Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation

The authors intensively studied 207 patients hospitalized because of suicidal ideation, but not for recent suicide attempts, at the time of admission. During a follow-up period of 5-10 years, 14 patients committed suicide. Of all the data collected at the time of hospitalization, only the Hopelessness Scale and the pessimism item of the Beck Depression Inventory predicted the eventual suicides. A score of 10 or more on the Hopelessness Scale correctly identified 91% of the eventual suicides. Taken in conjunction with previous studies showing the relationship between hopelessness and suicidal intent, these findings indicate the importance of degree of hopelessness as an indicator of long-term suicidal risk in hospitalized depressed patients.     

Subjective psychological well-being (WHO-5) in assessment of the severity of suicide attempt

An objective way to measure the severity of suicide attempt is to use different psychometric scales. Aspects of suicide risk like suicidal intent, depression, hopelessness and well-being can be assessed and different practical scales are in use to facilitate the risk assessment procedure. The aims of current study were: 1) to analyse the association between the severity of suicide attempt measured by suicidal intent scale and characteristics of emotional status of suicide attempters measured by depression, hopelessness and well-being scales in different gender and age groups; 2) to test the applicability of well-being measured by the World Health Organisation well-being index (WHO-5) in suicide risk assessment. The data on suicide attempters (n=469) was obtained in Estonia (Tallinn) by the WHO Suicide Prevention-Multisite Intervention Study on Suicidal Behaviours (SUPRE-MISS) methodology. Different psychometric scales were used to measure suicidal intent (Pierce Suicidal Intent Scale) and emotional status (Beck Depression Inventory for depression, Beck Hopelessness Scale for hopelessness, WHO-5 for well-being). All psychometric scales correlated well with each other (P<0.05). Low level of well-being associated with high level of suicidal intent, depression and hopelessness. Suicidal intent correlated the most strongly with well-being. Analysis by gender and age groups revealed also significant correlations with two exceptions only: correlation between suicidal intent and hopelessness did not reach the significant level in males and in older adults (40+). The WHO-5 well-being scale, which is a short and emotionally positively loaded instrument measuring protective factors, can be used in settings without psychological/psychiatric expertise in preliminary suicide risk assessment.     

Hopelessness,impulsiveness and intent among suicide attempters with major depression,alcohol dependence,or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

Clinical rating scales in suicide risk assessment

This study explores the usefulness of clinical rating scales in the assessment of suicidal risk in an urban psychiatric teaching hospital. Admission for clinically evaluated suicide risk was the outcome variable because actual suicide occurs rarely. Six clinical scales identified high-risk patients: the Modified SAD PERSONS scale, revised Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale, Beck Scale for Suicidal Ideation (BSS), and the High-Risk Construct Scale (NEW). It was hypothesized that patients who scored highly on the clinical scales were more likely to be admitted. Five of the scales had previously established psychometric properties, while one was new and untested. For our patient population, the established scales had 100% sensitivity and negative predictive value, but lower specificity and positive predictive value (range = 38–90% & 28–71%). We performed a correlation matrix and regression analysis to determine which scale(s) best predicted admission based upon suicidal concerns. The previously untested NEW scale was the best predictor followed by the BSS. Clinical rating scales cannot predict suicide in the individual and strict cut-off scores should not be used to dictate admission to hospital. However, the information provided can be a valuable adjunct to suicide risk assessment in psychiatric and non-psychiatric emergency settings     

Beck Hopelessness Scale: Exploring its Dimensionality in Patients with Schizophrenia

Hopelessness is a pre-eminent risk factor for suicide and non-fatal self-harm. Although the Beck Hopelessness Scale is often used for schizophrenia, its factor structure has been given relatively little consideration in this context. This study aimed to examine the reliability and validity of the Taiwanese version of the Beck Hopelessness Scale (BHS-T) in a chronic schizophrenia out-patient sample. One hundred and two (102) outpatients were evaluated using the translated Taiwanese version of the BHS (BHS-T), as well as several Beck-related symptom rating scales and the Positive and Negative Syndrome Scale (PANSS) for psycho-pathology. The patients were also evaluated for suicidal intent using the critical items of the Scale for Suicide Ideation (SSI) and suicide attempts. The psychometric properties of the BHS-T were also evaluated, including construct validity, internal consistency, test-retest reliability, convergence, and discriminative validity. The BHS-T showed good overall reliability and stability over time. This translated scale comprised a two-factor solution corresponding negative expectation and loss of motivation dimensions. Differences in mean hopelessness scores between participants with and without suicidal intent were significant. The results also indicated that, among individuals with schizophrenia, "negative expectation in the future" is more closely linked to suicide intent than "loss of motivation for the future". The BHS-T is a reliable and valid instrument for measuring the multi-dimensionality of hopelessness and may complement clinical suicidal risk assessments in individuals with schizophrenia.     

