Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children.

The Hoplessness Scale for Children was developed and administered to 66 8–13 yr old children along with the Children's Depression Inventory, Bellevue Index of Depression, Depression Symptom Checklist, and the Self-Esteem Inventory. As predicted, Ss who scored high on the Hopelessness Scale showed significantly more severe depression and lower self-esteem than those who scored low on the scale. Ss who evinced suicidal attempt or ideation, independently assessed at intake diagnosis, showed greater hopelessness than Ss with no such intent. Suicidal intent was more consistently correlated with hopelessness than with depression, a finding parallel to results obtained with adults. Overall, findings suggest that negative expectations toward oneself and the future can be assessed in children and are related both to depression and suicidal intent. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child–Adolescent Suicidal Potential Index (CASPI): A screen for risk for early onset suicidal behavior.

This study's purpose was to develop a reliable and valid self-report questionnaire, the Child–Adolescent Suicidal Potential Index (CASPI), to screen for risk for suicidal behavior in children and adolescents. Four hundred twenty-five child and adolescent psychiatric patients and nonpatients completed the CASPI and other research instruments to rate suicidal and assaultive behavior and symptoms of depression, anxiety, and hopelessness. The 30-item CASPI involves 3 factors (anxious–impulsive depression, suicidal ideation or acts, family distress) that contributed to a unidimensional 2nd-order factor accounting for 59% of the total variance. Internal consistency (alpha) for the total score was .90, and test-retest reliability (ICC) for the total score was .76. Total score distinguished between children and adolescents with different severity of psychopathology and different levels of suicidal and assaultive behavior. Each of the 3 factors had different contributions to discriminating between levels of suicidal status. CASPI total score of 11 distinguished suicidal ideation or acts from nonsuicidal behavior, with sensitivity 70% and specificity 65%. CASPI total score positively correlated with symptom severity of depression, anxiety, and hopelessness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of suicidal behavior in a juvenile detention population

The present study identifies the correlates of current suicidal ideation and past suicide attempt among 555 adolescents in a county juvenile detention center. Suicidal behavior in delinquent boys was generally associated with depression and decreased social connection, whereas suicidal behavior in delinquent girls was associated with impulsivity and instability. Current ideation was most significantly associated with current depression. In multivariate analyses, past attempts were associated with suicidal ideation and ineffective coping for males, with major life events and impulsivity for females, and with not residing with at least one biological parent prior to detention for both males and females.     

Psychopathology of adolescent suicide: Hopelessness, coping beliefs, and depression.

Two studies of adolescents examined the relation of several cognitive variables and depression to suicide-related behaviors. Study 1 compared hopelessness and depression in 281 high school students. Unlike research with adults, depression was significantly related to suicidal behaviors, even after hopelessness was statistically controlled. When depression was controlled, hopelessness was unrelated to suicidal behaviors for boys and only modestly related for girls. Study 2 examined depression, hopelessness, survival–coping beliefs, fear of social disapproval, and social desirability in relation to suicidal behaviors in 53 male juvenile delinquents. Again, hopelessness did not account for a significant proportion of the variance in suicide. Depression was uniquely related to past suicide attempts. Survival–coping beliefs were associated with self-predicted future suicide and other suicidal behaviors. Survival–coping beliefs are discussed as a cognitive buffer to suicidal ideation in adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of response set to observed suicide intent.

Examined the relationship of patients' response style to clinicians' ratings of suicidal intent. 50 suicide ideators (aged 16–52 yrs) were assessed using a scale measuring suicide ideation, the Hopelessness Scale, and the Desirability and Infrequency validity scales of the Personality Research Form. An item factor analysis of the scale measuring suicide ideation yielded 2 factors: Suicidal Desire and Suicide Preparation. Hopelessness and undesirability were associated with Suicidal Desire, but hopelessness was independent of Suicide Preparation. Similarities are noted with the factors previously identified by A. T. Beck et al (see record 1979-27627-001). It is suggested that negative desirability responding represents a distress set in the context of suicidal behavior. (French abstract) (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cynicism, hostility, and suicidal ideation in depressed outpatients

Differences between depressed patients with and without suicidal ideation were examined, focusing on anger, aggression, and hostility. The Adult Suicide Ideation Questionnaire was used to compare 42 outpatients with major depression in relationship to measures of anger, aggression, hostility, cynicism, life events, and depression. There were no differences on measures of anger, aggression, hostility, and on most measures of severity of depression, but the suicidal group demonstrated more evidence of cynicism. Suicidal ideation is associated with cynicism but is unrelated to measures of hostility, anger, or aggression or to severity of depression in outpatients.     

