Suicidal Behavior,Depression, and Hopelessness in Child Psychiatric Inpatients: A Replication and Extension

Examination of 55 consecutively admitted 6-to 13-year-old psychiatric inpatients indicated that 58% reported suicidal ideation and 40% had attempted suicide. Suicidal ideation was significantly associated with self-reports of hopelessness. Suicide attempts were significantly associated with both hopelessness and a diagnosis of depressive disorder, particularly major depression. Hopelessness and depression were highly correlated, and associations between Suicide attempts, hopelessness, and depression were accounted for partly by a group of hopeless depressed children. Thirty-six percent of suicide attempters had made prior attempts. This group of repeat attempters were older and had the highest rate of depressive disorders (75%). Whereas older (11- to 13-year-old) children tended to contemplate and attempt the same method, younger children tended to think of one method and attempt another, usually less lethal, method.     

Suicidality after traumatic brain injury: demographic,injury and clinical correlates

BACKGROUND: In spite of the high frequency of emotional distress after traumatic brain injury (TBI), few investigations have examined the extreme of such distress, namely, suicidality, and no large scale surveys have been conducted. The current study examined both the prevalence and demographic, injury, and clinical correlates of hopelessness, suicidal ideation and suicide attempts after TBI. METHODS: Out-patients (N = 172) with TBI were screened for suicidal ideation and hopelessness using the Beck Scale for Suicide Ideation and the Beck Hopelessness Scale. Data were also collected on demographic, injury, pre-morbid and post-injury psychosocial variables and included known risk factors for suicide. RESULTS: A substantial proportion of participants had clinically significant levels of hopelessness (35%) and suicide ideation (23%), and 18% had made a suicide attempt post-injury. There was a high degree of co-morbidity between suicide attempts and emotional/psychiatric disturbance. Results from regression analyses indicated that a high level of hopelessness was the most significant association of suicide ideation and a high level of suicide ideation, along with occurrence of post-injury emotional/psychiatric disturbance, were the most significant associations of post-injury suicide attempts. Neither injury severity nor the presence of pre-morbid suicide risk factors contributed to elevated levels of suicidality post-injury. CONCLUSIONS: Suicidality is a common psychological reaction to TBI among out-patient populations. Management should involve careful history taking of previous post-injury suicidal behaviour, assessment of post-injury adjustment to TBI with particular focus on the degree of emotional/psychiatric disturbance, and close monitoring of those individuals with high levels of hopelessness and suicide ideation.     

Problem-solving in suicide attempters

BACKGROUND: Recent research studies on the psychological processes underlying suicidal behaviour have highlighted deficits in social problem-solving ability, and suggest that suicide attempters may, in addition, be passive problem-solvers. The aim of this study was to examine problem-solving in suicide attempters (including passivity) and to see whether the deficits are mood-dependent. METHOD: Two groups, a suicide attempter group and a non-suicidal psychiatric control group completed measures of depression, hopelessness, suicidal ideation and social problem-solving ability shortly after admission, and again 6 weeks later. In addition, a non-psychiatric control group provided baseline data at a single time point. RESULTS: The suicide attempter group displayed poorer problem-solving ability than matched psychiatric controls and this difference persisted despite change in mood. However, although suicidal patients were more passive in their problem-solving style than non-psychiatric controls, they were not significantly more passive than psychiatric controls. Problem-solving did not change with improving mood. CONCLUSIONS: Although passivity is not unique to suicidal patients, in combination with the smaller number and less effective alternatives generated, it may increase vulnerability.     

Double depression in older adult psychiatric outpatients: hopelessness as a defining feature

BACKGROUND: There is a paucity of research on the distinguishing features of double depression, particularly in older adults. Preliminary studies have revealed that individuals with double depression diagnoses tend to have more severe depression than individuals with major depression or dysthymia alone, but few other distinctions between the diagnostic categories have been found. METHOD: We examined the possibility that hopelessness particularly characterizes double depression, by comparing older adults with double depression, dysthymia alone, or major depression alone, on hopelessness, as well as on internal and external locus of control. The sample included 54 older psychiatric outpatients who completed a battery of cognitive and symptom measures, and underwent structured clinical interviews. RESULTS: Double depressed patients showed high levels of hopelessness, whereas patients with either major depression or dysthymia alone showed more moderate levels of hopelessness. Low internal locus of control characterized both groups with a dysthymia diagnosis (dysthymia alone and double depression), and differentiated them from the group with major depression alone. LIMITATIONS: The sample size was modest, and the results may not generalize to older adults with different demographic characteristics. CONCLUSIONS: Hopelessness may be important in understanding the phenomenology of double depression in older adults, and may inform diagnostics and psychotherapeutics as well.     

