Beck Hopelessness Scale: Exploring its Dimensionality in Patients with Schizophrenia

Abstract

Hopelessness is a pre-eminent risk factor for suicide and non-fatal self-harm. Although the Beck Hopelessness Scale is often used for schizophrenia, its factor structure has been given relatively little consideration in this context. This study aimed to examine the reliability and validity of the Taiwanese version of the Beck Hopelessness Scale (BHS-T) in a chronic schizophrenia out-patient sample. One hundred and two (102) outpatients were evaluated using the translated Taiwanese version of the BHS (BHS-T), as well as several Beck-related symptom rating scales and the Positive and Negative Syndrome Scale (PANSS) for psycho-pathology. The patients were also evaluated for suicidal intent using the critical items of the Scale for Suicide Ideation (SSI) and suicide attempts. The psychometric properties of the BHS-T were also evaluated, including construct validity, internal consistency, test-retest reliability, convergence, and discriminative validity. The BHS-T showed good overall reliability and stability over time. This translated scale comprised a two-factor solution corresponding negative expectation and loss of motivation dimensions. Differences in mean hopelessness scores between participants with and without suicidal intent were significant. The results also indicated that, among individuals with schizophrenia, "negative expectation in the future" is more closely linked to suicide intent than "loss of motivation for the future". The BHS-T is a reliable and valid instrument for measuring the multi-dimensionality of hopelessness and may complement clinical suicidal risk assessments in individuals with schizophrenia.

Future‐directed thinking in first‐episode psychosis

“…The correlation between self-reported hopelessness and negative symptoms supports earlier work in individuals with chronic schizophrenia (Kao et al, 2012;Lysaker et al, 2008;R. G. White et al, 2007) as well as those in their first episode of psychotic illness (Aguilar et al, 1997).…”

“…They found that the group with hopelessness had significantly higher levels of negative symptoms than the group without hopelessness, though their between-groups approach is somewhat in contrast with the other studies of this relationship. Finally, recent work by Kao et al (2012) also supports the link between hopelessness and negative symptoms. In a study of 102 outpatients with chronic schizophrenia, factors derived from the BHS were shown to correlate with negative symptoms as measured by the PANSS.…”

“…On the basis of this evidence it may be predicted that individuals with first episode psychosis would have a reduced capacity for future-directed thinking, and as described in Section 1.4.4, reduced PFT in particular may be connected with hopelessness and the increased risk of suicide observed in this population. This prediction is partially supported by a study in which factor analysis was performed on BHS scores collected from individuals with schizophrenia (Kao, Liu, & Lu, 2012). After covarying for self-reported depression, individuals with and without suicidal ideation differed on a factor derived from the BHS described as "Negative Expectation Of The Future".…”

“…Participants in the other studies described had mean illness durations of 13 (R. G. White et al, 2007), 16 (Kao et al, 2012) and 22 (Lysaker et al, 2004;Lysaker et al, 2008) years (the latter figure is approximate, and is based on the figures reported for age at test minus age at first admission as specific illness duration was not reported).…”

“…However, studies of the correlation between self-reported hopelessness and suicidal ideation have shown a large effect size (Kao et al, 2012;O'Connor et al, 2008). To achieve 80% power to detect a large correlation at an alpha level of 5%, a sample size of 29 within the psychosis group was needed.…”