Co-occurrence of diabetes and hopelessness predicts adverse prognosis following percutaneous coronary intervention

We examined the impact of co-occurring diabetes and hopelessness on 3-year prognosis in percutaneous coronary intervention patients. Consecutive patients (n = 534) treated with the paclitaxel-eluting stent completed a set of questionnaires at baseline and were followed up for 3-year adverse clinical events. The incidence of 3-year death/non-fatal myocardial infarction was 3.5% in patients with no risk factors (neither hopelessness nor diabetes), 8.2% in patients with diabetes, 11.2% in patients with high hopelessness, and 15.9% in patients with both factors (p = 0.001). Patients with hopelessness (HR: 3.28; 95% CI: 1.49–7.23) and co-occurring diabetes and hopelessness (HR: 4.89; 95% CI: 1.86–12.85) were at increased risk of 3-year adverse clinical events compared to patients with no risk factors, whereas patients with diabetes were at a clinically relevant but not statistically significant risk (HR: 2.40; 95% CI: 0.82–7.01). These results remained, adjusting for baseline characteristics and depressive symptoms. These findings testify to the importance of identifying patients with co-occurring risk factors, as they likely require special management in clinical practice in addition to standard medical treatment.     

Pathways to distress: The multiple determinants of depression,hopelessness, and the desire for hastened death in metastatic cancer patients

We tested a model in which psychosocial and disease-related variables act as multiple protective and risk factors for psychological distress in patients with metastatic cancer. We hypothesized that depression and hopelessness constitute common pathways of distress, which mediate the effects of psychosocial and disease-related factors on the desire for hastened death. This model was tested on a cross-sectional sample of 406 patients with metastatic gastrointestinal or lung cancer recruited at outpatient clinics of a Toronto cancer hospital, using structural equation modeling. The results supported the model. High disease burden, insecure attachment, low self-esteem, and younger age were risk factors for depression. Low spiritual well-being was a risk factor for hopelessness. Depression and hopelessness were found to be mutually reinforcing, but distinct constructs. Both depression and hopelessness independently predicted the desire for hastened death, and mediated the effects of psychosocial and disease-related variables on this outcome. The identified risk factors support a holistic approach to palliative care in patients with metastatic cancer, which attends to physical, psychological, and spiritual factors to prevent and treat distress in patients with advanced disease.     

Svenska Psykiatriska Föreningen: Svenska psykiatriska föreningens årsmote 26. oktober 1946

Vid Sct. Hans Hospital, afd. E, har clozapin varit föremål för undersökningar, såväl djurexperimentellt som kliniskt, sedan 1971. Erfarenheter från dessa studier sammanfattas av Jes Gerlach i bifogade artikel, som också ger en översikt över litteraturen.     

Specificity and sensitivity of the Beck Hopelessness Scale for suicidal ideation among adolescents entering early intervention service

Previous studies have shown an association between hopelessness and suicidal behaviour in clinical populations. The aim of the study was to investigate sensitivity, specificity, and predictive validity of the Beck Hopelessness Scale (BHS) for suicidal ideation in adolescents who show early risk signs on the psychiatric disorder continuum. Three-hundred and two help-seeking adolescents (mean age?=?15.5 years) who were entering an early intervention team at Helsinki University Central Hospital, Finland, completed questionnaires of BHS and suicidal ideation, derived from Beck Depression Inventory (BDI-II). Results suggest that a BHS cut-off score ≥8 (sensitivity?=?0.70, specificity?=?0.76) or cut-off score ≥9 (sensitivity?=?0.63, specificity?=?0.80) may be useful to detect suicidal ideation with BHS in help-seeking adolescents population. Results remain mainly the same in a separate analysis with adolescents at risk for psychosis. The results support previous cut-off points for BHS in identification of suicidal ideation. The results suggest also that lower cut-off scores may be useful in sense of sensitivity, especially in clinical settings.     

A Daily Life Comparison of Sociotropy-Autonomy and Hopelessness Theories of Depression

The hopelessness theory and Beck’s cognitive theory of depression were compared, controlling for other factors associated with mood change and stress reactivity. Using a high-risk design, 179 individuals were selected based on cognitive vulnerabilities and substance use frequency. Assessments of mood, daily events, and specific attributions were acquired using the Experience Sampling Method. Strong support was found for attributional style and sociotropy as indirect determinants of depressed mood, as well as for the notions of causal mediation and vulnerability specificity. Hopelessness theory explained a slightly larger portion of variance in depressed mood overall. The personality diatheses described by either theory were largely independent of each other and their mechanisms of action were not influenced by depression history or substance use.     

