sciences 1, no. 3: 287–312. https://doi.org/10.1023/A:1021312100964.
———. 2005. “The Feeling of Being.” Journal of Consciousness Studies 12, no. 8–10: 43–60. https://www.ingentaconnect.com/contentone/imp/jcs/2005/00000012/f0030008/art00003.
———. 2008. Feelings of Being: Phenomenology, Psychiatry and the Sense of Reality. Oxford: Oxford University Press.
———. 2010. “Depression, Guilt and Emotional Depth.” Inquiry 53, no. 6: 602–626. https://doi.org/10.1080/0020174X.2010.526324.
———. 2013. “Depression and the Phenomenology of Free Will.” In The Oxford Handbook of Philosophy and Psychiatry, edited by K.W.M. Fulford, Martin Davies, Richard Gipps, George Graham, John Sadler, Giovanni Stanghellini, and Tim Thornton, 574–591. Oxford: Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199579563.013.0036.
———. 2015. Experiences of Depression: A Study in Phenomenology. New York: Oxford University Press.
———. 2020. “Existential Feelings.” In The Routledge Handbook of Phenomenology of Emotion, edited by Thomas Szanto and Hilge Landweer, 250–261. London: Routledge.
Ratcliffe, Matthew, Matthew Broome, Benedict Smith, and Hannah Bowden. 2013. “A Bad Case of the Flu? The Comparative Phenomenology of Depression and Somatic Illness.” Journal of Consciousness Studies 20, no. 7–8: 198–218. https://www.researchgate.net/publication/232250619_A_Bad_Case_of_the_Flu_The_Comparative_Phenomenology_of_Depression_and_Somatic_Illness.
Richards, Julie E., Ursula Whiteside, Evette J. Ludman, Chester Pabiniak, Beth Kirlin, Rianna Hidalgo, and Greg Simon. 2019. “Understanding Why Patients May Not Report Suicidal Ideation at a Health Care Visit Prior to a Suicide Attempt: A Qualitative Study.” Psychiatric Services 70, no. 1: 40–45. https://doi.org/10.1176/appi.ps.201800342.
Sartre, Jean-Paul. 1978. Being and Nothingness: A Phenomenological Essay on Ontology. Translated by Hazel E. Barnes. New York: Pocket Books.
Shen, Xi, and Jinliang Wang. 2023. “More Than the Aggregation of Its Components: Unveiling the Associations Between Anxiety, Depression, and Suicidal Behavior in Adolescents from a Network Perspective.” Journal of Affective Disorders 326: 66–72. https://doi.org/10.1016/j.jad.2023.01.081.
Shim, Eun-Jung, Hyeju Ha, Jee Eun Park, Byung-Soo Kim, Sung Man Chang, Jin Pyo Hong, Maeng Je Cho, and Bong-Jin Hahm. 2020. “Gender-Based Examination of the Association Between Individual Symptoms of Alcohol Use Disorder, Major Depressive Disorder, and Suicidal Behaviors: A Network Analysis of Data from the Korean Epidemiologic Catchment Area Study.” Journal of Affective Disorders 272: 432–439. https://doi.org/10.1016/j.jad.2020.03.162.
Shneidman, Edwin S. 1993. “Suicide as Psychache.” Journal of Nervous and Mental Disease 181, no. 3: 145–147. https://doi.org/10.1097/00005053-199303000-00001.
———. 1996. The Suicidal Mind. New York: Oxford University Press.
———. 1999. “The Psychological Pain Assessment Scale.” Suicide and Life-Threatening Behavior 29, no. 4: 287–294. https://doi.org/10.1111/j.1943-278X.1999.tb00524.x.
———. 2004. Autopsy of a Suicidal Mind. New York: Oxford University Press.
Solomon, Andrew. 2014. The Noonday Demon: An Atlas of Depression. New York: Simon & Schuster.
Spiegelberg, Herbert. 1972. Phenomenology in Psychology and Psychiatry: A Historical Introduction. Evanston: Northwestern University Press.
Styron, William. 2010. Darkness Visible: A Memoir of Madness. New York: Open Road Media. Accessed digitally.
Turecki, Gustavo, David A. Brent, David Gunnell, Rory C. O’Connor, Maria A. Oquendo, Jane Pirkis, and Barbara H. Stanley. 2019. “Suicide and Suicide Risk.” Nature Reviews Disease Primers 5, no. 74: 1–22. https://doi.org/10.1038/s41572-019-0121-0.
Upthegrove, Rachel, Maximillian Birchwood, K. Ross, K. Brunett, R. McCollum, and Lisa Jones. 2010. “The Evolution of Depression and Suicidality in First Episode Psychosis.” Acta Psychiatrica Scandinavica 122, no. 3: 211–218. https://doi.org/10.1111/j.1600-0447.2009.01506.x.
Wakefield, J.C., and M.F. Schmitz. 2015. “Feelings of Worthlessness During a Single Complicated Major Depressive Episode Predict Postremission Suicide Attempt.” Acta Psychiatrica Scandinavica 133, no. 4: 257–265. https://doi.org/10.1111/acps.12521.
Wenzel, Amy, Edward R. Berchick, Thomas Tenhave, Steffanie Halberstadt, Gregory K. Brown, and Aaron T. Beck. 2011. “Predictors of Suicide Relative to Other Deaths in Patients with Suicide Attempts and Suicide Ideation: A 30-Year Prospective Study.” Journal of Affective Disorders 132, no. 3: 375–382. https://doi.org/10.1016/j.jad.2011.03.006.
Wolfersdorf, Manfred. 1995. “Depression and Suicidal Behaviour: Psychopathological Differences Between Suicidal and Non-suicidal Depressive Patients.” Archives of Suicide Research 1, no. 4: 273–288. http://doi.org/10.1080/13811119508258988.
Wolfersdorf, M., B. Steiner, F. Keller, and M. Hautzinger. 1990. “Depression and Suicide: Is There a Difference Between Suicidal and Non-suicidal Depressed Inpatients?” European Journal of Psychiatry 4, no. 4: 235–252.
Yigletu, Hirut, Sharon Tucker, Marcelline Harris, and Jacqueline Hatlevig. 2004. “Assessing Suicide Ideation: Comparing Self-Report Versus Clinician Report.” Journal of the American Psychiatric Nurses Association 10, no. 1: 9–15. https://doi.org/10.1177/1078390303262655.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Danica Janse van Vuuren
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
- The Author agrees to digitally sign the Publisher’s final formatted PDF version of the Work.
