Research Article
Relations Between Hopelessness, Depressive Symptoms and Suicidality: Mediation by Reasons for Living
Courtney L. Bagge,
Dorian A. Lamis,
Michael Nadorff, Augustine Osman,
Corresponding Author
Courtney L. Bagge
University of Mississippi Medical Center
Please address correspondence to: Courtney L. Bagge, University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, Jackson, MS, 39216. E-mail: [email protected]Search for more papers by this authorDorian A. Lamis
Emory University School of Medicine/Grady Health System
Search for more papers by this authorCourtney L. Bagge,
Dorian A. Lamis,
Michael Nadorff, Augustine Osman,
Corresponding Author
Courtney L. Bagge
University of Mississippi Medical Center
Please address correspondence to: Courtney L. Bagge, University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, Jackson, MS, 39216. E-mail: [email protected]Search for more papers by this authorDorian A. Lamis
Emory University School of Medicine/Grady Health System
Search for more papers by this authorAbstract
Objective
The present study examined whether reasons for living (RFL) would partially account for the associations between traditional risk factors (depressive symptoms, hopelessness) and suicidal ideation and attempts.
Method
Data were collected from 1,075 undergraduate college students who completed a battery of online assessments.
Results
Results from a series of simultaneous mediational models indicated that the relations between risk factors and current suicidal ideation were partially mediated by total RFL (and Coping Beliefs and Self-Evaluation subscales). Further, total RFL (and the Coping Beliefs subscale) fully mediated the relation between hopelessness and past-year suicide attempt, and partially mediated the depressive symptoms-suicide attempt relation.
Conclusions
This study demonstrates the importance of assessing for the presence of these suicide risk and protective factors. Implications for the improved identification and treatment of young adults at risk for suicide are discussed.
References
- American College Health Association. (2011). ACHA-National College Health Assessment II: Reference group executive summary Spring 2011. Hanover, MD: Author.
- Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
- Barrios, L. C., Everett, S. A., Simon, T. R., & Brener, N. D. (2000). Suicide ideation among US college students: Associations with other injury risk behaviors. Journal of American College Health, 48, 229–233.
- Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row.
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory: Second edition. San Antonio, TX: The Psychological Corporation.
- Beck, A. T., & Weishaar, M. E. (1990). Suicide risk assessment and prediction. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 11, 22–30.
- Beck, A., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42, 861–865.
- Bisconer, S. W. & Gross, D. M. (2007). Assessment of suicide risk in a psychiatric hospital. Professional Psychology: Research and Practice, 38, 143–149.
- Bollen, K. A. (1987). Structural equation models with latent variables. New York: John Wiley.
- Brown, G., Bryan, C. J., & Holloway, M. (2012). Cognitive behavior therapy for reducing suicide risk with veterans and military service members. Panel presented at the annual meeting of the American Association of Suicidology, Baltimore, MD.
- Brown, G. K., Henriques, G. R., Sosdjan, D., & Beck, A. T. (2004). Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology, 72, 1170–1174.
- Centers for Disease Control and Prevention. (2010). Injury prevention & control: Data & Statistics (WISQARS). Retrieved from http://www.cdc.gov/injury/wisqars/fatal.html
- Chapman, A. L., Specht, M. W., & Cellucci, T. (2005). Factors associated with suicide attempts in female inmates: The hegemony of hopelessness. Suicide and Life-Threatening Behavior, 35, 558–569.
- Clum, G. A., & Yang, B. (1995). Additional support for the reliability and validity of the Modified Scale for Suicide Ideation. Psychological Assessment, 7, 122–125.
- Conner, K. R., Britton, P. C., Sworts, L., & Joiner, T. (2007). Suicide attempts among individuals with opiate dependence: The role of belonging. Addictive Behaviors, 32, 1395–1404.
- Conner, K. R., Houston, R. J., & Swogger, M. A. (2009). A test of the reactive aggression–suicidal behavior hypothesis: Is there a case for proactive aggression? Journal of Abnormal Psychology, 118, 235–240.
- Cornette, M. M., Strauman, T. J., Abramson, L. Y., & Busch, A. M. (2009). Self-discrepancy and suicidal ideation. Cognition and Emotion, 23, 504–527.
- Cull, J. G., & Gill, W. S. (1982). Suicide Probability Scale. Los Angeles, CA: Western Psychological Services.
- Dean, P., & Range, L. M. (1999). Testing the Escape Theory of Suicide in an outpatient clinical population. Cognitive Therapy and Research, 23, 561–572.
- Dogra, A. K., Basu, S., & Das, S. (2011). Impact of the meaning in life and reasons for living to hope and suicidal ideation: A study among college students. Journal of Projective Psychology and Mental Health, 18, 89–102.
- Drum, D. J., Brownson, C., Burton Denmark, A., & Smith, S. E. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40, 213–222.