Hopelessness and low-intent in parasuicide

Parasuicide is usually associated with low suicidal intent and research data show that rising rates remain a challenging clinical and research problem. Hopelessness, a core characteristic of depression, appears to be the link between depression and suicidal behavior in high-risk patients. Previous research in this regard focused largely on hopelessness as a correlate of suicide, attempted suicide, serious suicidal intent, and as a predictor of eventual suicide among serious suicidal ideators in the absence of a recent suicide attempt. The present study was designed to investigate the relationship between hopelessness and low suicidal intent in a cohort of 337 hospitalized adult parasuicide patients referred to a general hospital psychiatric unit. Within 24-48 hours after admission, all patients, once alert, underwent an individual detailed clinical interview and one of three assessments, viz., they were rated on the Beck Hopelessness Scale, The Zung Self-Rating Depression Scale or, DSM III criteria for depression. Results support the positive relationship between hopelessness and suicidal behavior in low-intent patients, previously demonstrated in high-intent patients. The need to also address hopelessness in low-intent patients as part of an effective therapeutic intervention strategy is discussed.     

Suicidal Intent Among Young Suicides in Rural China

To understand psychometric characteristics of Beck Suicide Intent Scale (SIS) and different characteristics of suicides between high and low intent in Chinese culture. Data of 386 suicides and 416 living controls aged 15–34 years were used to analyze psychometric characteristics of SIS with 6 items. SIS with 6 items had high reliability and validity. Different characteristics were found between suicides with high intent and low intent. Hopelessness, depression, impulsivity, and approach coping skill were common factors of suicide with high and low intent. Education years, marriage, social support, and mental disorders were specific factors of suicide with low intent. High intent suicides had different characteristics from low intent suicides. SIS with 6 items is suitable for use in young rural China.     

Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness and pharmacotherapy predict suicidal intent?

The aims of the present study were to examine clinical, personality, and sociodemographic predictors of suicide risk in a sample of inpatients affected by major affective disorders. The participants were 74 inpatients affected by major depressive disorder or bipolar disorder-I. Patients completed a semi-structured interview, the Beck Hopelessness Scale, the Aggression Questionnaire, the Barratt Impulsiveness Scale, and the Hamilton scales for depression and anxiety. Over 52% of the patients were high suicide risks. Those at risk reported more severe depressive-anxious symptomatology, more impulsivity and more hostility. Impulsivity, the use of antidepressants, anxiety/somatization, and the use of mood stabilizers (a negative predictor) resulted in accurate predicting of suicide intent. Impulsivity and antidepressant use were the strongest predictors even after controlling for several sociodemographic and clinical variables.     

CSF 5-HIAA, suicide intent and hopelessness in the prediction of early suicide in male high-risk suicide attempters

OBJECTIVE: To study the predictive value of the Beck Suicide Intent Scale (SIS), the Beck Hopelessness Scale (BHS) and of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid for future early suicide in a group of high-risk male suicide attempters. METHOD: Fifteen consecutive male suicide attempters admitted to a psychiatric ward at the Karolinska Hospital, who were not receiving any treatment with antidepressants were diagnosed according to DSM-III, assessed with SIS and BHS and submitted to lumbar puncture. All patients were followed up for cause of death. RESULTS: Five early suicides (within 2 years) were identified. Mean cerebrospinal fluid (CSF) 5-HIAA differed between suicides and survivors. Low CSF 5-HIAA was identified in those who committed early suicide. Neither the Suicide Intent Score nor the Hopelessness Score distinguished suicides from survivors. CONCLUSION: In high suicide risk hospitalized male psychiatric patients CSF 5-HIAA may be a better predictor of early suicide after attempted suicide than SIS or BHS.     

