Hopelessness as a Predictor of Suicide Ideation in Depressed Male and Female Adolescent Youth

We examined hopelessness as a predictor of suicide ideation in depressed youth after acute medication treatment. A total of 158 depressed adolescents were administered the Children's Depression Rating Scale‐Revised (CDRS‐R) and Columbia Suicide Severity Rating Scale (C‐SSRS) as part of a larger battery at baseline and at weekly visits across 6 weeks of acute fluoxetine treatment. The Beck Hopelessness Scale (BHS) was administered at baseline and week 6. A negative binomial regression model via a generalized estimating equation analysis of repeated measures was used to estimate suicide ideation over the 6 weeks of acute treatment from baseline measure of hopelessness. Depression severity and gender were included as covariates in the model. The negative binomial analysis was also conducted separately for the sample of males and females (in a gender‐stratified analysis). Mean CDRS‐R total scores were 60.30 ± 8.93 at baseline and 34.65 ± 10.41 at week 6. Mean baseline and week 6 BHS scores were 9.57 ± 5.51 and 5.59 ± 5.38, respectively. Per the C‐SSRS, 43.04% and 83.54% reported having no suicide ideation at baseline and at week 6, respectively. The analyses revealed that baseline hopelessness was positively related to suicide ideation over treatment (p = .0027), independent of changes in depression severity. This significant finding persisted only for females (p = .0024). These results indicate the importance of early identification of hopelessness.     

Trajectories of Suicide Ideation,Nonsuicidal Self‐Injury,and Suicide Attempts in a Nonclinical Sample of Military Personnel and Veterans

Nonsuicidal self‐injury (NSSI) is a risk factor for suicide attempts, but little is known about NSSI among military personnel and veterans, or about the temporal sequencing of NSSI relative to suicide ideation and attempts. This study evaluates trajectories of suicide ideation, NSSI, and suicide attempts in a sample of 422 military personnel and veterans. Of those with a history of NSSI, 77% also experienced suicide ideation. Suicide ideation emerged before NSSI (67%) more often than the reverse (17%). Of those with a history of suicide attempt, 41% also engaged in NSSI. NSSI emerged prior to the first suicide attempt (91%) more often than the reverse (9%). The length of time from suicide ideation to suicide attempt was longer for those who first engaged in NSSI (median = 3.5 years) compared with those who did not engage in NSSI (median = 0.0 years), Wald χ²(1) = 11.985, p = .002. Age of onset was earlier for participants reporting NSSI only compared with those reporting both NSSI and suicide attempts (16.71 vs. 22.08 years), F(1, 45) = 4.149, p = .048. NSSI may serve as a “stepping stone” from suicide ideation to attempts for 41% of those who attempt suicide.     

Hopelessness Predicts Suicide Ideation But Not Attempts: A 10‐Year Longitudinal Study

Hopelessness is one of the most commonly cited risk factors for suicidal behaviors. However, several retrospective studies suggest that hopelessness, while strongly correlated with suicide ideation, does not distinguish attempters from ideators without attempts. This study is the first to utilize a prospective design to disambiguate the relationship of hopelessness to ideation versus attempts. Participants were 142 depressed patients followed up over 10 years. Hopelessness and suicidality (ideation and attempts) were assessed using validated questionnaires and structured interviews. Both retrospective and prospective analyses revealed that hopelessness was higher among those reporting any suicidality (ideation or attempts) compared with nonsuicidal individuals. However, hopelessness failed to meaningfully distinguish attempters from ideators in both retrospective and prospective analyses. Taken together with results from previous studies, our findings suggest hopelessness is best conceptualized as a risk factor for suicide ideation but not progression from ideation to attempts.     

A Five‐Month Longitudinal Study of Psychache and Suicide Ideation: Replication in General and High‐Risk University Students

Shneidman's (1993) model of psychache as the cause of suicide was evaluated in a 5‐month longitudinal study of psychological pain and suicide ideation. Replicating across general (N = 683) and high‐risk undergraduates (N = 262), psychache was significantly associated with suicide ideation, and change in psychache was significantly associated with change in suicide ideation. For general suicide ideation and suicide preparation, these significant results were maintained even when depression and hopelessness were statistically controlled. This research is a unique contribution being the first large‐sample longitudinal study that evaluates and supports Shneidman's psychache causal model of suicidality in general and high‐risk groups.     

The Interpersonal Theory of Suicide Applied to Male Prisoners

The interpersonal theory of suicide proposes that severe suicide ideation is caused by the combination of thwarted belongingness (TB) and perceived burdensomeness (PB), yet few studies have actually examined their interaction. Further, no studies have examined this proposal in male prisoners, a particularly at‐risk group. To address this gap, the current study surveyed 399 male prisoners. TB and PB interacted to predict suicide ideation while controlling for depression and hopelessness. High levels of both TB and PB were associated with more severe suicide ideation. The interpersonal theory may aid in the detection, prevention, and treatment of suicide risk in prisoners.     

Multidimensional Future Time Perspective as Moderators of the Relationships between Suicide Motivation,Preparation, and Its Predictors

The moderating impact of future time perspective (FTP) components on the relationships of hopelessness, depressive symptoms, and psychache with suicide motivation and preparation was investigated. In a sample of first year college students (N = 87) recruited on the basis of elevated suicide ideation and depressive symptoms, future thinking, optimism, and future connectedness attenuated the relationship of suicide motivation with depressive symptoms and hopelessness. Future thinking moderated the impact of depressive symptoms on suicide preparation. No moderating effects were found for psychache. This study demonstrates that FTP may buffer against the worst effects of salient suicide predictors among high‐risk students.     

Testing a model of suicide ideation in college students

This study examined several risk factors-negative life events (NLE), hopelessness, and depressive symptoms-believed to commonly precipitate suicide ideation in college students. A total of 345 undergraduates participated in the study. Students completed four self-report questionnaires. Hierarchical regression analyses were used to construct a risk model of suicide ideation. This study confirmed depressive symptoms and hopelessness as predictors of suicide ideation in college students; however, NLE impacted suicidal thoughts through hopelessness and depressive symptoms. Interestingly, depressive symptoms exerted a stronger influence on suicide ideation than hopelessness. Hopelessness served as a partial mediator in the relationship between NLE and depressive symptoms; however, depressive symptoms fully mediated the relationship between NLE and hopelessness. Clinical implications for understanding suicide risk in college students are discussed.     

An Empirical Test of the Three‐Step Theory of Suicide in U.K. University Students

The purpose of this study was to further our understanding of how individuals move down the pathway from first thinking about suicide to ultimately attempting to take their own lives by empirically testing the Three‐Step Theory (3ST) in a sample of university students (n = 665). Results largely support the theory's central propositions. First, an interactive model of pain and hopelessness accounted for substantial variance in suicidal desire. This result replicated in both men and women, and across age groups (i.e., below 35 and at or above 35). Also, as predicted, connectedness was protective against ideation in those high on both pain and hopelessness. However, contrary to our prediction, connectedness was similarly protective among everyone else. Finally, suicide capacity predicted suicide attempt history over and above current and lifetime suicide ideation. These findings provide further support to the 3ST.     

Testing the Four Main Predictions of the Interpersonal–Psychological Theory of Suicidal Behavior in an Inpatient Sample Admitted Due to Severe Suicidality

This study aimed to evaluate four main predictions of the Interpersonal Psychological Theory of Suicide (IPTS): the importance of perceived burdensomeness (PB), thwarted belongingness (TB), hopelessness (H), and capability for suicide (CS) for (passive/active) suicide ideation, suicide intent and suicide attempts. N = 308 psychiatric inpatients admitted due to severe suicidality (53.6% female: n = 165; age: M = 36.82, SD = 14.30, range: 18–81) completed self-report measures of TB, PB, H, CS and suicide ideation as well as interviews on suicide intent and suicide attempts. TB and PB were associated with (passive/active) suicidal ideation, whereas the three-way interaction PB, TB, and H was not associated with active suicide ideation. Fearlessness about death in conjunction with active suicidal ideation was not associated with suicide intent and the interaction of PB, TB, and CS was neither predictive of recent suicide attempt status nor lifetime number of suicide attempts. Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. The results challenge the theoretical validity of the IPTS and its clinical utility—at least within the methodological limitations of the current study. Yet, findings underscore the importance of PB in understanding suicidality.     

Mediators of the Daily Hassles–Suicidal Ideation Link in African American Women

Depressive symptoms and hopelessness as mediators of the daily hassles–suicidal ideation link in low‐income African American women exposed to intimate partner violence (n = 100) were investigated. As hypothesized, daily hassles, depressive symptoms, and hopelessness were each significantly and positively associated with suicidal ideation. Moreover, the relation between daily hassles and suicidal ideation was, in part, accounted for by depressive symptoms and hopelessness. This study demonstrates the importance of assessing for the presence of these risk factors when determining the likelihood that an abused African American woman will consider suicide. The findings further highlight the value of designing and implementing interventions that target the reduction in depressive symptoms and hopelessness in abused African American women exposed to daily hassles to reduce their suicide risk.     

Religion,Sexual Orientation,and Suicide Attempts Among a Sample of Suicidal Adolescents

Despite condemnation of same‐sex attraction by certain religious groups, few studies have explored the relationship between religion, same‐sex attraction, and suicidality. This study examined the moderating effect of same‐sex attraction on the relationship between parent/adolescent religiosity and suicide ideation/attempts in a suicidal adolescent sample (N  = 129). Linear and negative binomial regressions tested the effects of a two‐way dichotomous (same‐sex attraction, yes/no) by continuous (religiosity) interaction on ideation and attempts, respectively. The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same‐sex attraction but fewer attempts in those reporting opposite‐sex attraction only.     

Body image and suicidal ideation in adolescents

Data from 231 adolescents (mean age = 15.7, SD = 1.39) were collected from a public school setting in the United States. Participants completed several measures, including those assessing depression, hopelessness, past suicidal behavior, body image, and current suicidal ideation. It was hypothesized that depression, hopelessness, past suicidal behavior, and body image (a risk factor seldom examined) would significantly predict current suicidal ideation and that there would be gender differences for body image. Regression analyses indicated that all risk factors including body image were significant predictors of current suicidal ideation for the whole sample. For both males and females, body image offered a unique contribution to the measurement of suicide ideation above and beyond the other risk factors, with body attitudes/feelings being the strongest predictor. Results encourage the inclusion of body image as a variable in risk models for adolescent suicidal ideation, as it likely accounts for additional variance above and beyond traditional risk factors.     

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression,Suicidal Ideation,and Suicidal Behavior in High‐Risk Adolescents

The relationship between hopelessness and depression in predicting suicide‐related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2‐ to 4‐year period. In multivariate regressions controlling for depression, suicidal ideation, and negative‐expectation hopelessness, positive‐expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.     

Belongingness and Burdensomeness in Adolescents: Slovene Translation and Validation of the Interpersonal Needs Questionnaire

The Interpersonal Needs Questionnaire (INQ) for assessing thwarted belongingness (TB) and perceived burdensomeness (PB) has not been validated with community adolescents. We translated and administered the INQ to 307 Slovenian adolescents twice over 2–3 months and found that the 15‐item version (INQ‐15) did not fit without modification. TB and PB scales correlated with concurrent and later suicide ideation and lifetime suicide attempt history. The latent PB factor was associated with concurrent and later ideation controlling for TB, age, gender, depressive symptoms, binge drinking, and peer victimization. Suicide ideation and binge drinking were independently related to attempt history. Assessing and intervening on PB and binge drinking may be promising approaches to suicide prevention with community adolescents.     

Perfectionism and Suicide Ideation in Adolescent Psychiatric Patients

This study was conducted to examine the relations between dimensions of perfectionism and suicide ideation in an adolescent psychiatric sample. A sample of 66 adolescents from an inpatient psychiatric facility completed the Child and Adolescent Perfectionism Scale, the Child's Hopelessness Scale, and the Suicide Ideation Questionnaire. Overall, the results indicated that socially prescribed perfectionism was associated with greater suicide ideation and that it, along with hopelessness, accounted for unique variance in suicide ideation scores. The findings are discussed in terms of their practical and theoretical significance as well as their consistency with similar research with adults.     

A Prospective Examination of the Interpersonal‐Psychological Theory of Suicidal Behavior Among Psychiatric Adolescent Inpatients

The challenge of identifying suicide risk in adolescents, and particularly among high‐risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal‐Psychological Theory of Suicidal Behavior (IPTS)—with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self‐injury—predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three‐way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2‐way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12‐month attempts. Results suggest gender‐specific associations between theory components and attempts. The time‐limited effects of these associations point to TB and PB being dynamic and modifiable in high‐risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively.     

Perceived Burdensomeness Predicts Outcomes of Short‐Term Psychological Treatment of Young People at Risk of Suicide

The interpersonal‐psychological theory of suicide (IPTS; Joiner, 2005 ) provides a model for understanding the mechanisms underlying suicide risk, but there is limited research measuring change in the constructs over the course of treatment. This study aimed to test whether changes in perceived burdensomeness (PB) and thwarted belongingness (TB) mediated the effects of changes in depression and hopelessness on suicide risk. The sample comprised 226 Australian young people (aged 12–24; 67.7% female; 5.7% Aboriginal and Torres Strait Islander) receiving short‐term psychological treatment for suicide‐related behaviors. Change scores over the course of therapy were generated using admission and discharge measures of PB, TB, depression, hopelessness, and suicide risk. Results revealed partial support for the theory. The relationship between changes in depression and hopelessness on suicide risk was fully mediated by changes in PB. However, changes in TB did not mediate these relationships. This study offers encouragement for the potential use of the IPTS in the context of psychological treatment of young people. Assessment of the IPTS constructs may be helpful in assessing change in suicide risk and further assist in treatment.     

A case-control study of hopelessness and suicidal behavior in the city of Athens,Greece. The role of the financial crisis

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M = 9) presented higher hopelessness than the controls (M = 3). The patients’ age positively correlated with hopelessness (r_s = .35, p < .001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M = 3) and after (M = 3, p > .05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness.     

The moderating role of pessimism in the association between retrospective relational peer victimization,interpersonal risk factors,and suicide ideation

Peer victimization (PV) is a serious concern for youth and is associated with subsequent suicide ideation in young adulthood. The interpersonal theory of suicide may provide a framework for understanding suicide ideation in this population. Specifically, thwarted belongingness (TB) and perceived burdensomeness (PB) have been significantly associated with suicide ideation among young adults with a history of peer victimization. Additionally, the personality trait of pessimism is associated with elevated suicide ideation. Thus, this study tested the association between self-reported frequency of retrospective relational (i.e., verbal and indirect) PV in primary and secondary school, thwarted interpersonal needs (TB and PB), and current suicide ideation, as well as how these relations may vary based on current pessimism. Participants were 330 undergraduate students. Nonparametric bootstrap moderated mediation procedures were used to test hypotheses. Results indicated significant indirect effects of frequency of retrospective relational PV and suicide ideation through PB and TB. Contrary to predictions, results did not indicate significant moderated mediation; however, the association between PB and suicide ideation was stronger at lower pessimism levels. We also provide supplemental analysis with optimism as the moderator. These findings suggest that clinicians may consider targeting TB, PB, as well as pessimism and optimism among those with a history of relational PV when assessing and intervening on current suicide ideation. Implications, limitations, and future directions are further discussed.     

A multisystems analysis of adolescent suicide attempters

The present study tested an ecologically based model, which predicted that hopelessness (individual level) mediates the effects of family dysfunction (interpersonal level) and socioeconomic status (sociocultural level) on both suicidal intent and suicidal ideation, within a sample of attempters. Subjects included adolescent males and females presenting at a general hospital emergency room following suicide attempts. Baron and Kenny's (1986) criteria for testing mediation models through multiple-regression analyses were employed. Little evidence of mediation was found. Hopelessness proved to be the best predictor of suicidal intent and ideation within a sample of attempters.