Factor Validity of the Beck Hopelessness Scale in Italian Medical Patients

The aim of the present study was to assess the factor structure of the Italian version of the Beck Hopelessness Scale (BHS) in a large sample of patients with medical conditions, comparing four different models proposed previously in the literature. Participants were 514 Italian adult patients with diagnoses of chronic daily headache, type 1 (insulin-dependent) or type 2 diabetes mellitus, epilepsy, open-angle glaucoma, human immunodeficiency virus infection, and women admitted for childbirth to a Department of Fetal–Maternal Medicine. All the patients were administered the BHS during routine visits. Confirmatory factor analyses were used to compare four models using several fit indices. The one-construct two-method model (i.e., the BHS measures one substantive hopelessness construct plus artifacts due to negative–positive item polarity) had the best fit indices and was more parsimonious than other models. The BHS seems to be a unidimensional measure of hopelessness, although there may be artifacts due to item polarity (i.e., positively and negatively worded items). Hopelessness scores differed in patients with particular medical diseases, with higher scores in conditions such as chronic daily headache and diabetes, and lower scores in patients positive for the human immunodeficiency virus (HIV), and with open-angle glaucoma or epilepsy.     

An inventory to measure helplessness, hopelessness, and haplessness

Using a sample of 69 undergraduates, scales were devised to measure helplessness, hopelessness, and haplessness and shown to have good reliability. Briefer scales were also developed whose scores were independent of one another in a factor analysis. Scores for 19 male and 50 female undergraduates on the 4-item scales of Helplessness and Hopelessness were associated with two different measures of depression, but scores on Hopelessness provided the stronger correlate.     

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.     

Dispositional and explanatory style optimism as potential moderators of the relationship between hopelessness and suicidal ideation

To test the hypothesis that higher levels of optimism reduce the association between hopelessness and suicidal ideation, 284 college students completed self-report measures of optimism and Beck scales for hopelessness, suicidal ideation, and depression. A statistically significant interaction between hopelessness and one measure of optimism was obtained, consistent with the hypothesis that optimism moderates the relationship between hopelessness and suicidal ideation. Hopelessness is not inevitably associated with suicidal ideation. Optimism may be an important moderator of the association. The development of treatments to enhance optimism may complement standard treatments to reduce suicidality that target depression and hopelessness.     

Normativity unbound: Liminality in palliative care ethics

This article applies the anthropological concept of liminality to reconceptualize palliative care ethics. Liminality possesses both spatial and temporal dimensions. Both these aspects are analyzed to provide insight into the intersubjective relationship between patient and caregiver in the context of palliative care. Aristotelian practical wisdom, or phronesis, is considered to be the appropriate model for palliative care ethics, provided it is able to account for liminality. Moreover, this article argues for the importance of liminality for providing an ethical structure that grounds the doctrine of double effect and overcomes the impasse of phronesis in the treatment of the terminally ill.     

Initial development of a brief measure of psychological distress

This paper addresses the preliminary development, construct validity, and psychometric properties of a brief self-report measure of psychological distress. 40 items were originally generated by doctoral level psychologists for use in the preliminary clinical sample. Inpatients from a psychiatric unit (N = 125) completed the items, and a principal-components analysis with a direct oblimin rotation was used to evaluate construct validity. The study indicated a four-factor solution, using the constructs of Depression, Hopelessness, Anxiety, and Anger, with good estimates of reliability. After evaluation of factor structure, item analyses, and reliability estimates, a redacted 19-item scale was identified.     

Does quality of sleep mediate the effect of depression on hopelessness?

The objectives of the study were to evaluate the relationship between sleep quality, depression, and hopelessness in advanced cancer patients and whether sleep quality mediated the effect of depression on hopelessness. The final sample consisted of 102 advanced cancer patients under palliative treatment. Patients completed the Greek Pittsburgh Sleep Quality Index, a sleep quality instrument, the Greek Beck Depression Inventory for measuring depression, and finally the Beck Hopelessness Scale. Patients' performance status was assessed by their overall physical functioning, as defined by the Eastern Cooperative Oncology Group. Depression was highly associated with hopelessness (r = .52, p<.001). Statistically significant associations were found between sleep quality with hopelessness (r = .37, p<.001), as well as with depression (r = .36, p<.001). Mediation analyses indicated that depression influenced hopelessness directly as well as indirectly by its effect on sleep quality. About 14.58% of the variation in hopelessness was explained by depression; 4% of the variance in hopelessness explained by depression was accounted for by the mediation pathway indicating that sleep quality mediated the relationship between depression and hopelessness. Similarly, in the reverse mediation analysis, depression mediated the relationship between sleep quality and hopelessness; 43% of the variation in hopelessness was explained by sleep quality. In conclusion, some of the effect of depression on hopelessness was mediated by sleep quality, but depression had a direct effect on hopelessness as well. Additionally, some of the effect of sleep quality on hopelessness was mediated by depression. The current findings are important because improving sleep quality by treating depression may contribute to decreased hopelessness scores and vice versa: Treating depression by improving sleep quality may also contribute to lower hopelessness scores.     