Assessment of suicidal intention: The Scale for Suicide Ideation.

Describes the rationale, development, and validation of the Scale for Suicide Ideation, a 19-item clinical research instrument designed to quantify and assess suicidal intention. In a sample with 90 hospitalized Ss, the scale was found to have high internal consistency and moderately high correlations with clinical ratings of suicidal risk and self-administered measures of self-harm. Furthermore, it was sensitive to changes in levels of depression and hopelessness (Beck Depression Inventory and Hopelessness Scale, respectively) over time. Its construct validity was supported by 2 studies by different investigators testing the relationship between hopelessness, depression, and suicidal ideation and by a study demonstrating a significant relationship between high level of suicidal ideation and "dichotomous" attitudes about life and related concepts on a semantic differential test. Factor analysis yielded 3 meaningful factors: Active Suicidal Desire, Specific Plans for Suicide, and Passive Suicidal Desire. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal ideation and behavior and noncompliance with the medical regimen among diabetic adolescents

OBJECTIVE: To examine (1) the 1-year and lifetime prevalence of suicidal thoughts and behavior among adolescents with insulin-dependent diabetes mellitus (IDDM), (2) the relationship between suicidal thoughts and serious noncompliance with the medical regimen, and (3) factors including psychiatric disorder, self-efficacy expectations, and hopelessness that might mediate the relationship between suicidal thoughts and noncompliance. METHOD: Semistructured and structured interview instruments and self-report questionnaires were used to determine history of suicidal thoughts and behavior, serious noncompliance with the medical regimen, current psychiatric disorder, hopelessness, and self-efficacy expectations among 91 adolescents attending outpatient clinic appointments. RESULTS: The rate of suicidal ideation among the diabetic adolescents was higher than expected, but the rate of suicide attempts was comparable with that reported for the general population. Suicidal thoughts were strongly associated with serious noncompliance with the medical regimen. Duration of IDDM and psychiatric diagnosis were related to both suicidal ideation within the previous year and lifetime suicidal ideation. Diagnosable psychiatric disorder and not living in a two-parent home were related to noncompliance with medical treatment. CONCLUSIONS: Suicidal thoughts and serious noncompliance with the medical regimen are strongly associated among diabetic teenagers, and psychiatric disorder is a common correlate of both.     

Suicide ideation in a college population: A test of a model.

Examined a model of suicide behavior with 65 undergraduate suicide ideators (as measured by a self-report adaptation of the Scale for Suicide Ideators). The model focuses on the relationship between negative life stress, cognitive rigidity and/or poor problem-solving skills, hopelessness, and suicide ideation and attempting. The model proposes that individuals deficient in the capacity for divergent thinking are cognitively unprepared to cope with the high levels of life stress observed in suicide attempters and, as a result, are likely to become hopeless under such circumstances. This hopelessness resulting from the individual's inability to engage in effective problem-solving places the individual at risk for suicidal behavior. Ss were administered a battery of tests that included the Self-Rating Depression Scale, Life Experiences Survey, and Hopelessness Scale. Results indicate that Ss were under higher levels of negative life stress, were more hopeless, and had higher levels of depression than their nonideating peers. Although no relationship was observed between suicide ideation and cognitive rigidity or between suicide intent and cognitive rigidity, poor problem-solvers under high stress were found to be significantly higher on suicide intent than any other group. Results support a stress/problem-solving model of suicidal behavior in which poor problem-solvers under high life stress are considered to be at risk for depression, hopelessness, and suicidal behavior. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self- and other-appraisals by suicidal, psychosomatic, and normal hospitalized patients.