Personality and reports of suicide ideation among depressed adults 50 years of age or older

BACKGROUND: Accuracy in patient reports of suicide ideation is a concern in clinical assessment, given that some patients deny suicide ideation even when suicidal. Despite this concern, there is little research on the psychological processes driving reported suicide ideation in at-risk patients. METHODS: A cross-sectional design was used to examine the association of personality and suicide ideation in a clinical sample of 134 depressed adults 50 years and older. Patients completed a structured diagnostic interview, an interviewer-rated measure of current suicide ideation and self-report measures of personality (NEO-Personality Inventory Revised; NEO-PI-R) and hopelessness. The main outcome variable in logistic regression analyses was suicide ideator status; covariates included comorbid psychopathology, hopelessness and physical illness burden. Predictors were Neuroticism and Openness to Experience (OTE) scores on the NEO-PI-R. RESULTS: Elevated OTE and neuroticism were associated with suicide ideation in unadjusted analyses; OTE was also associated with suicide ideation in adjusted regression analyses. LIMITATIONS: This study used a cross-sectional methodology with depressed patients 50 years or older; it is possible that patients' depression severity may have influenced their responses to personality measures. Prospective studies of personality vulnerability to future suicide ideation are warranted. CONCLUSIONS: Elevated neuroticism increases the likelihood of reporting suicide ideation, just as it may enhance risk for suicidal behavior and death by suicide. The pattern for openness is markedly different. Although elevated openness increases the likelihood of reporting suicide ideation, previous research has shown that it may decrease risk of death by suicide, suggesting that the personality-mediated expression of suicide ideation may be adaptive in certain contexts. In contrast, low levels of openness may mute reports of suicide ideation in at-risk patients and confer risk for poor outcomes by potentially undermining clinician vigilance.     

Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness

A 9-point clinical rating scale was used to assess the severity of hopelessness in 141 patients hospitalized with suicidal ideation. The patients were followed from 5 to 10 years, and 10 (7.1%) eventually committed suicide. The mean hopelessness rating for the patients committing suicide was significantly higher than that for the patients not committing suicide. A cutoff score of 6 or above successfully predicted 9 (90.0%) of those committing suicide. The results supported previous findings in which self-reported hopelessness on the Beck Hopelessness Scale was reported to predict suicide in both psychiatric outpatients and inpatients.     

The Inventory of Suicide Orientation-30: further validation with adolescent psychiatric inpatients

The present study examined the construct validity of the Inventory of Suicide Orientation-30 (ISO-30; King & Kowalchuk, 1994) with a sample of adolescent psychiatric inpatients. The ISO-30 is designed to assess five dimensions of risk factors related to suicide: hopelessness, suicide ideation, low self-esteem, inability to cope with emotions, and social isolation and withdrawal. Participants included 202 psychiatric hospitalized (106 boys, 96 girls) adolescents, ages 14 to 17 years. Confirmatory factor analyses provided support for the fit of the original five-factor oblique model. Reliability estimates of the study measures were adequate. Evidence of discriminant, convergent, and incremental validity estimates of the ISO-30 were strong. Contributions and limitations of the present findings are discussed.     

A comparison of specific positive future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers

BACKGROUND: Hopelessness and the lack of positive future expectancies have been related to suicidality. This is the first study to compare the power of positive future expectancies and global hopelessness in the prediction of suicidal ideation. In short, are specific positive expectancies or global hopelessness attitudes more closely related to suicidality? METHOD: One hundred and forty four adults hospitalized following a suicidal self-harm episode completed a range of clinical and psychological measures in hospital and were followed up approximately 2.5 months after discharge. All participants reported at least one other self-harm episode in addition to the index episode. RESULTS: Hierarchical regression analyses confirmed that specific positive future expectancies were better predictors of Time 2 suicidal ideation than global hopelessness. In addition, as hypothesized, negative future thinking was not independently associated with suicidal ideation. LIMITATIONS: Short-term follow-up. CONCLUSIONS: Specific, idiographic expectancies for positive events (i.e., positive future thinking) are more important predictors of suicidal ideation than global attitudes of hopelessness. Unlike global hopelessness, they provide more options for intervention (e.g., identifying life goals and plans). These findings are particularly noteworthy given the widespread use of measures of global hopelessness. The theoretical and clinical implications are discussed.     

