The importance of existential questions in patients with a depressive disorder – a pilot study

Psychopathology. 2025 Oct 30:1-21. doi: 10.1159/000548702. Online ahead of print.

ABSTRACT

BACKGROUND: Depressive disorders are among the most common mental illnesses. Many approaches to treatment using psychotherapy or psychotropic drugs exist, but the proportion of non-responders should not be ignored. The consideration of existential, so-called ‘meaningful questions’ of life, although their significance is well known, has so far been used little or not at all in the diagnosis and treatment of mental illnesses like depressive disorders. The aim of this study was therefore to examine the significance of existential questions in the context of depressive disorders and to shed light on the attitudes of affected patients.

METHOD: This exploratory cross-sectional study used semi-structured interviews and questionnaires to examine 30 inpatients with a diagnosed depression and 30 mentally healthy individuals as a comparison group. Clinical parameters were collected from all study participants. The psychometrics included the recording of depression (BDI-II), anxiety (STAI-I/II), loneliness (UCLA Loneliness Scale), and life meaning (LeBe/SoMe). The BOFRETTA scale was also used to assess the subjects’ fear of death and attitudes toward death. The Bochum Questionnaire on the Importance of Existential Questions (BOFBEX), newly designed for this study, was used to assess attitudes to existential issues.

RESULTS: For the depressed patients, there were unfavourable and significantly different values compared to the mentally healthy subjects years with regard to meaningfulness, and crisis of meaning. Most depressives (66.7%) stated they suffered subjectively from experience of meaninglessness at most, whereas this did not occur in any of the healthy subjects. However, the level of depressiveness correlated significantly positively with loneliness in both groups and with the perception of a crisis in meaning.

CONCLUSIONS: Depressed patients had a need and desire to be able to address existential questions, which mainly concerned their loneliness, the feeling of autonomy, and having meaning in life, more strongly and more frequently with reference therapists as part of psychiatric-psychotherapeutic treatment.

PMID:41166561 | DOI:10.1159/000548702