Hopelessness, defeat, and entrapment in posttraumatic stress disorder: their association with suicidal behavior and severity of depression

ABSTRACT: Research has shown an increased frequency of suicidal behaviors in those with PTSD, but few studies have investigated the factors that underlie the emergence of suicidal behavior in PTSD. Two theories of suicide, the Cry of Pain and the Schematic Appraisal Model of Suicide, propose that feelings of hopelessness, defeat, and entrapment are core components of suicidality. This study aimed to examine the association between suicidal behavior and hopelessness, defeat, and entrapment in trauma victims with and without a PTSD diagnosis. The results demonstrated that hopelessness, defeat, and entrapment were significantly positively associated with suicidal behavior in those with PTSD. Hopelessness and defeat were also significantly positively associated with suicidal behavior in trauma victims without PTSD. In those with PTSD, the relationship between suicidal behavior and hopelessness and entrapment remained significant after controlling for comorbid depression. The findings provide support for the contemporary theories of suicidality and have important clinical implications.     

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

Objective: Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors. Method: We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures. Results: Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety. Conclusion: Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.     

Book Reviews

This study clarified the association of maladaptive, potentially self-damaging behaviors with suicidality. Specifically, we examined whether greater frequency (i.e., how often) or greater versatility (i.e., how many ways) of several self-damaging behaviors, including non-suicidal self-injury (NSSI), substance use, and disordered eating, increased risk for suicide. Participants who engaged in NSSI (N = 142) completed questionnaires assessing suicidal and self-damaging behavior at baseline and engagement in suicidal behaviors (e.g., ideation, attempts, talking about suicide) 3 months later. Results suggest that the versatility rather than frequency of self-damaging behaviors is most robustly associated with suicide risk. Engaging in multiple methods of NSSI and using a greater number of illicit substances were positively associated with suicide risk. Further, versatility of NSSI interacted with depression to predict suicide risk at 3-month follow-up such that highly depressed participants who engaged in more methods of NSSI exhibited highest risk, whereas those who engaged in more methods with low depression exhibited the lowest risk.     

Impulsivity,hostility and suicidality in patients diagnosed with obsessive compulsive disorder

Abstract

Background: There are limited data on suicidal behaviour in obsessive-compulsive disorder (OCD). This study aimed to evaluate several aspects affecting suicidality in OCD patients and determine whether impulsivity or hostility are associated with suicide attempts in this vulnerable group.

Methods: Eighty-one patients with OCD were assessed by structured clinical interview for DSM-IV (SCID I), Yale-Brown Obsessive–Compulsive Scale (Y-BOCS), Suicide Probability Scale (SPS), Barratt impulsivity scale-11 (BIS) and Scale for suicide ideation (SSI).

Results: Of the 81 patients, 22 (27%) had suicide ideation, 29 (33%) attempted suicides with OCD and 30 (37%) OCD patients who never experienced suicide ideation nor attempted suicide. Suicide ideation was associated with high hopelessness, higher severity of OCD and the presence of aggressive obsessions. On the other hand, suicide attempts were associated with longer duration of untreated illness, cognitive impulsivity, higher severity of OCD symptoms and the presence of religious obsessions.

Conclusion: Higher severity of OCD symptoms is associated with both suicide ideation and attempts. And while hopelessness was related to suicidal thoughts, cognitive impulsivity may have acted as a facilitating factor for suicide attempts. Higher frequency of symptoms like religious/ aggressive obsessions was also associated with suicidality. It is vital that patients with OCD undergo detailed assessment for suicide risk.

• Key points

• OCD is associated with a high risk for suicidal behaviour.

• Suicide ideation was associated with high levels of hopelessness, OCD severity, and the presence of aggressive obsessions.

• Suicide attempts were associated with longer duration of untreated illness, cognitive impulsivity, severity of OCD, and the presence of religious obsessions.

     

The Differentiating Role of State and Trait Hopelessness in Suicidal Ideation and Suicide Attempt

With suicide being a leading cause of death in the United States, research must aim to increase efficacious prevention methods. The purpose of the present study was to gain greater understanding of the difference between suicidal ideation and suicide attempt. Previous research emphasizes the role of hopelessness in attempts and ideation (Bagge, Lamis, Nadorff, &; Osman, 2014 Bagge, C. L., Lamis, D. A., Nadorff, M., &; Osman, A. (2014). Relations between hopelessness, depressive symptoms and suicidality: Mediation by reasons for living. Journal of Clinical Psychology, 70(1), 18–31. doi:10.1002/jclp.22005[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Yet while hopelessness offers predictive value to suicide attempt, it fails in discriminating between suicide attempters and suicide ideators. Thus the goal was to examine the possible influence of different types of hopelessness on suicidal ideation and attempt. The experience of hopelessness as a temporary feeling, or state, versus as an enduring emotion, or trait, was examined in this study. The State-Trait Hopelessness Scale and 4 suicidal thought and suicidal behavior questions were assessed. Results of logistic regression analysis supported the hypothesis that state and trait hopelessness were differentially associated with ideation and attempt. While trait hopelessness was significantly positively associated with responses to all 4 suicidality questions (p’s?相似文献   

Thought and Speech†

Objective: Sense of belonging has demonstrated significant relationships with depression and suicidal thoughts, highlighting its potential utility in refining assessment of suicide risk. Method: Structured clinical interviews and self-report measures were used to assess depression, suicidal behaviors, hopelessness, life stress, social support, and sense of belonging in a sample of 116 depressed psychiatric patients. Results: Lower sense of belonging was significantly associated with greater severity of depression, hopelessness, suicidal ideation, and history of prior suicide attempt(s). However, sense of belonging did not predict suicidal ideation and history of prior suicide attempt(s) beyond the association between suicidal behaviors and established risk factors. Sense of belonging displayed a significant relationship with depression and hopelessness and is likely to play a critical role in both the development of and recovery from depression. Conclusions: Sense of belonging is directly related to depression and hopelessness, while indirectly related to suicidal ideation. Low sense of belonging provides an important target for assessment and intervention in the treatment of depression. Cognitive, behavioral, and interpersonal interventions may help improve an individual’s sense of belonging and decrease symptoms of depression and hopelessness.     

Factor structure and psychometric properties of the Modified Scale for Suicidal Ideation among suicidal youth

Background: Although suicidal behaviors occur at a high rate in adolescence, relatively few interview‐based measures are available to assess suicidal ideation among youth. Existing interview measures are limited by a paucity of empirical study, a failure to conform to standard suicide nomenclature, or a lengthy administration time. This study presents data on the psychometric properties and factor structure of the brief, layperson‐administered Modified Scale for Suicidal Ideation (MSSI) among suicidal youth. Methods: The MSSI was administered to an inpatient sample of 102 suicidal youth aged 13–17 years. Additional interview and self‐report measures were administered to examine the convergent validity of the MSSI. Results: Consistent with previous findings among suicidal adults, the MSSI displayed good internal consistency and expected patterns of convergent validity. Principal component analysis revealed a bidimensional structure, with factors corresponding to (1) Desire and Ideation and (2) Plans and Preparations. Each factor displayed acceptable internal consistency and expected patterns of convergent validity via associations with hopelessness, depressive symptoms, impulsivity, and a self‐report measure of suicidal behaviors. The Plans and Preparations factor significantly associated with the presence of a current suicide attempt and with greater suicide intent among attempters, whereas the Desire and Ideation factor did not. Conclusions: The MSSI appears to be a reliable and valid instrument to assess suicidal ideation among distressed youth. Clinicians are encouraged to pay particular attention to responses on the Plans and Preparations factor given its stronger association with suicide attempt and more serious suicide intent. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication

Messias E, Clarke DE, Goodwin RD. Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication. Objective: Studies have shown an association between allergies and suicidality, and a seasonality of suicide has also been described. We hypothesize an association between history of seasonal allergies and suicide ideation and attempt. Method: Data came from the National Comorbidity Survey Replication, a nationally representative sample (n = 5692) of adults living in the US. Logistic regression models were used to calculate adjusted odds ratios (OR) controlling for the following: age, sex, race, smoking, asthma and depression. Results: After weighting and adjustment, a positive and statistically significant association was found between history of seasonal allergies and history of suicidal ideation [adjusted OR = 1.27 (1.01–1.58)]. We found no association between history of seasonal allergies and history of suicide attempts [adjusted OR = 1.17 (0.89–1.52)]. Conclusion: Findings from a population‐based sample support the hypothesized relationship between allergies and suicidal ideation.     