Resilience is a good predictor of hopelessness even after accounting for stressful life events, mood and personality (NEO-PI-R)

A better understanding of the relation between protection and vulnerability may advance our understanding of mental health. Therefore the purpose of this study was to examine the incremental validity of the Resilience Scale for Adults (RSA) as a predictor for level of hopelessness. A healthy sample (N = 532) completed the Beck Hopelessness Scale, a list of Stressful Life Events (SLE), the Hopkins Symptom Checklist-25 (HSCL-25), NEO-PI-R (NEO Personality Inventory Revised) and the RSA. The relations between the variables were explored with correlations and multiple hierarchical regression analyses. The results indicated that the RSA measures important protective factors that significantly predict lower levels of hopelessness even when accounting for age, gender, SLE, HSCL-25 and NEO-PI-R. This study supports the notion that the protective resilience factors in the RSA have unique contributions over and above established constructs of stressful life events, depressive and anxiety symptoms and personality in predicting hopelessness, supporting the incremental validity of the RSA.     

Detecting Potential Underreporting of Suicide Ideation Among U.S. Military Personnel

Using a military sample comprised largely of National Guard personnel, zero‐inflation negative binomial regression was applied to estimate the effects of indirect, nonface valid indicators of suicide ideation [Thwarted Belongingness (TB), Perceived Burdensomeness (PB), and Hopelessness], in predicting suicide ideation. Data from a sample of 497 military personnel (82.1% male; m_age = 27.24; range = 18–59) were analyzed. TB and the interaction of TB with Hopelessness were significant predictors in the logistic regression, and in the negative binomial regression, the main effects of TB and hopelessness, and the interactions of TB with hopelessness and PB with hopelessness were significant. The findings further indicated that approximately 10% of those not reporting ideation would be predicted to be ideators. Clinically, these results indicate that, in samples reluctant to report ideation, the assessment of suicide risk may improve through the use of relevant measures that do not explicitly reference suicide thoughts.     

A preliminary study into stress in palliative care: optimism, self-efficacy and social support

Caring for the terminally ill is a demanding, but rewarding area of health care. Stressors unique to this working environment--dealing with patient death rather than cure, and supporting entire family units, for example--put caregivers at risk from stress related illness. This study investigated the buffering effects of optimism, self-efficacy and social support against two measures of stress within the palliative setting. Comparisons were made between volunteer (n = 18) and professional (n = 18) caregivers across three caregiving settings. Data were collected retrospectively about personal control variables; use of and satisfaction with, social support; and, perceived general and occupational specific stress levels. Differences in reported stress levels were found both between settings (NHS, hospice and community-based) and between caregiver type (salary status and occupational category). Optimism was more strongly and consistently associated with low levels of perceived stress than was self-efficacy. Satisfaction with social support was highest among paid workers, and in terms of buffering stress in the whole sample, appeared mediated by optimism. Worksite interventions targeting caregiver self-efficacy and optimism are recommended as a potential source of stress management within this population.     

The structure of the Beck Hopelessness Scale: A confirmatory factor analysis in UK students

The aim of this paper was to confirm the factor structure of the 20-item Beck Hopelessness Scale in a non-clinical population. Previous research has highlighted a lack of clarity in its construct validity with regards to this population.Based on previous factor analytic findings from both clinical and non-clinical studies, 13 separate confirmatory factor models were specified and estimated using LISREL 8.72 to test the one, two and three-factor models.Psychology and medical students at Queen’s University, Belfast (n = 581) completed both the BHS and the Beck Depression Inventory (BDI).All models showed reasonable fit, but only one, a four-item single-factor model demonstrated a non-significant chi-squared statistic. These four items can be used to derive a Short-Form BHS (SBHS) in which increasing scores (0-4) corresponded with increasing scores in the BDI. The four items were also drawn from all three of Beck’s proposed triad, and included both positively and negatively scored items.This study in a UK undergraduate non-clinical population suggests that the BHS best measures a one-factor model of hopelessness. It appears that a shorter four-item scale can also measure this one-factor model.     