- Drum, D. J., & Burton Denmark, A. (2011). College suicide prevention programs and interventions. In D. A. Lamis & D. Lester (Eds.), Understanding and preventing college student suicide (pp. 255–272). Charles C. Thomas Publishers: Springfield, IL.
- Dyck, M. J. (1991). Positive and negative attitudes mediating suicide ideation. Suicide and Life-Threatening Behavior, 21, 360–373.
- Elliott, J. L., & Frude, N. (2001). Stress, coping styles, and hopelessness in self-poisoners. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 22, 20–26.
- Ellis, J. B., & Lamis, D. A. (2007). Adaptive characteristics and suicidal behavior: A gender comparison of young adults. Death Studies, 31, 845–854.
- Freedenthal, S., Lamis, D. A., Osman, A., Kahlo, D., & Gutierrez, P. M. (2011). Evaluation of the psychometric properties of the Interpersonal Needs Questionnaire-12 in samples of men and women. Journal of Clinical Psychology, 67, 609–623.
- Fremouw, W., Callahan, T., & Kashden, J. (1993). Adolescent suicidal risk: Psychological, problem solving, and environmental factors. Suicide and Life-Threatening Behavior, 23, 46–54.
- Galfalvy, H., Oquendo, M. A., Carballo, J. J., Sher, L., Grunebaum, M. F., Burke, A., & Mann, J. (2006). Clinical predictors of suicidal acts after major depression in bipolar disorder: A prospective study. Bipolar Disorders, 8, 586–595.
- Ghahramanlou-Holloway, M. M., Bhar, S. S., Brown, G. K., Olsen, C. C., & Beck, A. T. (2012). Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. Psychological Medicine, 42, 1185–1193.
- Gutierrez, P., Osman, A., Barrios, F., Kopper, B., Baker, M., & Haraburda, C. (2002). Development of the Reasons for Living Inventory for Young Adults. Journal of Clinical Psychology, 58, 339–357.
- Gutierrez, P. M., Osman, A., Kopper, B. A., Barrios, F. X., & Bagge, C. L. (2000). Suicide risk assessment in a college student population. Journal of Counseling Psychology, 47, 403–413.
- Haney, E. M., O'Neil, M. E., Carson, S., Low, A., Peterson, K., Denneson, L. M., & … Kansagora, D. (2012). Suicide risk factors and risk assessment tools: A systematic review. VA-ESP Project #05-225.
- Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York, NY: The Guilford Press.
- Hills, A. L., Cox, B. J., McWilliams, L. A., & Sareen, J. (2005). Suicide attempts and externalizing psychopathology in a nationally representative sample. Comprehensive Psychiatry, 46, 334–339.
- Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
- Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
- Joiner, T. R., Voelz, Z. R., & Rudd, M. (2001). For suicidal young adults with comorbid depressive and anxiety disorders, problem-solving treatment may be better than treatment as usual. Professional Psychology: Research and Practice, 32, 278–282.
- Kashden, J., Fremouw, W. J., Callahan, T. S., & Franzen, M. D. (1993). Impulsivity in suicidal and nonsuicidal adolescents. Journal of Abnormal Child Psychology, 21, 339–353.
- Keilp, J. G., Grunebaum, M. F., Gorlyn, M., LeBlanc, S., Burke, A. K., Galfalvy, H., & … Mann, J. (2012). Suicidal ideation and the subjective aspects of depression. Journal of Affective Disorders, 140, 75–81.
- Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617–626.
- Kline, R. B. (2005). Principles and practice of structural equation modeling ( 2nd ed.). New York, NY: Guilford Press.
- Lamis, D. A., & Lester, D. (2012). Risk factors for suicidal ideation among African American and European American college women. Psychology of Women Quarterly, 36, 337–349.
- Lamis, D. A., & Malone, P. S. (2011). Alcohol-related problems and risk of suicide among college students: The mediating roles of belongingness and burdensomeness. Suicide and Life-Threatening Behavior, 41, 543–553.
- Lauer, S., de Man, A. F., Marquez, S., & Ades, J. (2008). External locus of control, problem-focused coping and attempted suicide. North American Journal of Psychology, 10, 625–632.
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
- Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking of killing yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51, 276–286.
- MacKinnon, D. P. (2008). An introduction to statistical mediation analysis. New York, NY: Lawrence Erlbaum Associates.
- MacKinnon, D. P., Lockwood, C. A., Brown, C. H., Wang, W., & Hoffman, J. M. (2007). The intermediate endpoint effect in logistic and probit regression. Clinical Trials, 4, 499–513.
- MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.
- Malone, K. M., Oquendo, M. A., Haas, G. L., Ellis, S. P., Li, S., & Mann, J. J. (2000). Protective factors against suicidal acts in major depression: Reasons for living. The American Journal of Psychiatry, 157, 1084–1088.
- Mann, J., Waternaux, C., Haas, G. L., & Malone, K. M. (1999). Toward a clinical model of suicidal behavior in psychiatric patients. The American Journal of Psychiatry, 156, 181–189.