Beck自杀意念量表中文版评价抑郁症患者的信、效度

目的探讨Beck自杀意念量表中文版(Beck Scale for Suicide Ideation-Chinese Version,BSI-CV)在抑郁症患者自杀意念评价中的信、效度。方法采用BSI-CV和自杀意念自评量表(SIOSS)对334名抑郁患者进行问卷调查。用SPSS软件和LISREL8.7进行信度、效度分析。结果①BSI-CV用于评价抑郁症患者"近1周"和"最消沉忧郁"时自杀意念的内部一致性信度分别为0.944/0.957,分半信度分别为0.926/0.896;②模型拟合分析显示,各条目因子载荷均在0.5以上,模型拟合优度指标提示模型拟合较好;③BSI-CV评分与SIOSS评分呈相关关系(P<0.01)。结论 Beck自杀意念量表中文版在抑郁症患者人群中具有良好的信、效度。     

Suicidal behaviour during different phases of bipolar disorder

BACKGROUND: There are no previous studies comparing the prevalence and risk factors for suicidal behaviour during different phases of bipolar disorder. METHODS: In the Jorvi Bipolar Study (JoBS), 1630 psychiatric in- and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire. Using SCID I and II interviews, 191 patients were diagnosed with bipolar disorders (90 bipolar I, 101 bipolar II). Suicidal ideation was measured using the Scale for Suicidal Ideation (SSI). Prevalence and risk factors for ideation and attempts during different phases (depressive, mixed, depressive mixed and hypomanic/manic phases) were investigated. RESULTS: There were marked differences between phases regarding suicide attempts and level of suicidal ideation. Hopelessness predicted suicidal behaviour during the depressive phase, whereas a subjective rating of severity of depression and younger age predicted suicide attempts during mixed phases. LIMITATIONS: The relatively small sample size in some phases. CONCLUSIONS: Suicidal behaviour varied markedly between different phases of BD. Suicide attempts and suicidal ideation were related to phases which are associated with depressive aspects of the illness. Hopelessness and severity of depression were key indicators of risk in all phases.     

The reasons for living inventory and a college population: adolescent suicidal behaviors, beliefs, and coping skills

The suicidal behavior of a college population (N = 205) was assessed. Individuals were categorized into four groups: never suicidal, brief suicidal ideation, serious suicidal ideation, and parasuicidal. They also answered questions about why they would not choose suicide, on the Reasons For Living (RFL) Inventory. Depression, hopelessness, and social desirability scales also were presented. A significant difference existed between suicidal and nonsuicidal individuals on the RFL. Hopelessness and depression were found to be correlated significantly with suicidal behavior; social desirability was found to be high among those who were not suicidal and declined as suicidal behaviors became more severe.     

The spectrum of suicidal ideation in Great Britain: comparisons across a 16-74 years age range

BACKGROUND: Previous studies have examined suicidal ideation in older populations and emphasized the strong association with the presence of psychiatric disorder. However, associations with the presence of psychiatric disorder across the age range are unclear. Representative epidemiological estimates are needed. METHOD: In a national survey of psychiatric morbidity in Great Britain, 8580 randomly selected adults were interviewed. Three questions were asked to assess suicidal ideation, and psychiatric disorder was identified using the revised Clinical Interview Schedule (CIS-R). RESULTS: Suicidal ideation was up to three times commoner in younger adults than in those aged 55-74 years but the odds of depression in those with suicidal thoughts was significantly greater in the older age group (p<0.01). Tiredness with life (p<0.01) and thoughts of death (p<0.01) were also more strongly associated with depression in the older age group. Other major associations of suicidal ideation for all ages were: smaller social support group, being divorced or separated, poor self-rated general health, and limitations in activities of daily living (ADL). Being single was an important factor for younger age groups, and widowhood for older people. Life events were also important in younger people, but not in those aged 55-74 years. CONCLUSIONS: Suicidal thoughts and death wishes are comparatively more unusual in older people; however, they are more likely to be associated with clinical depression. In terms of suicide prevention this study emphasizes the importance of improving rates of recognition and treatment of depression in older people.     

Risk factors for suicide in psychiatric outpatients: a 20-year prospective study

To determine the risk factors for suicide, 6,891 psychiatric outpatients were evaluated in a prospective study. Subsequent deaths for the sample were identified through the National Death Index. Forty-nine (1%) suicides were determined from death certificates obtained from state vital statistics offices. Specific psychological variables that could be modified by clinical intervention were measured using standardized scales. Univariate survival analyses revealed that the severity of depression, hopelessness, and suicide ideation were significant risk factors for eventual suicide. A multivariate survival analysis indicated that several modifiable variables were significant and unique risk factors for suicide, including suicide ideation, major depressive disorder, bipolar disorder, and unemployment status.     

