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

Authors

  • E. David Klonsky PhD,

    1. E. DavidKlonsky, University of British Columbia, Vancouver, Canada; RomanKotov, Evelyn J. Bromet, Stony Brook University, Stony Brook, NY, USA; ShellyBakst and Jonathan Rabinowitz, Bar Ilan University, Ramat Gan, Israel.
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  • Roman Kotov PhD,

    1. E. DavidKlonsky, University of British Columbia, Vancouver, Canada; RomanKotov, Evelyn J. Bromet, Stony Brook University, Stony Brook, NY, USA; ShellyBakst and Jonathan Rabinowitz, Bar Ilan University, Ramat Gan, Israel.
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  • Shelly Bakst PhD,

    1. E. DavidKlonsky, University of British Columbia, Vancouver, Canada; RomanKotov, Evelyn J. Bromet, Stony Brook University, Stony Brook, NY, USA; ShellyBakst and Jonathan Rabinowitz, Bar Ilan University, Ramat Gan, Israel.
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  • Jonathan Rabinowitz PhD,

    1. E. DavidKlonsky, University of British Columbia, Vancouver, Canada; RomanKotov, Evelyn J. Bromet, Stony Brook University, Stony Brook, NY, USA; ShellyBakst and Jonathan Rabinowitz, Bar Ilan University, Ramat Gan, Israel.
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  • Evelyn J. Bromet PhD

    1. E. DavidKlonsky, University of British Columbia, Vancouver, Canada; RomanKotov, