Hopelessness factor in predicting suicides

Press, 6 March 1985, Page 30

Hopelessness factor in predicting suicides

By

DANIEL GOLEMAN

“New York Times”

through NZPA New York

The sense of hopelessness among those contemplating suicide is the strongest predictor of which people will actually go on to kill themselves, according to a study done at the University of Pennsylvania School of Medicine.

Hopelessness, the study showed, was a more telling indicator than were feelings of depression in predicting which patients admitted to hospital for contemplating suicide subsequently killed themselves over the next five years. In the study, 207 patients who were admitted to hospital because they were contemplating suicide but had not made a recent attempt were followed for five to seven years. In that period 14 patients committed suicide — 13 of them had high scores on a measure of hopelessness when originally tested.

The tests were administered within two days of the patients’ admission to a psychiatric hospital. In most cases, the suicide itself occurred several years after the patient was tested. The study, made by a team under the direction of Dr Aaron Beck, will be

reported in the “American Journal of Psychiatry.”

Although all those studied were included because they said they had thought of killing themselves, they did not all share a single psychiatric diagnosis. About half were disgnosed as having one or another variety of depression, about a quarter were given a diagnosis of schizophrenia, and the rest included diagnoses of personality disorders, neuroses or other syndromes.

While researchers in the past have tested various ways to predict which people who contemplate suicide are the highest risks, this study is unusual in the extent to which the investigators managed to follow those studied for several years after being admitted to hospital.

Patients were reached yearly, either directly or through family or friends. In several instances, patients were traced to foreign countries; in others, according to Dr Beck, favorite bartenders served as the contacts through which patients- were followed.

Further, the death records of the Philadelphia Medical Examiner’s Office were scanned daily. Whenever a patient died, coroner’s reports were requested to varify the cause of death.

Of the original 207 patients in the study, all were followed successfully for five years, and the manner of death was established for all those who died in that period. The particular test that identified those patients with an attitude of hopelessness was the Beck Depression Inventory, which is widely used in psychological assessment.

The key part of the inventory was the “hopelessness scale,” which includes items such as the statements, “I might as well give up because I can’t make things better for myself,” and “I never get what I want so it’s foolish to want anything.” Suicide is relatively rare; far more people contemplate the act than attempt it. Nevertheless, it is crucial to psychiatrists and psychologists to be able to identify which patients among those who say they think of killing themselves are actually at higher risk of doing so.

Because suicide is so hard to predict, the researchers note, having a high score on the hopelessness scale does not necessarily mean a person is a high risk for suicide. In the same study, 76 patients who did not subsequently commit suicide also had high scores on the hopelessness scale.

Nevertheless, because such a large proportion of those who did commit suicide were among those scoring high on the hopelessness scale, the researchers believe it will be a useful instrument in the care of patients at risk for suicide. A high score on the hopelessness scale, the researchers conclude, indicates that a person should not only be observed closely while under treatment but should be watched carefully and re-evaluated after leaving psychiatric care.