Presentation on theme: "Hopelessness and Psychache in the Prediction of Suicide Frédérick Dionne 1,2,3, B. sc, cand. Ph.D., Réal Labelle 1,2, Ph.D, Jacques Baillargeon 1, Ph.D."— Presentation transcript:
Hopelessness and Psychache in the Prediction of Suicide Frédérick Dionne 1,2,3, B. sc, cand. Ph.D., Réal Labelle 1,2, Ph.D, Jacques Baillargeon 1, Ph.D 1 Department of psychology, Université du Québec à Trois-Rivières (UQTR), Québec, Canada. 1 Department of psychology, Université du Québec à Trois-Rivières (UQTR), Québec, Canada. 2 Centre de recherche et dintervention sur le suicide et leuthanasie (CRISE). UQUAM, Québec, Canada. 2 Centre de recherche et dintervention sur le suicide et leuthanasie (CRISE). UQUAM, Québec, Canada. 3 Correspondence: Frederick_Dionne@uqtr.ca Limitations The questionnaires were auto-reported, the results could have been influenced by social desirability and they were based on respondents 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. Conclusions 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? Aims of study 1) 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 Shneidmans (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 statistics Structural equation without depression and hopelessness Minimum fit function Chi 2 147.199 ( p<0.01) 150.631 ( p<0.01), 32 dl Ratio Chi 2 / dl147.99/30 dl = 4.93 150.631- 147.199 = 3.432, 2dl (n-s.) RMSEA0.07920.0769 Standardized RMR0.03170.0325 GFI0.9550.954 Expected cross validation index ECVI 0.3180.316 Non-normed fit index NNFI 0.956 Comparative fit index CFI 0.9690.968 Paths to suicide with schemas of disconnection and rejection and hopelessness. Goodness of fit statistics Structural equation with hopelessness Minimum fit function Chi 2 193.053 ( p<0.01) Ratio Chi 2 / dl193.053/62 dl = 3.11 RMSEA0.0576 Standardized RMR0.0443 GFI0.958 Expected cross validation index ECVI 0.447 Non-normed fit index NNFI0.954 Comparative fit index CFI0.969 Variance explainedR² = 0.230 Paths to suicide with schemas of disconnection and rejection and psychache Goodness of fit statistics Structural equation without depression and hopelessness Minimum fit function Chi 2 169.486 ( p<0.01) Ratio Chi 2 / dl169.486/62 dl = 2.73 RMSEA0.0514 Standardized RMR0.0260 GFI0.964 Expected cross validation index ECVI 0.405 Non-normed fit index NNFI0.970 Comparative fit index CFI0.968 Variance explainedR² = 0.348 Results 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 SUICIDE Item 9 of the BDI-II Serious 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 MistrustAbuse2 MistrustAbuse1 Aband.Instability1 Emotion. Deprivation2 Emotion. Deprivation1 Aband.Instability2 Social Isol.Alienation2 DefectivenessShame1 DefectivenessShame2 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 SUICIDE Item 9 of the BDI-II Serious 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 (1.89) 0,27 (5.35) 0,09 (1.46) Hopelessness SUICIDE Item 9 of the BDI-II Serious Ideation Serious Ideation with a plan and Suicide attempts in the last year. 0.48 (10.66) Structural equation: R² = 0.23 0.92 0.76 0.90 0.70 0.73 0.86 0.85 0.92 0.87 Social Isol.Alienation1 MistrustAbuse2 MistrustAbuse1 Aband.Instability1 Emotion. Deprivation2 Emotion. Deprivation1 Aband.Instability2 Social Isol.Alienation2 DefectivenessShame1 DefectivenessShame2 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 (2.25).35 (5.33) 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. Conclusions 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. Introduction Method 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 Shneidmans theorizing that emphasizes on pychological pain as a key variable related to suicidality. References Disconnection and rejection: «The expectations that ones 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), abandonmentinstability, 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, heres 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 Shneidmans (1987;1993) cubic model (press, perturbation and psychache), equivalent in several ways to Rudds (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.