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Can Anhedonia Be Considered a Suicide Risk Factor? A Review of the Literature

Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
Psychology Program, Stockton University, Galloway, NJ 08205, USA
Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
Author to whom correspondence should be addressed.
Medicina 2019, 55(8), 458;
Received: 11 June 2019 / Revised: 25 July 2019 / Accepted: 6 August 2019 / Published: 9 August 2019
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
PDF [2114 KB, uploaded 19 August 2019]


Background and Objectives: At present, data collected from the literature about suicide and anhedonia are controversial. Some studies have shown that low levels of anhedonia are associated with serious suicide attempts and death by suicide, while other studies have shown that high levels of anhedonia are associated with suicide. Materials and Methods: For this review, we searched PubMed, Medline, and ScienceDirect for clinical studies published from 1 January 1990 to 31 December 2018 with the following search terms used in the title or in the abstract: “anhedonia AND suicid*.” We obtained a total of 155 articles; 133 items were excluded using specific exclusion criteria, the remaining 22 articles included were divided into six groups based on the psychiatric diagnosis: mood disorders, schizophrenia spectrum disorders, post-traumatic stress disorder (PTSD), other diagnoses, attempted suicides, and others (healthy subjects). Results: The results of this review reveal inconsistencies. Some studies reported that high anhedonia scores were associated with suicidal behavior (regardless of the diagnosis), while other studies found that low anhedonia scores were associated with suicidal behavior, and a few studies reported no association. The most consistent association between anhedonia and suicidal behavior was found for affective disorders (7 of 7 studies reported a significant positive association) and for PTSD (3 of 3 studies reported a positive association). In the two studies of patients with schizophrenia, one found no association, and one found a negative association. For patients who attempted suicide (undiagnosed), one study found a positive association, one a positive association only for depressed attempters, and one a negative association. Conclusions: We found the most consistent positive association for patients with affective disorders and PTSD, indicating that the assessment of anhedonia may be useful in the evaluation of suicidal risk. View Full-Text
Keywords: anhedonia; PTSD; suicide; suicide risk; suicidal behavior anhedonia; PTSD; suicide; suicide risk; suicidal behavior
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Bonanni, L.; Gualtieri, F.; Lester, D.; Falcone, G.; Nardella, A.; Fiorillo, A.; Pompili, M. Can Anhedonia Be Considered a Suicide Risk Factor? A Review of the Literature. Medicina 2019, 55, 458.

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