hopelessness and psychache in the prediction of suicide frédérick dionne 1,2,3, b. sc, cand....

Hopelessness and Psychache in the Prediction of SuicideHopelessness and Psychache in the Prediction of SuicideFrédérick DionneFrédérick Dionne1,2,31,2,3, B. sc, cand. Ph.D., Réal Labelle, B. sc, cand. Ph.D., Réal Labelle1,21,2, Ph.D, Jacques Baillargeon, Ph.D, Jacques Baillargeon11, Ph.D , Ph.D

11Department of psychology, Université du Québec à Trois-Rivières (UQTR), Québec, Canada.Department of psychology, Université du Québec à Trois-Rivières (UQTR), Québec, Canada.

22Centre de recherche et d’intervention sur le suicide et l’euthanasie (CRISE). UQUAM, Québec, Canada.Centre de recherche et d’intervention sur le suicide et l’euthanasie (CRISE). UQUAM, Québec, Canada.33Correspondence: [email protected]: [email protected]

Limitations

• The questionnaires were auto-reported, the results could have been influenced by social desirability and they were based on respondent’s conscious awareness.

• The suicide variable is mostly composed of suicide ideaters.

• The item that attest suicide was statistically taken out of BDI-II questionnaire, this could have modified the construct of depression.

• The SQ is more a clinical tool and lacks psychometrics data. Even tough first results of the psychometrics properties of the SQ are encouraging (Lee, Taylor, & Dunn) 1999, Schmidt, 1995), as for the equivalence of the short form and the long form (Waller, Meyer, & Ohanian, 2001), the SQ, especially the french version, need more empirical data.

• The research employed a cross-sectional design and the suicide criteria were taken retrospectively. Therefore, inferences about causality cannot be made. Longitudinal research is required.

ConclusionsConclusions

See adress of correspondence for references

Aaron T. Beck and al. (1975) have certainly contributed remarkably to the comprehension of suicidal behaviors by showing that hopelessness is a «catalytic agent» to suicide. On the other hand, Edwin S. Shneidman (1985; 2004) has put emphasis on the role of psychological pain (psychache) as the key variable related to suicidal behaviors. Recently, this concept was operationalized (Orbach, Mikulincer, Sirota, & Gilboa-Schechtman, 2003; Holden, and al., 2001), but very few studies put this concept to empirical scrutiny. The objective of the present study is to determine which variables between hopelessness and psychache explain suicidal behaviors (ideations and attempts) best in a sample of 619 French-Canadian undergraduate students between 18 and 30 years old.

Participants

Six hundred and nineteen young adults university students from different faculties were recruited at Université du Québec à Trois-Rivières (UQTR), Quebec, Canada. Students were seen during their class in September 2003 and they were ask to respond to several questionnaires for a research on mental health. Participants ranged in age from 18 to 30 years (M = 21.82, SD = 2.39) and were 31.5 % males and 68.3 % females. They were treated in accordance with the ethical standards of UQTR.

Materiel

The package contained a letter of introduction including a consent form, a sociodemographical information sheet and a debriefing sheet with information on local counseling resources. Also, here are the questionnaires we included to measure our variables:

•Beck Depression Inventory II (BDI-II) (Beck and al.,1996).

•Beck Hopelessness Scale (BHS) (Beck and al., 1974; Bouvard, and al., 1992).

•Psychache Scale (Holden and al., 2001; Dionne and al., 2004),

•Schema Questionnaire with early maladaptive schemas derived from the category «disconnection and rejection». (Short form, Young, 1998; Mihaescu and al., 1997; Cousineau, 2000).

•Suicide variable: an additive variable that ranges between 1 to 7 was created from questions of the BDI-II and from Enquetes Sante Quebec. Here are frequencie statistics of the suicide criterias. Item 9 of the BDI-II: question 1 (13.4 %); question 2 (.5 %); question 3 (.2 %).

Severe ideation in the last 12 months: (Yes: 6.3 %)

Severe ideation with a plan in the last 12 months: (Yes: 2.6 %)

Suicidal attempts in the last 12 months: 1 attempt (.1 %); 2 attempts (.2 %).

Hopelessness or psychache in the prediction of suicide?Hopelessness or psychache in the prediction of suicide?