- Miller, I. W., Norman, W. H., Bishop, S. B., & Dow, M. G. (1986). The Modified Scale for Suicide Ideation: Reliability and validity. Journal of Consulting and Clinical Psychology, 54, 724–725.
- Muthén, L. K., & Muthén, B. O. (1998–2011). Mplus 6.1 [Computer software]. Los Angeles, CA: Author.
- Muthén, B. O. (2011). Applications of causally defined direct and indirect effects in mediation analysis using SEM in Mplus. Manuscript submitted for publication.
- Naragon-Gainey, K., Watson, D., & Markon, K. E. (2009). Differential relations of depression and social anxiety symptoms to the facets of extraversion/positive emotionality. Journal of Abnormal Psychology, 118, 299–310.
- National Institute of Mental Health. (2011). Suicide in the U.S.: Statistics and Prevention. Retrieved from http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml
- Osman, A., Gutierrez, P., Kopper, B., Barrios, F., & Chiros, C. (1998). The Positive and Negative Suicide Ideation Inventory: Development and validation. Psychological Reports, 82, 783–793.
- Osman, A., Kopper, B. A., Barrios, F. X., Gutierrez, P. M., & Bagge, C. L. (2004). Reliability and validity of the Beck Depression Inventory-II with adolescent psychiatric inpatients. Psychological Assessment, 16, 120–132.
- Osman, A., Kopper, B. A., Linehan, M. M., Barrios, F. X., Gutierrez, P. M., & Bagge, C. L. (1999). Validation of the Adult Suicidal Ideation Questionnaire and the Reasons for Living Inventory in an adult psychiatric inpatient sample. Psychological Assessment, 11, 115–123.
- Pettit, J., Garza, M., Grover, K., Schatte, D., Morgan, S., Harper, A., & Saunders, A. E. (2009). Factor structure and psychometric properties of the Modified Scale for Suicidal Ideation among suicidal youth. Depression and Anxiety, 26, 769–774.
- Pollock, L. R., & Williams, M. G. (1998). Problem solving and suicidal behavior. Suicide and Life-Threatening Behavior, 28, 375–387.
- Pompili, M., Girardi, P., Tatarelli, G., & Taterelli, R. (2006). Suicidal intent in single-car accident drivers: Review and new preliminary findings. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 27, 92–99.
- Pukay-Martin, N. D., Pontoski, K. E., Maxwell, M. A., Calhoun, P. S., Dutton, C. E., Clancy, C. P. … Beckman, J. C. (2012). The influence of depressive symptoms on suicidal ideation among U.S. Vietnam-Era and Afghanistan/Iraq-Era veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 25, 578–582.
- Rich, A. R., & Bonner, R. L. (1987). Concurrent validity of a stress-vulnerability model of suicidal ideation and behavior: A follow-up study. Suicide and Life-Threatening Behavior, 17, 265–270.
- Schotte, D. E., & Clum, G. A. (1987). Problem-solving skills in suicidal psychiatric patients. Journal of Consulting and Clinical Psychology, 55, 49–54.
- Schotte, D. E., Cools, J., & Payvar, S. (1990). Problem-solving deficits in suicidal patients: Trait vulnerability or state phenomenon? Journal of Consulting and Clinical Psychology, 58, 562–564.
- Steed, L. (2001). Further validity and reliability evidence for Beck Hopelessness Scale scores in a nonclinical sample. Educational and Psychological Measurement, 61, 303–316.
- Strosahl, K., Chiles, J. A., & Linehan, M. (1992). Prediction of suicide intent in hospitalized parasuicides: Reasons for living, hopelessness, and depression. Comprehensive Psychiatry, 33, 366–373.
- Vickers, K., & McNally, R. J. (2004). Panic disorder and suicide attempt in the National Comorbidity Survey. Journal of Abnormal Psychology, 113, 582–591.
- Wang, M. C., Lightsey, O. R., Pietruszka, T., Uruk, A. C., & Wells, A. G. (2007). Purpose in life and reasons for living as mediators of the relationship between stress, coping, and suicidal behavior. The Journal of Positive Psychology, 3, 195–204.
10.1080/17439760701228920 Google Scholar
- Wenzel, A., Brown, G. K., & Beck, A. T. (2008). Cognitive therapy for suicidal patients: Scientific and clinical applications. Washington, DC: APA Books.
- Williams, J. M., Barnhofer, T., Crane, C., & Beck, A. T. (2005). Problem solving deteriorates following mood challenge in formerly depressed patients with a history of suicidal ideation. Journal of Abnormal Psychology, 114, 421–431.
- Wingate, L. R., Van Orden, K. A., Joiner, T. E., Williams, F. M., & Rudd, M. D. (2005). Comparison of compensation and capitalization models when treating suicidality in young adults. Journal of Consulting and Clinical Psychology, 73, 756–762.
- Xu, J., Kochanek, K. D., Murphy, S. L., & Tejada-Vera, B. (2010). Deaths: Final Data for 2007. National Vital Statistics Reports, 58. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf
