Hopelessness as a Predictor of Attempted Suicide among First Admission Patients with Psychosis: A 10‐year Cohort Study

Klonsky, E. David; Kotov, Roman; Bakst, Shelly; Rabinowitz, Jonathan; Bromet, Evelyn J.

doi:10.1111/j.1943-278x.2011.00066.x

Cited by 170 publications

(90 citation statements)

References 38 publications

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“…50 That such factors do not help patients with BPD may relate to the more impulsive nature of their suicidal behavior, minimizing protective effects of considerations captured by the Reasons For Living Inventory. The lack of effect of “depressive cognitions” is consistent with our past findings that hopelessness does not predict suicidal behavior, 14, 19 in contrast with other reports 6061,62 .…”

Section: Discussionsupporting

confidence: 91%

Life events: a complex role in the timing of suicidal behavior among depressed patients

et al. 2013

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Suicidal behavior is often conceptualized as a response to overwhelming stress. Our model posits that given a propensity for acting on suicidal urges, stressors such as life events or major depressive episodes (MDEs) determine the timing of suicidal acts.Depressed patients (n=415) were assessed prospectively for suicide attempts and suicide, life events and MDE over 2 years. Longitudinal data was divided into 1-month intervals characterized by MDE (yes/no), suicidal behavior (yes/no), and life event scores. Marginal logistic regression models were fit, with suicidal behavior as the response variable and MDE and life event score in either the same or previous month, respectively, as time-varying covariates.Among 7843 person-months, 33% had MDE and 73% had life events. MDE increased risk for suicidal behavior (OR=4.83, p< 0.0001). Life event scores were unrelated to the timing of suicidal behavior (OR=1.06 per 100 point increase, p=0.32), even during an MDE (OR=1.12, p=0.15). However, among those without Borderline Personality Disorders (BPD), both health and work related life events were key precipitants, as was recurrent MDE, with a 13-fold effect. The relationship of life events to suicidal behavior among those with BPD was more complex. Recurrent MDE was a robust precipitant for suicidal behavior, regardless of BPD comorbidity. The specific nature of life events is key to understanding the timing of suicidal behavior. Given unanticipated results regarding the role of BPD and study limitations, these findings require replication. Of note, that MDE, a treatable risk factor, strongly predicts suicidal behaviors is cause for hope.

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Section: Discussionsupporting

confidence: 91%

Life events: a complex role in the timing of suicidal behavior among depressed patients

et al. 2013

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“…This finding suggests that the relations between insomnia symptoms, thwarted belongingness, and suicidal ideation may demonstrate similar patterns across populations and may not be specific to South Korean young adults or military service members and veterans. In our current sample, it is also worthwhile to note that thwarted belongingness remained a significant mediator even after controlling for hopelessness and anxiety sensitivity, both of which have been associated with suicide risk and sleep problems (Beck, 1986; Capron et al, 2012; Klonsky, Kotov, Bakst, Rabinowitz, & Bromet, 2012). This finding underscores the robustness of this study’s results.…”

Section: Discussionmentioning

confidence: 61%

Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans

Hom

Chu

Schneider

et al. 2017

Journal of Affective Disorders

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Background Although insomnia has been identified as a robust predictor of suicidal ideation and behaviors, little is known about the mechanisms by which sleep disturbances confer risk for suicide. We investigated thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation across three military service member and veteran samples. Methods Data were collected among United States military service members and veterans (N1=937, N2=3,386, N3=417) who completed self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation, and related psychiatric symptoms (e.g., anxiety, hopelessness). Bias-corrected bootstrap mediation analyses were utilized to examine the indirect effects of insomnia symptoms on suicidal ideation through thwarted belongingness, controlling for related psychiatric symptoms. Results Consistent with study hypotheses, thwarted belongingness significantly accounted for the relationship between insomnia and suicidal ideation across all three samples; however, insomnia symptoms did not significantly account for the relationship between thwarted belongingness and suicidal ideation, highlighting the specificity of our findings. Limitations This study utilized cross-sectional, self-report data. Conclusions Insomnia may confer suicide risk for military service members and veterans, in part, through the pathway of thwarted belongingness. Additional prospective studies are warranted to further delineate this model of risk. Our results offer a potential target for the therapeutic prevention of suicide, via the promotion of belongingness, among service members and veterans experiencing insomnia symptoms.

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“…High and modest levels of hopelessness heightened suicide risk in individuals with mental disorders (David Klonsky et al, 2012). Hopelessness was also often accompanied by psychopathological factors such as depression among multiple attempters compared to first time attempters (Chandrasekaran & Chandrasekaran, 2008; Choi et al, 2013; Forman et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Who are likely to attempt suicide again? A comparative study between the first and multiple timers

Liu

Zhang

Sun

2017

Comprehensive Psychiatry

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Background Various explanations account for suicide incidents, and some patients continue to attempt afterwards and others never again. The suicide mortality rate increases with the number of serious attempts. The prevention of secondary attempt of suicide should be an important approach to reduce suicide mortality. However, the characteristics of the targeted population of repeated suicide attempters are understudied. Methods This was a cross-sectional data collection from hospital emergency room from patients who had either attempted suicide for the first time (n=721) or for two or more times (n=70). The subjects were between 14–53 years old and comprised 293 males and 498 females. In-depth interview was conducted for each suicide attempter with a semi-structural protocol. Demographic and social-psychological characteristics were compared between the two groups of suicide attempters. Logistic regression was used to identify independent predictors of multiple attempts. Findings The two groups only differed in religion factor among demographic characteristics and multiple suicide attempters group have a higher percentage of subjects who reported to have a religion affiliation than first time suicide attempters. Multiple attempters were more likely to have family suicide history, physical illness, mental disorder, higher scores on Beck Hopelessness Scale (BHS) and Suicide Intent Scale (SIS) and lower scores on Duke Social Support Scale (DSSI). In the final regression model, family history of suicide, mental disorder, hopelessness and social support emerged as significant predictors of multiple suicide attempts. Conclusion Suicide attempters that have mental disorder, family history of suicide, higher level of hopelessness and lower level of social support are more likely to re-attempt suicide again. Social and clinical interventions may have to also focus on this sub-group of patients with these characteristics to effectively reduce suicide mortality rate.

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Hopelessness as a Predictor of Attempted Suicide among First Admission Patients with Psychosis: A 10‐year Cohort Study

Cited by 170 publications

References 38 publications

Life events: a complex role in the timing of suicidal behavior among depressed patients

Life events: a complex role in the timing of suicidal behavior among depressed patients

Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans

Who are likely to attempt suicide again? A comparative study between the first and multiple timers

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