Aims of studyAims of study1) The relative contributions of hopelessness

and psychache, while controlling for each other variable as well as depression, is tested with a structural linear equation computed with LISREL 8.51 (Jöreskog and Sörbom, 2001).

2) Adding concepts of the schema therapy (Young, and al., 2003), an integrative framework that can account for both Shneidman’s (1987;1993) theorizing on suicide and cognitive theory for suicidality (Rudd, 2004), hopelessness and psychache are each compare on the basis of their goodness of fit statistics and their variance explained in two structural equations models.

Goodness of fit statisticsStructural equation without depression and hopelessness

Minimum fit function Chi2

147.199 ( p<0.01)150.631

( p<0.01), 32 dl

Ratio Chi2 / dl 147.99/30 dl = 4.93150.631- 147.199 =

3.432, 2dl (n-s.)

RMSEA 0.0792 0.0769

Standardized RMR 0.0317 0.0325

GFI 0.955 0.954

Expected cross validation index ECVI

0.318 0.316

Non-normed fit index NNFI

0.956 0.956

Comparative fit index CFI

0.969 0.968

Paths to suicide with schemas of disconnection and rejection and hopelessness.Paths to suicide with schemas of disconnection and rejection and hopelessness.

Goodness of fit statisticsStructural equation with

hopelessness

Minimum fit function Chi2 193.053 ( p<0.01)

Ratio Chi2 / dl 193.053/62 dl = 3.11

RMSEA 0.0576

Standardized RMR 0.0443

GFI 0.958


0.447

Non-normed fit index NNFI 0.954

Comparative fit index CFI 0.969

Variance explained R² = 0.230

Paths to suicide with schemas of disconnection and rejection and psychachePaths to suicide with schemas of disconnection and rejection and psychache

Goodness of fit statisticsStructural equation without

depression and hopelessness

Minimum fit function Chi2 169.486 ( p<0.01)

Ratio Chi2 / dl 169.486/62 dl = 2.73

RMSEA 0.0514

Standardized RMR 0.0260

GFI 0.964


0.405

Non-normed fit index NNFI 0.970

Comparative fit index CFI 0.968

Variance explained R² = 0.348

ResultsResults

Figure 1. Model with three latent variables as predictors (depression, hopelessness and psychache) regressed simultaneously on the suicide variable. Standardized path coefficients are provided, along with errors associated with each measured variable, t values are enclosed in parentheses and the variance explained (R²) for the structural equation is provided.

Figure 2. Path analysis for the model incorporating schemas and testing with hopelessness. Standardized path coefficients are provided, along with errors associated with each measured variable, t values are enclosed in parentheses and the variance explained for the structural equation is provided.

0,85

0,64

0,91

0,88

0,73

0,89

0,74

0,78

0,82

0.23

0.33

0.17

0.21

0.39

0.59

0.47

0.45

0.27

Psychache1

Hopelessn.1

Depression3

Depression1

Psychache2

Psychache3

Hopelessn.3

Hopelessn.2

Depression2

SUICIDEItem 9 of the BDI-IISerious Ideation

Serious Ideation with a plan and suicide attempts

in the last year.

Depression

Hopelessness

Psychache

0,13 (1.50)

-0,00 (-0.05)

0,48 (6.82)

Structural equation:

R² = 0.35

Signif.

Non-signif.

(T-values)

Structural equation:

R² = 0.35

0,92

0,77

0,90

0,70

0,73

0,87

0,84

0,85

0,92

0,87

Social Isol.∕Alienation1

Mistrust∕Abuse2

Mistrust∕Abuse1

Aband.∕Instability1

Emotion. Deprivation2




Defectiveness∕Shame1


0.28

0.16

0.25

0.18

0.47

0.30

0.41

0.15

0.24

0.51

Emotional Deprivation

Abandonment∕Instability

Mistrust∕Abuse

Social Isolation∕Alienation

Defectiveness∕Shame

Signif.

Non-signif.

(T-values)

Psychache

SUICIDEItem 9 of the BDI-IISerious Ideation

Serious Ideation with a plan and Suicide

attempts in the last year.

0.59 (16.30)

0,32 (5.79)

0,13 (2.16)

0,12

(1.8

9)0,

27 (5

.35)

0,09 (1.46)

Hopelessness

SUICIDE

Item 9 of the BDI-IISerious Ideation

Serious Ideation with a plan and Suicide

attempts in the last year.