The 3 groups of patients rated themselves and others by a semantic differential on the factor scales of evaluation, activity, and potency. Suicidal Ss rated themselves lower in value and potency, both absolutely and in comparison to other people, than did the psychosomatic and normal groups. The extent of the negative self-evaluation was considered surprising, particularly on the potency factor. It is suggested that the feeling of impotence may be more important in producing suicidal behavior than the feeling of being "good" or "bad." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, family environment, and adolescent suicidal behavior

OBJECTIVE: To assess the specific influence of family relationship difficulties, over and above the effect of depression, on the risk of adolescent suicidal behavior. METHOD: The study was based on the clinical data summaries, "item sheets," of children and adolescents who attended the Maudsley Hospital during the 1970s and 1980s. Two hundred eighty-four cases of suicidal behavior, defined as suicidal ideas, attempts, or threats (mean age 13.9 years, SD 2.6), were compared with 3,054 nonsuicidal controls, using stepwise logistic regression controlling for age and sex. RESULTS: The following variables were each independently associated with suicidal behavior: an operationally defined depressive syndrome, odds ratio (OR) = 4.4 (95% CI 3.1 to 6.3); family discord, OR = 1.5 (95% CI 1.1 to 2.0); disturbed mother-child relationship, OR = 1.5 (95% CI 1.1 to 2.0); and familial lack of warmth, OR = 1.6 (95% CI 1.1 to 2.3). Twenty-seven percent of the suicidal cases met operational criteria for depression. In a separate analysis of nondepressed cases (n = 198), female gender, OR = 2.4 (95% CI 1.7 to 3.2), and conduct symptoms, OR = 1.4 (95% CI 1.02 to 1.95), were independent risk factors for suicidal behavior. Among the depressed cases (n = 73), gender and conduct symptoms did not affect the risk of suicidal behavior. CONCLUSIONS: Although depression is the largest single risk factor for teenage suicidal behavior, family relationship difficulties make a significant independent contribution to this risk. Depression also interacts with gender, so that the excess risk of suicidal behavior in females is confined to nondepressed cases.     

Suicidal ideation and behavior in youthful nonpsychiatric populations.

Administered the Suicidal Incidence Survey developed by the authors to a total of 352 music, psychology, engineering, and medical college students, and 128 Air Force basic trainees. Median age was 21 for students and 19 for military trainees. 18% of the Ss reported suicidal gestures or attempts, or serious suicidal ideation at some time in their lives, while 59% reported experience with suicidal behavior in others. Ss reporting serious suicidal behavior in the self reported significantly more suicidal behavior in others, including relatives. Significant subgroup differences suggest the possibility of a repression-sensitization continuum. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impairment in risk-sensitive decision-making in older suicide attempters with depression.

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory (“Cambridge Gamble Task”) in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Assessment of suicide ideation and parasuicide: Hopelessness and social desirability.

196 Seattle area shoppers completed the Beck Depression Inventory, Edwards Social Desirability Scale (ESDS), and Suicidal Behaviors Questionnaire. Results show that hopelessness was related to reports of past suicidal behavior, frequency of current suicidal ideation, and Ss' predictions of future suicide potential. Social desirability was related to suicidal behavior and ideation. A marked correlation existed between hopelessness and ESDS scores. Attempts to control statistically for the covariation of social desirability with hopelessness left little useful variation in predictions based on hopelessness. This was especially true among Ss who had formerly been seriously suicidal. Results may indicate a need for caution in using self-report measures of hopelessness in examining suicidality. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal thinking among adolescents with a history of attempted suicide

OBJECTIVE: To examine the risk of suicidal plans and ideation, depression, and other factors (low self-esteem, loneliness, fatalism, pessimism) among adolescents with a lifetime history of attempted suicide. METHOD: A self-administered questionnaire was used in a school-based survey of five middle schools (grades 6 through 8) enrolling 6,400 students. Usable questionnaires were obtained from 5,423 (85.3%). Data were obtained on a wide range of constructs including recent and lifetime suicide attempts, recent and lifetime suicide plans, recent ideation, symptoms of DSM-IV major depression, self-esteem, pessimism, loneliness, and fatalism. RESULTS: Data on crude prevalence showed thoughts about death, wishing to be dead, thoughts of suicide, and suicide plans were all significantly higher among youths with a history of attempts. Suicidal thinking was related to being more lonely, more fatalistic, and more pessimistic, and to less self-esteem, in addition to depression and a history of attempts. Multivariate analyses revealed the strongest factors associated with current suicidal thinking were history of attempts (odds ratio [OR] = 3.50), depression (OR = 5.34), and recent life stress (OR = 2.64). Compared with youths with none of the factors examined, those with six or more were at extreme risk (OR = 67.87). CONCLUSIONS: The strong association between history of suicide attempts, current ideation, and depression indicates that past suicide attempts occur in the context of other signs of psychosocial dysfunction. Given the paucity of epidemiological data on the natural history of suicidal behaviors among youths, more epidemiological studies of the antecedents and consequences of the range of suicidal behaviors among children and adolescents are needed. Given the high risk of subsequent suicidal behaviors by youths who have attempted but not completed suicide, this constitutes a high-risk population on which future research should focus.     