Hopelessness at the end of life: The utility of the hopelessness scale with terminally ill cancer patients

Objectives. We sought to investigate the utility of the Beck Hopelessness Scale (HS) in a sample of terminally ill cancer patients by examining the scale properties. Moreover, we sought to identify and remove potentially problematic items in order to ascertain a “purer” index of hopelessness for this population. Design. A cross‐sectional study of 200 hospice inpatients with a life expectancy of less than 6 months. The HS, as well as several other distress measures, were administered to patients at bedside by trained clinicians. Methods. An item analysis of the HS was conducted, looking specifically at item endorsement and item‐total correlations. Three abbreviated versions (3‐item 7‐item, 13‐item) were developed based on certain denoted item‐total correlation cut‐offs. Reliability and validity of the original 20‐item HS was then compared to that of the newly developed abbreviated version. Results. All scales were found to be reliable and valid measures of hopelessness. The three abbreviated versions were more highly correlated with the distress measures than the original version, and the 7‐item and 13‐item subscales outperformed the original HS in the prediction of suicidal ideation and desire for hastened death. Conclusion. The data suggest that the HS may be improved, when applied to a terminally ill sample, by the elimination of problematic items. The development of a shorter, purer measure of hopelessness for this population is crucial given the need to reduce the burden placed on those who participate in end‐of‐life studies, and the important role of hopelessness in the prediction of suicide and desire for hastened death.     

医学生的绝望感与自杀意念:心理韧性的作用机制

目的:探讨医学生的绝望感与心理韧性和自杀意念的关系,以及心理韧性在医学生的绝望感与自杀意念之间是否具有补偿、调节及中介效应。方法:采用贝克绝望量表(BHS)、自杀意念自评量表(SIOSS)和青少年心理韧性量表(RSCA)对1120名医学生进行施测。结果:绝望感各因子及总分与自杀意念呈显著正相关(r=0.443,0.472,0.493,0.608;P0.01),心理韧性总分与绝望感总分及各因子呈显著负相关(r=-0.555,-0.300,-0.500,-0.470;P0.01),心理韧性总分与自杀意念总分呈显著负相关(r=-0.528,P0.01)。医学生的心理韧性在其绝望感与自杀意念之间同时具有补偿(β=-0.275,-0.247,-0.199;P0.001)、中介(β=0.455,0.481,0.515;P0.001)和调节效应(B=-1.096,-1.013,-1.105;P0.001)。结论:心理韧性是抑制医学生自杀意念的重要保护因素,它可以补偿、缓冲和调节绝望感对自杀意念的促进作用,同时这一保护因素也会受到绝望感的削弱。     

Socio-economic and psychological correlates of suicidality among Hong Kong working-age adults: results from a population-based survey

BACKGROUND: The global toll of suicide is estimated to be one million lives per year, which exceeded the number of deaths by homicide and war combined. A key step to suicide prevention is to prevent less serious suicidal behaviour to preclude more lethal outcomes. Although 61% of the world's suicides take place in Asia and the suicide rates among middle age groups have been increasing since the economic crisis in many Asian countries, population-based studies of suicidal behaviour among working-age adults in non-western communities are scarce. METHOD: Data from a population-based survey with 2015 participants were used to estimate the prevalence of suicidal ideation and behaviour among the working-age population in Hong Kong, and to study the associated socio-economic and psychological correlates. We focused particularly on potential modulating factors between life-event-related factors and suicidal ideation. RESULTS: Six per cent of the Hong Kong population aged 20-59 years considered suicide in the past year, while 1.4% attempted suicide. Hopelessness, reasons for living, and reluctance to seek help from family and friends had direct association with past-year suicidal ideation. Reasons for living were found to moderate the effect of perceived stress on suicidal ideation. CONCLUSIONS: Suicidality is a multi-faceted problem that calls for a multi-sectored, multi-layered approach to prevention. Prevention programmes can work on modulating factors such as reasons for living to reduce suicidal risk in working-age adults.     

Coping, meaning in life, and suicidal manifestations: examining gender differences.