Appraisals and Suicidality: The Mediating Role of Defeat and Entrapment

This study tested whether feelings of defeat and entrapment mediated the effects of negative appraisals upon suicidal ideation and behavior. A sample of 93 university students who reported some degree of suicidal ideation completed questionnaires of negative appraisals of social-support and problem-solving, defeat, entrapment, hopelessness and suicidality. The results supported a model whereby defeat and entrapment fully mediated the effect of appraisals of social support and problem-solving ability upon suicidality. Furthermore, controlling for hopelessness had no substantive impact upon this model. The findings support socio-cognitive models of suicidal behavior and highlight the key role of defeat and entrapment in suicide. The clinical implications of these findings are discussed.     

Suicidal ideation in family carers of people with dementia

Objective: Two small studies have suggested that family carers of people with dementia may be a high-risk group for suicide. The objective of this study was to further explore the rate of suicidal ideation in a large sample of carers and identify psychosocial risk and protective factors.

Method: A cross-sectional survey was conducted with 566 family carers. The survey included measures of suicidality, self-efficacy, physical health, depression, anxiety, hopelessness, optimism, burden, coping strategies, and social support.

Results: Sixteen percent of carers had contemplated suicide more than once in the previous year. There were univariate differences between suicidal and non-suicidal carers on self-efficacy, social support, coping, burden, depression, anxiety, hopelessness, optimism, reasons for living, and symptoms of dementia, as well as age and income management. In a multivariate model, age, depression, and reasons for living predicted suicidal ideation. In tests for mediation, satisfaction with social support and dysfunctional coping had indirect effects on suicidal ideation via depression.

Conclusion: Family carers of people with dementia have high rates of suicidal ideation, with depression a risk factor and increasing age and reasons for living as protective factors. Depression and reasons for living should be targeted in interventions to reduce suicide risk in dementia carers.     

Hopelessness,neurocognitive function,and insight in schizophrenia: relationship to suicidal behavior

Insight and hopelessness have been reported to be associated with suicidality in schizophrenia. In addition, there is evidence that diminished insight is correlated with impairment in some domains of cognitive function in schizophrenia. The purpose of this study was to clarify the relative importance for suicidality in patients with schizophrenia of hopelessness, cognitive dysfunction, and insight. This study included 333 patients with chronic schizophrenia who were prospectively studied. Insight was rated by the insight items from the Schedule for Affective Disorders and Schizophrenia (SADS) and the Hamilton Depression Rating Scale (HDRS). Positive, negative, and anxiety-depression symptoms were measured with the Brief Psychiatric Rating Scale (BPRS). Cognition was assessed with a neurocognitive battery, which included measures of attention and psychomotor speed, verbal fluency, verbal memory, working memory, and executive function. Current and lifetime suicidality was prospectively assessed. Hopelessness, substance abuse, and greater insight were associated with attempted suicide and suicidal ideation. Those with a history of lifetime, but not current, suicidality had better function on tests of psychomotor speed and attention, verbal working memory, verbal fluency, verbal memory, and executive function. Neurocognitive measures were not significantly correlated with hopelessness and insight. Hopelessness was more severe in those with current and lifetime suicidality. A multiple regression analysis was used to predict current and lifetime suicidality from hopelessness, substance abuse, insight, and cognitive factor scores. The regression models predicting current and lifetime suicidality indicated that hopelessness was the most important predictor of both (beta=0.41, p=0.0001; and beta=0.35, p=0.01, respectively). These findings suggest that hopelessness, substance abuse, greater insight into illness, and higher cognitive function are associated with greater suicidality in chronic schizophrenia, but that among these, hopelessness may be the principal predictor of suicidality.     

Maternal suicidality and risk of suicidality in offspring: findings from a community study

OBJECTIVE: This study evaluated the associations between suicidal ideation and suicide attempts in mothers and various aspects of suicidality in their offspring in a representative community sample. METHOD: Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology study, a prospective, longitudinal community study of adolescents and young adults. Results are based on 933 adolescents who completed follow-up and for whom direct diagnostic information for the biological mother was available. Suicidal ideation and suicide attempts were assessed in adolescents and mothers with the Munich-Composite International Diagnostic Interview. RESULTS: Compared to offspring of mothers without suicidality, offspring of mothers reporting suicide attempts showed a remarkably higher risk for suicidal thoughts and suicide attempts and a tendency toward suicide attempts at an earlier age. Associations were comparable for male and female offspring. Transmission of maternal suicidality was roughly stable with control for maternal comorbid psychopathology. CONCLUSIONS: The offspring of mothers with suicide attempts are at a markedly increased risk for suicidality themselves and tend to manifest suicide attempts earlier than offspring of mothers without suicidality. Suicidality seems to run in families, independent of depression and other psychopathology.     

Rumination and Pessimistic Certainty as Mediators of the Relation Between Lifetime Suicide Attempt History and Future Suicidal Ideation

This study examined whether rumination and certainty about pessimistic future-event predictions (P-Certainty) would mediate the relation between lifetime suicide attempt history and future suicidal ideation. Young adults, ages 18–25 (N = 143), with a suicide attempt history (n = 32) or no previous suicide attempt history (n = 111) at baseline, were followed up 2–3 years later and completed measures of rumination, depressive symptoms, hopelessness, suicidal ideation, and pessimistic future-event certainty. Lifetime suicide attempts at baseline were associated with higher suicidal ideation at follow up, and this relation was mediated by rumination and P-Certainty. Suicide attempters may be vulnerable to later ideation due to higher levels of rumination and also certainty in their pessimistic future expectations.     

Hopelessness and suicidal risk in bipolar disorder. A study in clinically nonsyndromal patients

Objective

Attempted suicide and death due to suicide are not uncommon among patients with bipolar disorder. Although some risk factors for suicidality in bipolar patients have been identified, little is known about hopelessness and other possible trait or diathesis-related factors. Consequently, the objective of this study was to investigate variables associated with suicidal risk in clinically nonsyndromal bipolar patients.

Methods

A sample of 102 outpatients with a diagnosis of bipolar disorder according to International Classification of Diseases, 10th Revision criteria during nonsyndromal stage were evaluated. On the basis of suicidal history, patients were divided into suicide attempt, suicidal ideation, and nonsuicidal groups. Sociodemographic, clinical, and psychopathological variables were assessed.

Results

As compared with the nonsuicidal group, female sex, combined psychopharmacologic treatment, and hopelessness were independently associated with suicide attempt. Hopelessness and insight into having a mental disorder were independently associated with history of suicidal ideation.

Conclusions

Patients with bipolar disorder and suicidal history are characterized by the presence of hopelessness, which probably confers greater vulnerability for suicidal behavior in the presence of stress factors. This identification of the risk profile for suicidal behavior in nonsyndromal bipolar patients adds complementary information to risk factors established for suicidality during acute phases of the disease, allows for differentiated preventive and treatment approaches of patients at risk, and suggests psychotherapy as an advisable intervention in this group of patients.     

Parental influence,pessimism and adolescent suicidality

Abstract

As part of a series of studies into the early detection of suicidal behaviour in adolescence, this study investigated relationships between adolescents' self-reports of perceived parental style, pessimism, and the spectrum of suicidal behaviour in a sample of Australian high school students (Mean age = 15.8). Three hundred and seven students completed a questionnaire that included demographic details. the Influential Relationships Questionnaire (IRQ), the Beck Hopelessness Scale, and the Adolescent Suicide Questionnaire. There was a high level of suicidal behaviour reported with suicidal adolescents perceiving their pants to be significantly more critical, less caring and more overprotective. Multiple regression analyses examining a proposed pathway from perceived parental style to suicidality through the mediation of hopelessness found that both parental style and hopelessness made unique contributions to a composite suicidality score. The quality of parenting is relevant to the assessment of adolescent suicidality and the KRQ may be useful for the detection of perceived parenting difficulties in suicide prevention programmes.     

Predicting Risk for Suicide: A Preliminary Examination of Non-Suicidal Self-Injury and the Acquired Capability Construct in a College Sample

The interpersonal psychological theory of suicide provides a useful framework for considering the relationship between non-suicidal self-injury and suicide. Researchers propose that NSSI increases acquired capability for suicide. We predicted that both NSSI frequency and the IPTS acquired capability construct (decreased fear of death and increased pain tolerance) would separately interact with suicidal ideation to predict suicide attempts. Undergraduate students (N = 113) completed self-report questionnaires, and a subsample (n = 66) also completed a pain sensitivity task. NSSI frequency significantly moderated the association between suicidal ideation and suicide attempts. However, in a separate model, acquired capability did not moderate this relationship. Our understanding of the relationship between suicidal ideation and suicidal behavior can be enhanced by factors associated with NSSI that are distinct from the acquired capability construct.     

Predictors of Suicidal Behaviors in Canadian Adolescents with No Recent History of Depression

We examined risk factors for suicidal behaviors (i.e., suicidal ideation and suicide attempts) in the absence of depression during adolescence. Using 6,788 adolescents from the National Longitudinal Survey of Children and Youth (NLSCY), we identified participants with “no recent history of depression.” We then tested the effects of risk factors at age 14–15 on suicidal behaviors at age 16–17. Absence of recent depression history negatively predicted both suicidal ideation and suicide attempt. However, among those with no history of depression, substance use and the presence of a chronic illness both increased the risk of suicidal behaviors. Suicidal behavior in adolescents in the absence of depression history may be explained by factors such as substance use and chronic illness.     

A comparison of the medical lethality of suicide attempts in bipolar and major depressive disorders

Objectives:  Among mood disorders, bipolar disorder (BPD) is often noted to involve the highest rates of suicide attempts and possibly of completion. This study sought to determine whether suicide attempters with BPD exhibit suicide attempts with higher lethality than attempters with major depressive disorder (MDD) and to explore differences in clinical features associated with suicidal acts.
Methods:  Mood disordered suicide attempters were interviewed about Axis I and II diagnoses, lifetime history of suicide attempts, suicidal intent, suicidal ideation, the medical lethality of their most severe suicide attempt, severity of depression, hopelessness, lifetime aggression, and impulsivity.
Results:  The maximum lethality of suicidal acts tended to be higher among BPD attempters compared with those with MDD. However, there were no differences in the number of suicide attempts, intent to die or suicidal ideation. Suicide attempters with BPD reported higher levels of aggression and impulsivity but less hopelessness compared with MDD attempters. These differences could not be explained by Cluster B personality disorder comorbidity. Of note, within the BPD group, but not the MDD group, males reported suicidal acts with higher lethality. Multivariate analyses suggested that risk for more lethal suicide attempts is associated with BPD and male sex and that bipolar males appear to be especially vulnerable to these behaviors.
Conclusions:  Males with BPD make more lethal suicide attempts than females with BPD, an effect not observed among the MDD sample. Our findings suggest that higher rates of suicidal behavior in BPD may be due to a specific effect of BPD on males, leading to more dangerous suicidal behaviors. This effect, together with the larger proportion of males in the BPD group compared with the MDD group may lead to higher rates of reported attempted and completed suicide.     

Prevalence of suicide risk factors in people at ultra-high risk of developing psychosis: a service audit

Background: Little data is available on the prevalence of suicide risk factors in people at ultra‐high risk (UHR) of developing psychosis. Aim: The aim of this study was to provide an estimate of the cross‐sectional prevalence of possible suicide risk factors in those attending a routine clinical service for people at UHR of developing psychosis. Methods: For all patients in treatment (n = 34) over a 4‐week period, levels of suicidal ideation and depression upon entry to the service were assessed by auditing intake scores on the Beck Depression Inventory, second edition. Level of engagement with services, social isolation, substance and alcohol misuse, ready access to means, current suicidal ideation, previous suicide attempts, current or previous self‐harm, expressions of concern from others, depression, agitation, hopelessness, worthlessness, suspiciousness and fears of mental disintegration were all assessed by case note review and interview with the treating clinician. Results: There was a high prevalence of at least mild suicidal ideation (58.8%, n = 20) and severe depressed mood (47%, n = 16) in this client group at point of entry to the service. Seven people (20.6%) had engaged in serious self‐harm (including attempted suicide) during the time they were in contact with the service. Forty‐seven per cent (n = 16) reported at least 27 suicide attempts between them; the mean number of attempts being 1.69 (standard deviation = 1.08). Conclusion: Suicide risk was high in this small sample of people at UHR of developing psychosis. Controlled research with larger samples and better methodology is urgently required to inform legal, ethical and scientific debates surrounding this group.     

Suicidal Behaviors Among Ukrainian College Students: the Role of Substance Use,Religion, and Depression

Early adulthood is a critical life period associated with increased suicide risk. The present study used a sample of students from ten Ukrainian public universities (N = 1005). Participants were 17 to 24 years of age (M = 19.19, SD = 1.99). The prevalence of lifetime suicidal ideation was 26.13% and 5.45% of participants reported a lifetime suicide attempt. Participants were more likely to report higher lifetime suicidal ideation if they had higher rates of alcohol and marijuana use, have met a clinical cutoff point for depression and were older, females, and not affiliated with any religion. The lifetime suicide attempt was associated with clinical levels of depression, increased marijuana use, and non-religious affiliation. These results suggest that mental health, alcohol and cannabis use can increase the risk of suicidality while religious affiliation might be an important protective mechanism for Ukrainian young adults at risk for suicidal behaviors.