Death anxiety and death-related depression in opioid use disorder: relationships with suicidal ideation, impulsivity, and psychological resilience.

BACKGROUND

Opioid use disorder (OUD) is associated with elevated suicide and impulsivity risks, yet the underlying existential vulnerabilities remain underexplored. This study aimed to examine death anxiety and death-related depression as potential mechanisms associated with suicidal ideation and impulsivity in OUD, and to evaluate the protective role of psychological resilience.

METHODS

Participants included 86 individuals with OUD in remission (under buprenorphine/naloxone treatment) and 86 healthy controls. Self-report measures assessed death anxiety, death-related depression, suicidal ideation, impulsivity, and psychological resilience. Data were analyzed using group comparisons and hierarchical regression models.

RESULTS

While death anxiety did not significantly differ between groups (p = 0.153), the OUD group showed significantly higher death-related depression, suicidal ideation, and impulsivity, alongside lower resilience (p < 0.003). Hierarchical regression analyses revealed that death-related depression positively predicted suicidal ideation (β = 0.278, p = 0.007), whereas psychological resilience demonstrated a significant negative association (β = -0.296, p = 0.002). In the impulsivity model, psychological resilience emerged as the only significant predictor (β = -0.482, p < 0.001).

CONCLUSIONS

Findings suggest that death-related depression, reflecting existential hopelessness rather than threat-based anxiety, represents an overlooked psychological vulnerability closely linked to suicidal ideation in OUD. Psychological resilience acts as a critical protective factor against both suicidal ideation and impulsivity. Interventions targeting meaning-making and resilience may be vital for mitigating suicide risk in this population.