Cognitive risk factors and suicide attempts among formerly hospitalized adolescents: a prospective naturalistic study

OBJECTIVE: To examine the relationship between cognitive variables and time until suicide attempts among 180 adolescents who were monitored for as much as 6.9 years after discharge from an inpatient psychiatry unit. METHOD: In a prospective naturalistic study, adolescents were assessed at the time of their psychiatric hospitalization and semiannually thereafter. Suicidal behavior at index hospitalization and over the follow-up period was assessed with semistructured psychiatric diagnostic interviews. At hospitalization, cognitive risk factors were assessed with a problem-solving task and with questionnaires assessing hopelessness, expectations for posthospitalization suicidal behavior, reasons for living, and dysfunctional attitudes. RESULTS: Expectations about future suicidal behavior were related to posthospitalization suicide attempts. Among youths with previous suicide attempts, higher levels of hopelessness were associated with increased risk, and greater survival and coping beliefs were associated with decreased risk for posthospitalization suicide attempts. Hopelessness and survival and coping beliefs were not related to posthospitalization attempts among adolescents without prior suicidal behavior, and hopelessness was not predictive after controlling for overall severity of depression. CONCLUSIONS: Expectations for suicidal behavior, hopelessness, and survival and coping beliefs provide important prognostic information about later suicidal behavior and should be targeted in interventions with suicidal youths.     

The Spanish Reasons for Living Inventory (SRFL-I): Factor Structure and Association with Suicide Risk Among Spanish Speaking Hispanics

The present study examined the factor structure of a Spanish-translated version of the Reasons for Living Inventory (SRFL-I; Oquendo, Baca-Garcia, Graver et al., 2000). Participants (N = 168) were from a combined sample of bilingual undergraduate students and monolingual Spanish speaking outpatients at a community health center. Factor analytic results yielded a seven factor structure: Survival Beliefs, Suicide Appraisal, Problem Solving Beliefs, Family Related Concerns, Suicide Self-Efficacy, Moral Objections, and Fear of Suicide. The SRFL-I subscales displayed high internal consistencies, as well as appropriate convergent and divergent associations with depression and suicide indicators. As expected, subscales (Problem Solving Beliefs, Moral Objections, Survival Beliefs, and Suicide Self-Efficacy) from the SRFL-I displayed direct and moderating effects on suicide risk indicators. Results are discussed with respect to how culturally specific beliefs among Hispanics are reflected using the SRFL-I.     

Assessment of psychiatrically hospitalized suicidal adolescents: self-report instruments as predictors of suicidal thoughts and behavior

OBJECTIVE: The validity and clinical utility of the Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Suicidal Ideation Questionnaire-Junior, and Suicide Probability Scale (SPS) were examined longitudinally among suicidal adolescents. METHOD: Between 1998 and 2000, 289 psychiatrically hospitalized, suicidal youth, ages 12 to 17 years, participated in this study. Self-report measures were completed at baseline. Clinician-rated suicidality and suicide attempt were collected at baseline and 6-month follow-up. RESULTS: Baseline self-reports were internally consistent and strongly intercorrelated within male, female, white, and black subsamples. All of the measures predicted follow-up suicidality and suicide attempts. Using published cutoff scores, the Beck Hopelessness Scale and SPS were moderately to highly sensitive predictors of subsequent suicide attempts, as was the Suicidal Ideation Questionnaire-Junior for predicting suicide attempts and broad suicidality. Alternative cutoff scores that predicted outcomes with moderate and high sensitivity also were examined, with attention to resultant sacrifices in specificity. CONCLUSIONS: Baseline self-report scores predicted follow-up suicidality. SPS contributed uniquely to prediction of future suicidality and suicide attempt. SPS may supplement other sources of information when assessing suicide risk with this population.     