Dimensions of Perfectionism,Hopelessness, and Attempted Suicide in a Sample of Alcoholics

This study assessed whether specific dimensions of perfectionism and hopelessness were elevated in individuals who had made a serious suicide attempt in comparison to individuals with no history of suicide attempts. A sample of 39 inpatients with alcoholism who had made a serious suicide attempt and a matched sample of 39 inpatients with alcoholism but no history of suicide attempts completed the Multidimensional Perfectionism Scale, the Hopelessness Scale, ratings of achievement and social hopelessness, and the Beck Depression Inventory. The attempter group had higher scores on socially prescribed perfectionism, generalized hopelessness, achievement hopelessness, social hopelessness, and depression. A discriminant function analysis revealed that depression, social hopelessness, socially prescribed perfectionism, and other-oriented perfectionism were unique discriminators of the suicide groups. The results are discussed in terms of the importance of social personality variables in attempted suicide.     

Gender Differences in the Suicide-Related Behaviors of Adolescents and Young Adults

Gender differences in suicide-related behaviorswere examined in an older adolescent and a young adultsample (primarily Caucasian). Suicide-related behaviorswere assessed by the Life Attitudes Schedule (LAS) as well as by measures of depressivesymptomatology and hopelessness. The LAS measures a broadcontinuum of potentially life-diminishing orlife-enhancing behaviors. There are four LAScontent-category subscales: overtly suicidal and death-related,self-related, risk and injury-related, and health-relatedbehaviors. As hypothesized, in both samples, genderdifferences in the expression of suicide-related behaviors were obtained. Males from both samplesendorsed substantially more risk-taking andinjury-producing behaviors than females. Males in bothsamples also reported more negative health-relatedbehaviors than females. In contrast, females reported moresymptoms of depression than males. Hopelessness scoresonly differentiated male and female young adults; maleand female adolescents did not differ significantly on the hopelessness measure. These findings areprimarily discussed in terms of gender-role socializationtheory. Implications for the treatment of suicidality aredrawn.     

Negative attributional style, hopelessness depression and endogenous depression

The hopelessness theory of depression [Abramson, L. Y., Metalsky, G. I. & Alloy, L. B. (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review, 96, 358-372.] postulates that a negative attributional style represents a risk factor for a particular constellation of depressive symptoms, termed 'hopelessness depression'. Four studies tested the relation of negative attributional style to hopelessness depression symptoms versus endogenous depression symptoms. Despite the considerable overlap of hopelessness and endogenous depression symptoms, negative attributional style was more related to the former than the latter, consistent with hopelessness theory.     

The Dream in Terminal Illness: A Jungian Formulation

It is a central assumption of Jungian theory that psychical transformation occurring during the critical developmental stages of the life cycle is anticipated, inspired, and orchestrated by the archetypal symbol. In this way, archetypal dreams are afforded particular significance during these transitional stages. The present paper purports to consider the clinical and theoretical implications of this understanding with reference to the dying process. The concepts discussed are illustrated by a series of dreams of a terminally ill cancer patient, which are elucidated by way of the method of amplification. Thematic analysis of the dream series supports Jung's conceptualization of death and dying as being a critical stage of the individuation process, characterized by profound psychical development of a specific and purposeful nature. The value of using dreams in the psychotherapeutic care of dying patients and their families is discussed, with case illustrations. It is suggested that such an approach may foster creative development, assist patients to integrate meaningfully subjective experiences pertaining to dying, and counteract the sense of isolation experienced by the terminally ill. The need for further research and the development of specific treatment modalities is highlighted.     

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.     

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.     

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.     

Hopelessness

ABSTRACT: In a sample of 87 hospitalized suicide attempters, a hopelessness scale was found to be significantly better than a depression inventory as an indicator of suicidal risk. Hopelessness also correlated better than depression with self-ratings of the attenuation of the desire to go on living.     

Desire for euthanasia or physician-assisted suicide in palliative cancer care.

OBJECTIVE: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. DESIGN: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. MAIN OUTCOME MEASURES: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. RESULTS: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p=.010), reduced functional status (p=.024), a diagnosis of major depression (p<.001), and greater distress on 12 of 22 individual symptoms and concerns (p<.025). In follow-up interviews with 17 participants, 2 (11.8%) showed instability in their expressed desire. CONCLUSION: Among patients receiving palliative care for cancer, the desire to receive euthanasia or PAS is associated with religious beliefs; functional status; and physical, social, and psychological symptoms and concerns. Although this desire is sometimes transitory, once firmly established, it can be enduring.