0.48 (10.66)

Structural equation: R² = 0.230.92

0.76

0.90

0.70

0.73

0.86

0.85

0.85

0.92

0.87


Mistrust∕Abuse2

Mistrust∕Abuse1








0.28

0.16

0.25

0.18

0.47

0.28

0.42

0.15

0.24

0.51

Emotional Deprivation

Abandonment∕Instability

Mistrust∕Abuse

Social Isolation∕Alienation

Defectiveness∕Shame

.09 (1.27)

.19 (2.54)

.18

(2.2

5)

.35

(5.3

3)

Signif.

Non-signif.

(T-values)

-.03 (-.41)

Figure 3. Path analysis for the model incorporating schemas and testing with psychache. Standardized path coefficients are provided, along with errors associated with each measured variable, t values are enclosed in parentheses and the variance explained for the structural equation is provided.

ConclusionsConclusions

Table 1. Well known goodness of fit statistics of the model presented on Figure 1, comparing with the model without the

non-significatives t-values.

Table 2. Well known goodness of fit statistics of the model presented in Figure 2.

Table 3. Well known goodness of fit statistics of the model presented in Figure 3.

IntroductionIntroduction

MethodMethod

Results show the statistical pre-eminence of psychache over the construct of hopelessness in the prediction of suicide manifestations in young adults. First (see Figure 1), multiple regression results highlight the strength of psychache over the construct of hopelessness. When we statistically controlled for each others variables including depression, psychache retained his statistical significance and reduced both hopelessness and depression to nonsignificance. Second, the performance of psychache was supported in two structural equations model adding early maladaptative schemas from the category disconnection and rejection. The model with psychache (see Figure 3, Table 3) showed a better fit of the data and more variance explained compare to the model with hopelessness (see Figure 2, Table 2). The results support Shneidman’s theorizing that emphasizes on pychological pain as a key variable related to suicidality.

ReferencesReferences

Disconnection and rejection: «The expectations that one’s needs for security, safety, stability, nurturance, empathy, sharing of feelings,

acceptance, and respect will no be met in a predictable manner» (Young, Klosko, & Weishaar, 2003, p.14).

1. The findings corroborate other studies that tested depression or hopelessness and its relationship with psychological pain (Berlim and al., 2003; Orbach, Mikuliner, Gilboa-Schechtma, and Sirota, 2003; Orbach and al., 2003; Holden and al., 2001).

2. They also suggest to add the concept of psychache, particularly with depression or hopelessness, in future researches on suicide. Those studies needs to be done in a various suicidal clinical populations.

3. The results showed in Figure 2 and 3 unfold paths to suicide from a schema theory perspective. With the hopelessness variable as the mediating variable to suicide (Figure 2), the defectiveness/shame, emotional deprivation and social isolation/alienation appeared to be the strongest risk factor to suicide. With the psychache variable as the mediating variable to suicide (Figure 3), abandonment∕instability, defectiveness /shame as well as emotional deprivation appeared to be the most powerful risk factor to suicide. This is mostly in accordance with Freeman and Reinecke (1993) that stated that the schemas of suicidal individuals frequently center around themes of vulnerability to loss or abandonment and their personal inadequacy or unlovability. Furthermore, here’s how Shneidman (1998) resumes the main frustrated needs that are involved in suicides:

«In general, we are talking about thwarted love, fractured control, assaulted self-image, excessive anger, a surfeit of shame, ruptured key relations and the attendand grief- and the inner pain of that turmoil. »

4. From a clinical standpoint, the results underlie the importance on intervening on psychological pain, perhaps before hopelessness or depression, when intervening with a suicidal young adult.

5. For further researches, it may be beneficial to examine how coping, distress tolerance or stressful life events interact with psychache, notably to have a clearer outlook on how Shneidman’s (1987;1993) cubic model (press, perturbation and psychache), equivalent in several ways to Rudd’s (2004) conceptual framework, are valid explicative models of suicidality. It would also be beneficial to examine a model proposed by Holden et al. (2001) (depression hopelessness psychache suicide), again, especially in clinical settings.

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hopelessness and psychache in the prediction of suicide frédérick dionne 1,2,3, b. sc, cand....

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