Characteristics of 77 Puerto Ricans who attempted suicide

Seventy-seven patients of Puerto Rican origin who had attempted suicide and were admitted to the inpatient psychiatric unit of a general hospital were administered the Schedule for Affective Disorders and Schizophrenia (SADS), selected items of the Life Crisis Inventory, and the Beck Depression Inventory. Their scores on the SADS medical lethality and suicidal intent scales were in the minimal range, and their Beck inventory scores were in the mild range. Logistic regression analyses showed that alcohol and other substance abuse was a significant predictor of attempted suicide; place of birth (Puerto Rico versus the continental United States) was not.     

Hopelessness in patients presenting to their family physician

In order to reduce suicide rate in Hungary, it is essential to screen for and detect individuals with high suicide risk. For people with suicidal thoughts and intentions often visit their GP, our intention was to assess the potential suicide risk amongst patients going to the GP's. Based on a former study, we assumed the rate of depression to be about 30% amongst patients waiting at the GP's consulting room, and that there would be suicidal patients too. A randomised study of 158 patients together with 91 matched controls was conducted in GP's practices. Four different scales were applied: Beck Hopelessness Scale, Beck Depression Scale, Beck's Anxiety Scale and Paykel's Life Event Scale. Unfortunately, our results showed a more serious picture than expected: people visiting the GP were significantly more depressed, hopeless and anxious than controls, and one third of them proved to be at high suicide risk. CONCLUSION: GPs can play an important role in suicide prevention, and should do as well. Hopelessness Scale and Beck's Depression Scale are reliable test materials for local doctors.     

The relationship between CSF HVA/5-HIAA ratio and suicide intent in suicide attempters.

There is a need to find stable biomarkers for suicidal behavior and suicide prediction. Reduced homovanillic acid/5-hydroxyindolacetic acid (HVA/5-HIAA) ratios in cerebrospinal fluid (CSF) in depressed suicide attempters have been reported. Suicide intent is a predictor of repetition of attempts and suicide. In the present study we investigated the relationship of HVA/5-HIAA ratio to the scales rating suicide intent and depressive symptoms. Fifteen consecutive medication-free male suicide attempters admitted to a psychiatric ward at the Karolinska Hospital and eight healthy male volunteers underwent lumbar puncture and had the CSF monoamine metabolite levels assayed. Patients were assessed with the Beck Suicide Intent Scale (SIS), the Montgomery Asberg Depression rating Scale (MADRS) and the Chapman Scale of Anhedonia. Within the suicide attempter group, HVA/5-HIAA ratio was significantly associated with the Suicide Intent Scale (SIS), but not with the MADRS scale or the Chapman Scale of Anhedonia indicating that the HVA/5-HIAA ratio may be a biomarker of suicide intent.     

Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients

A prospective study of 1,958 outpatients found that hopelessness, as measured by the Beck Hopelessness Scale, was significantly related to eventual suicide. A scale cutoff score of 9 or above identified 16 (94.2%) of the 17 patients who eventually committed suicide, thus replicating a previous study with hospitalized patients. The high-risk group identified by this cutoff score was 11 times more likely to commit suicide than the rest of the outpatients. The Beck Hopelessness Scale thus may be used as a sensitive indicator of suicide potential.     

Protective factors against suicidal behavior in Latinos

Latinos appear to be relatively protected against suicidal behavior, but the factors that mediate this effect are not known. Some protective factors may be related to cultural constructs that provide a buffer against suicidal behavior in the face of psychiatric illness. We sought to determine whether the Reasons for Living Inventory (RFLI) might capture protective factors against suicidal behavior in Latinos and non-Latinos. Patients with major depression, bipolar disorder, or schizophrenia were interviewed regarding their depressive symptomatology and lifetime history of suicidal behavior. The RFLI, which measures protective factors against suicidal acts, was also administered. Multivariate analyses were used to assess the relationship between suicide measures, ethnicity, and selected clinical and demographic variables. Although Latinos and non-Latinos did not differ significantly in attempter status (attempter/nonattempter), number of attempts, or suicide intent, Latinos reported significantly less suicidal ideation and made less lethal attempts. On the RFLI, Latinos scored significantly higher on subscales regarding survival and coping beliefs, responsibility to family, and moral objections to suicide, possibly reflective of cultural norms endorsed by Latino groups. Multivariate analyses suggested that although being Latino was independently associated with less suicidal ideation, other suicidal behaviors held a stronger relationship to moral objections to suicide and survival and coping skills than to ethnicity. Self-identification as Latino may be associated with espousing cultural constructs that mediate protective effects against suicidal behavior. Constructs identified in the RFLI may protect Latinos from acting on suicidal thoughts, affecting moral objections to suicide and survival and coping beliefs. Further studies to elucidate the impact of these factors on suicidal behavior and their relationship to specific cultural constructs would be of interest.     