Life meaning and coping strategies were investigated as statistical predictors of suicidal manifestations in a sample of 298 university undergraduates. Participants completed measures of hopelessness, sense of coherence, purpose in life, coping for stressful situations, suicide ideation, prior suicide attempts, and self-reported likelihood of future suicidal behavior. Moderated multiple regression techniques examined the incremental validity of life meaning by coping interactions for predicting each suicide variable separately by gender. The interaction of sense of coherence and emotion-oriented coping made a unique, significant contribution to the statistical prediction of all suicide variables for women. For men, the interaction between sense of coherence and emotion-oriented coping contributed significantly to the statistical prediction of suicide ideation. All interactions remained significant when hopelessness was statistically controlled. The hypothesis that life meaning acts as a buffer between coping style and suicidal manifestations was partially supported. Implications for suicide prevention and intervention are discussed.     

Correlates of self‐harm behaviour in acutely ill patients with schizophrenia

Objective. This study compared acutely ill patients with schizophrenia with a history of self‐harm (N=17) to those without a history of self‐harm (N=16) on measures of depression, hopelessness, suicidal ideation, and demographic and psychiatric variables. A subgroup of these patients who experience auditory hallucinations, with and without a history of self‐harm, were selected and compared on measures of depression, hopelessness, suicidal ideation and beliefs about voices. Design. Employing a cross‐sectional design, in‐patients of two local psychiatric hospital, who met DSM‐IV‐TR criteria for schizophrenia and who were in an acute phase of the illness, were selected. Method. Each patient was assessed using the Beck Depressions Inventory (BDI), Beck Hopelessness Scale (BHS) and the Beck Suicide Scale (BSS). Patients who experienced auditory verbal hallucinations completed the Beliefs About Voices Questionnaire Revised (BAVQ‐R). Patients with a history of self‐harm completed the Beck Suicide Intent Scale (BSI). Results. Patients with a history of self‐harm (N=17) had significantly greater symptoms of depression, greater suicidal thoughts, increased number of hospital admissions, greater duration of illness and were more likely to be married, compared to patients without a history of self‐harm (N=16). Among the subgroup of patients who experience auditory hallucinations, those with a history of self‐harm (N=9), believed their voice to be more malevolent, had a tendency to resist their voice and experienced significantly greater symptoms of depression and hopelessness compared to those without a history of self‐harm (N=6). Conclusions. These findings highlight the importance for screening by clinicians during inpatient hospital stays and for monitoring to be ongoing following discharge. For the subgroup of patients who experience auditory hallucinations, future research should seek to explore the relationship between self‐harm and beliefs about voices.     

Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization

Remarkably little is known regarding the temporal course of adolescent suicidal ideation and behavior, the prediction of suicidal attempts from changes in suicidal ideation, or the prediction of suicidal attempts after accounting for suicidal ideation as a predictor. A sample of 143 adolescents 12-15 years old was assessed during psychiatric inpatient hospitalization and again at 3, 6, 9, 15, and 18 months postdischarge through a series of structured interviews and parent- and adolescent-reported instruments. Symptoms of depression, posttraumatic stress disorder, externalizing psychopathology, hopelessness, and engagement in several forms of self-injurious/suicidal behaviors (i.e., suicide threats/gestures, plans, nonsuicidal self-injury [NSSI]) were assessed. Latent growth curve analyses revealed a period of suicidal ideation remission between baseline and 6 months following discharge, as well as a subtle period of suicidal ideation reemergence between 9 and 18 months postdischarge. Changes in suicidal ideation predicted suicide attempts. After accounting for the effects of suicidal ideation, baseline suicide threats/gestures also predicted future suicide attempts. Higher adolescent-reported depressive symptoms, lower parent-reported externalizing symptoms, and higher frequencies of NSSI predicted weaker suicidal ideation remission slopes. Findings underscore the need for more longitudinal research on the course of adolescent suicidality.     

Coping,meaning in life,and suicidal manifestations: Examining gender differences*

Life meaning and coping strategies were investigated as statistical predictors of suicidal manifestations in a sample of 298 university undergraduates. Participants completed measures of hopelessness, sense of coherence, purpose in life, coping for stressful situations, suicide ideation, prior suicide attempts, and self‐reported likelihood of future suicidal behavior. Moderated multiple regression techniques examined the incremental validity of life meaning by coping interactions for predicting each suicide variable separately by gender. The interaction of sense of coherence and emotion‐oriented coping made a unique, significant contribution to the statistical prediction of all suicide variables for women. For men, the interaction between sense of coherence and emotion‐oriented coping contributed significantly to the statistical prediction of suicide ideation. All interactions remained significant when hopelessness was statistically controlled. The hypothesis that life meaning acts as a buffer between coping style and suicidal manifestations was partially supported. Implications for suicide prevention and intervention are discussed. © 2003 Wiley Periodicals, Inc. J Clin Psychol, 2003.