Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression, Suicidal Ideation, and Suicidal Behavior in High‐Risk Adolescents

Horwitz, Adam G.; Berona, Johnny; Czyz, Ewa K.; Yegüez, Carlos E.; King, Cheryl A.

doi:10.1111/sltb.12273

Cited by 128 publications

(89 citation statements)

References 28 publications

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“…Consistent with prior research on suicide risk factors, we observed correlations between thoughts of being better off dead or suicide and depression, stress, anxiety, hopelessness, and alcohol use (Esposito-Smythers and Spirito, 2004; Horwitz et al, 2016; Nemeroff et al, 2001; Nyer et al, 2013). In fact, the presence of this entire constellation of symptoms was sufficient for the latent class model to categorize respondents in the highest risk group (class 6), even if they did not endorse thoughts of suicide.…”

Section: Discussionsupporting

confidence: 89%

Suicidal ideation and behavior in institutions of higher learning: A latent class analysis

Bernanke

Galfalvy

Mortali

et al. 2017

Journal of Psychiatric Research

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Suicide is the second leading cause of death among undergraduate students, with an annual rate of 7.5 per 100,000. Suicidal behavior (SB) is complex and heterogeneous, which might be explained by there being multiple etiologies of SB. Data-driven identification of distinct at-risk subgroups among undergraduates would bolster this argument. We conducted a latent class analysis (LCA) on survey data from a large convenience sample of undergraduates to identify subgroups, and validated the resulting latent class model on a sample of graduate students. Data were collected through the Interactive Screening Program deployed by the American Foundation for Suicide Prevention. LCA identified 6 subgroups from the undergraduate sample (N=5654). In the group with the most students reporting current suicidal thoughts (N=623, 66% suicidal), 22.5% reported a prior suicide attempt, and 97.6% endorsed moderately severe or worse depressive symptoms. Notably, LCA identified a second at-risk group (N=662, 27% suicidal), in which only 1.5% of respondents noted moderately severe or worse depressive symptoms. When graduate students (N=1138) were classified using the model, a similar frequency distribution of groups was found. Finding multiple replicable groups at-risk for suicidal behavior, each with a distinct prevalence of risk factors, including a group of students who would not be classified as high risk with depression-based screening, is consistent with previous studies that identified multiple potential etiologies of SB.

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Section: Discussionsupporting

confidence: 89%

Suicidal ideation and behavior in institutions of higher learning: A latent class analysis

Bernanke

Galfalvy

Mortali

et al. 2017

Journal of Psychiatric Research

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“…This suggests that as an individual's hopelessness increases, even slightly, the potential for the presence of suicide ideation is significantly increased over the course of a short period of acute treatment. These findings mirror those from previous studies, which suggest that hopelessness is a key variable in understanding suicidality in youth (e.g., DeCamp & Bakken, ; Groholt et al., ; Horwitz et al., ). Specifically, our results support prior research which has suggested that greater levels of hopelessness are related to an increased risk for suicide ideation and behaviors (DeCamp & Bakken, ; Labelle et al., ; Nock & Kazdin, ; Stewart et al., ).…”

Section: Discussionsupporting

confidence: 89%

“…Indeed, Horwitz et al. () suggested that the various theoretical orientations may conceptualize the role of hopelessness differently and thus influence the relevance, development, and potential intervention to address this important variable.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Horwitz et al. () exploring the influence of hopelessness on suicidal behavior, the findings indicate that a lack of positive expectations for one's future, as opposed to the presence of negative expectations, is indicative of future suicidal behavior among adolescents. Indeed, Stewart et al.…”

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confidence: 99%

“…However, given the findings of previous research that highlight the importance of the role of hopelessness in suicidality, researchers have recently begun to more thoroughly examine the role of hopelessness on suicidality in adolescents. There now exists a growing evidence base to support the role of hopelessness in adolescent suicidal behavior (DeCamp & Bakken, ; Groholt, Ekeberg, & Haldorsen, ; Horwitz, Berona, Czyz, Yeguez, & King, ). For instance, DeCamp and Bakken () report that adolescents who feel a greater sense of hopelessness are at an increased risk for suicide.…”

mentioning

confidence: 99%

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Hopelessness as a Predictor of Suicide Ideation in Depressed Male and Female Adolescent Youth

Wolfe

Nakonezny

Owen

et al. 2017

Suicide & Life Threat Behav

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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.

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How individuals change during internet‐based interventions for depression: A randomized controlled trial comparing standardized and individualized feedback

et al. 2019

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BackgroundStandardized and individualized Internet‐based interventions (IBI) for depression yield significant symptom improvements. However, change patterns during standardized or individualized IBI are unknown. Identifying subgroups that experience different symptom courses during IBI and their characteristics is vital for improving response.MethodsMildly to moderately depressed individuals according to self‐report (N = 1,089) were randomized to receive module‐wise feedback that was either standardized or individualized by a counselor within an otherwise identical cognitive‐behavioral IBI for depression (seven modules over six weeks). Depressive symptoms were assessed at baseline and before each module (Patient Health Questionnaire; PHQ‐9). Other individual characteristics (self‐report) and the presence of an affective disorder (structured clinical interview) were assessed at baseline. Growth mixture modeling was used to identify and compare subgroups with discernable change patterns and associated client variables across conditions.ResultsModel comparisons suggest equal change patterns in both conditions. Across conditions, a group of immediate (62.5%) and a group of delayed improvers (37.5%) were identified. Immediate improvers decreased their PHQ‐9 score by 5.5 points from pre to post, with 33% of improvement occurring before treatment commenced. Delayed improvers were characterized by stable symptom severity during the first two modules and smaller overall symptom decrease (3.4 points). Higher treatment expectations, a current major depressive disorder (interview), and lower social support were associated with delayed improvement.ConclusionInternet‐based interventions for depression with individualized and with standardized feedback lead to comparable patterns of change. Expectation management and bolstering of social support are promising strategies for individuals that are at risk for delayed improvement.

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Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression, Suicidal Ideation, and Suicidal Behavior in High‐Risk Adolescents

Cited by 128 publications

References 28 publications

Suicidal ideation and behavior in institutions of higher learning: A latent class analysis

Suicidal ideation and behavior in institutions of higher learning: A latent class analysis

Hopelessness as a Predictor of Suicide Ideation in Depressed Male and Female Adolescent Youth

How individuals change during internet‐based interventions for depression: A randomized controlled trial comparing standardized and individualized feedback

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