Evaluation of the Automatic Thoughts Questionnaire: Negative cognitive processes and depression among children.

The Automatic Thoughts Questionnaire (ATQ [S. D. Hollon and P. C. Kendall; see PA, Vol 66:180]) assesses negative thoughts that are associated with depression among adults. In this study, the scale was extended to children. Internal consistency and validity of the ATQ were evaluated with 250 child psychiatric inpatient children (ages 6 to 13). Validity was evaluated by examining whether depressed and nondepressed children differed on the scale, whether performance was related to other measures of cognitive attributional processes, and whether the measure was more closely related to depression and cognitive processes than to other constructs predicted to be less central to negative thoughts. The ATQ showed high internal consistency and yielded moderate to high item–total score correlations. Convergent validity was supported by the finding that the ATQ correlated positively with severity of depression, hopelessness, and external locus of control and negatively with self-esteem. Discriminant validity was suggested, but not strongly supported, by higher correlations between ATQ and measures of depression and other cognitive processes than between the ATQ and severity of impairment, prosocial behavior, and positive affective experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal investigation of depression, hopelessness, social support, and major and minor life events and their relation to suicidal ideation in adolescents

The longitudinal relationship of psychological and social-environmental factors with adolescent suicidal ideation over a 1-year-period was examined in a sample of 374 high school students. Students were assessed twice over a 1-year period with measures of depression, hopelessness, major negative life events, daily hassles, social support, and suicidal ideation. At the initial assessment, daily hassles and negative life events for males and social support and depression for females were significant factors related to suicidal ideation levels 1 year later. Changes in depression and hopelessness were significantly related to changes in suicidal ideation over the 1 year interval for males and females. Differences found between males and females in the relationship of psychological and social-environmental variables with suicidal ideation supports the need to examine gender specific relationships when conducting research on suicidal behavior in adolescents.     

Development of a semistructured clinical interview for suicidal behaviors in adolescents.

Describes the development of the Suicidal Behaviors Interview (SBI) developed by W. M. Reynolds (in press), a semistructured clinical interview measure of suicidal behaviors designed for use with adolescents. Ss were 352 adolescents, ages 12–19 yrs. Results indicate high internal consistency (rα?=?.92) and interrater reliability (rrr?=?.97, ricc?=?.99) and significant correlations with self-report measures of depression (r?=?.47) and suicidal ideation (r?=?.62 and .68). Factor analysis of SBI items resulted in a 3-factor solution that was parsimonious with the general formulation of suicidal behavior represented by the SBI. Examination of SBI factors indicated relatively high levels of reliability (rα?=?.83 to .90) and moderate intercorrelations (r?=?.49 to .66) among the factors. The results of this investigation suggest that the SBI is a psychometrically sound clinical interview for the evaluation of suicidal behaviors of adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are body dissatisfaction, eating disturbance, and body mass index predictors of suicidal behavior in adolescents? A longitudinal study.

Disordered eating, body dissatisfaction, and obesity have been associated cross sectionally with suicidal behavior in adolescents. To determine the extent to which these variables predicted suicidal ideation and attempts, the authors examined these relationships in a longitudinal design. The study population included 2,516 older adolescents and young adults who completed surveys for Project EAT-II (Time 2), a 5-year follow-up study of adolescents who had taken part in Project EAT (Time 1). Odds ratios for suicidal behaviors at Time 2 were estimated with multiple logistic regression. Predictor variables included Time 1 extreme and unhealthy weight control behaviors (EWCB and UWCB), body dissatisfaction, and body mass index percentile. Suicidal ideation was reported by 15.2% of young men and 21.6% of young women, and suicide attempts were reported by 3.5% of young men and 8.7% of young women. For young women, suicidal ideation at Time 2 was predicted by Time 1 EWCB. The odds ratio for suicide attempts was similarly elevated in young women who had reported EWCB at Time 1. These odds ratios for both suicidal ideation and suicide attempts remained elevated even after controlling for Time 2 depressive symptoms. In young men, EWCB was not associated with suicidal ideation or suicide attempts 5 years later. Body mass index and body dissatisfaction did not predict suicidal ideation or suicide attempts in young men or young women. These results emphasize the importance of EWCB. (PsycINFO Database Record (c) 2010 APA, all rights reserved)