高校单亲大学生绝望感及其影响因素

目的:探究单亲大学生绝望感水平以及单亲大学生绝望感与生活事件、功能性失调态度的关系,针对于单亲大学生的心理干预提供依据。方法:采取分层随机整群抽样方法,在山东省12所高校内采用BECK绝望量表(BHS)、青少年生活事件量表、功能失调态度量表对991名普通大学生进行问卷调查,用SPSS 21.0对数据进行分析。结果:单亲大学生在对未来的期待因子上得分与非单亲大学生具有明显差异(t=2.21,P0.05);单亲男性大学生在青少年生活事件的寻求赞许(t=2.69,P0.05)和认知哲学(t=2.37,P0.05)因子上得分与单亲女性大学生有明显差异;生活事件和绝望感相关(r=0.60,P0.01),绝望感与功能性失调态度相关(r=0.56,P0.01);脆弱性、完美化、健康适应、吸引和排斥、认知哲学、丧失对单亲大学生绝望感有62%的预测作用。结论:加强对单亲大学生的关注,尤其是单亲男性大学生,要引导其改变认知和构建方式以减少其绝望,预防心理和行为问题。     

Adaptation of the Beck Hopelessness Scale as a suicide risk screening tool among Nigerian patients with schizophrenia

Objectives: We examined the adaptation of the Beck Hopelessness Scale (BHS) as a subjective suicide risk assessment tool in detecting Nigerian patients with schizophrenia who are at a high risk of suicide.

Methods: Schizophrenia patients (211) completed the BHS in addition to a sociodemographic questionnaire. They were objectively interviewed with the suicidality module of the Mini International Neuropsychiatric Interview (MINI) as the ‘gold standard’, against which the criterion validity of the BHS was examined.

Results: The receiver operating characteristics (ROC) curve of the 20-item BHS scale at a total cut-off score of 9 (sensitivity 0.889, specificity 0.916) against the patients’ MINI Suicidality Module risk categorisation had an Area Under the Curve (AUC) of 0.96 (95% CI: 0.928–0.987), while, the four-item BHS scale demonstrated a ROC curve with an AUC of 0.92 (95% CI: 0.868–0.966) at a cut-off score of 1 (sensitivity 1.000, specificity 0.832).

Conclusions: The BHS has proven to be valid in terms of its sensitivity and specificity in the identification of the high suicidal risk Nigerian schizophrenia outpatients.     

Effectiveness of Cognitive-Behavioral Therapy in Decreasing Suicidal Ideation and Hopelessness of the Adolescents with Previous Suicidal Attempts

Objective

To evaluate the effectiveness of a Cognitive-Behavioral therapy (CBT) for suicide prevention in decreasing suicidal ideation and hopelessness in a sample of depressed 12 to 18 year-old adolescents who had at least one previous suicidal attempt.

Methods

In a clinical trial, 30 depressed adolescents who attempted suicide in the recent 3 months were selected using simple sampling method and divided randomly into intervention and wait-list control groups. Both groups received psychiatric interventions as routine. The intervention group received a 12 session (once a week) of CBT program according to the package developed by Stanley et al, including psychoeducational interventions and individual and family skills training modules. All of the patients were evaluated by Scale for Suicidal Ideation, Beck''s hopelessness Inventory, and Beck''s Depression Inventory before the intervention and after 12 weeks.

Findings

There were significant differences between the two groups regarding the scores of the above mentioned scales after 12 weeks. Fifty-four to 77 percent decreases in the mean scores of the used scales were observed in the invention group. There were no significant changes in the scores of the control wait-list group. The differences between pre- and post-intervention scores in the intervention group were significant.

Conclusion

CBT is an effective method in reducing suicidal ideation and hopelessness in the depressed adolescents with previous suicidal attempts.     

The Impact of a Family-Based Economic Intervention on the Mental Health of HIV-Infected Adolescents in Uganda: Results From Suubi + Adherence

PurposeThis study examines the extent to which three mental health measures (hopelessness, depression, and poor self-concept) are improved through a family-based economic intervention implemented among adolescents living with HIV in Uganda.MethodsWe used repeated measures from Suubi + Adherence, a large-scale 6-year (2012–2018) longitudinal randomized controlled trial. Bivariate analyses were conducted to test for observable group differences between the intervention and control conditions. Multilevel piecewise repeated measure mixed models were then conducted to assess hypothesized time × intervention interaction in changes in hopelessness, depression, and self-concept using participant-specific follow-up intervals.ResultsAt 24-month postintervention initiation, adolescents in the intervention condition reported a statistically significant lower hopelessness score than adolescents in the control condition (4.79 vs. 5.56; p = .018; N = 358). At 36-month follow-up, the intervention condition reported a statistically significant lower score on depression in the depression subgroup (N = 344) than the control condition (4.94 vs. 5.81; p = .029).ConclusionsThe results indicate that family-based economic interventions such as Suubi + Adherence can effectively improve the mental health of adolescents living with HIV who evidenced mental health challenges at baseline. Given the promising positive effects of these interventions, at least in the short term, future studies should investigate strategies to promote the sustainability of these mental health benefits.