Comparison of the suicidal behavior of adolescent inpatients with borderline personality disorder and major depression

The objective of the study was to examine the hypothesis that some forms of suicidal behavior among adolescents are related to helplessness and depression, whereas others are related to anger and impulsivity. Sixty-five adolescents were studied. Thirty-three had borderline personality disorder (BPD), of whom 17 had made a recent suicide attempt. Thirty-two had major depressive disorder (MDD), of whom 16 had made a recent suicide attempt. Assessments were made with the Child Suicide Potential Scale, the Beck Depression Inventory, the Beck Hopelessness Scale, the Multidimensional Anger Inventory, the Overt Aggression Scale, the Impulsiveness-Control Scale, and the Suicide Intent Scale. Adolescents with BPD had more anger, aggression, and impulsiveness than those with MDD, but similar levels of depression and hopelessness. Suicidal versus nonsuicidal adolescents were more depressed, hopeless, and aggressive, but not more angry or impulsive. There were no significant differences in impulsiveness for the MDD suicidal group versus the MDD nonsuicidal group, but the suicidal BPD adolescents were significantly more impulsive than the nonsuicidal BPD adolescents. In the subjects with BPD, impulsiveness and aggression correlated significantly and positively with suicidal behavior. In the subjects with MDD, no such correlations were seen. In both diagnostic groups, depression and hopelessness correlated positively and significantly with suicidal behavior. Anger did not correlate with suicidal behavior in either of the groups. The suicidal subjects with MDD had significantly higher suicidal intent scores than the suicidal adolescents with BPD. We conclude that the nature of suicidal behavior in adolescents with BPD differs from that seen in MDD with respect to the role of anger and aggression.     

Interaction of affective and cognitive impairments in the suicidal state: a brief elaboration

This report examines the comorbidity among three key symptoms associated with suicidal intent, namely hopelessness, depression and unusual thinking. A total of 97 out-patients with suicidal thoughts were assessed using the Beck Hopelessness Scale, the anxious depression and unusual thinking factor scales of the Derogatis Symptom Checkhst-90, and the Beck Scale for Suicide Ideation. It was found that, in considering the interaction between key presenting symptoms, the combination of hopelessness and unusual thinking (which consisted of symptoms such as ‘trouble concentrating’ and ‘mind going blank’) was the strongest predictor of the seriousness of current suicidal inclinations.     

Suicidality in High-Risk Psychiatric Patients: The Contribution of Protective Factors

Objective: This study’s objective was determine the incremental association of reasons for living to the lifetime number of suicide attempts in relation to other known risk and protective factors in a sample of psychiatric patients with extensive psychopathology in residential treatment. Methods: Participants (n = 131) completed a demographic questionnaire that also asked for information about lifetime suicide history, psychiatric history, trauma, and abuse history. Additional measures of resilience, reasons for living (RFL), and impulsiveness were completed. Results: A history of sexual abuse was associated with an increasing lifetime number of suicide attempts, while a history of physical abuse and trait impulsiveness were not associated with the lifetime number of suicide attempts. Survival and coping beliefs, a subscale of the Reasons for Living Inventory (RFLI), was found to add incremental predictive validity to the number of lifetime suicide attempts. A composite fear variable, combining fear of suicide and fear of social consequences of suicide, was negatively correlated with lifetime number of attempts but did not add incremental validity to the prediction of lifetime number of suicide attempts. Conclusion: In a sample of participants with significant psychiatric impairment, the protective factor of survival and coping beliefs may be an important barrier to repeated suicide attempts and may be considered a suicide-specific resilience measure. Understanding the psychological processes contributing to the development of such protective factors as resilience, meaning in life, and coping resources is an important area of study and a potential avenue for targeted therapeutic intervention in high-risk populations.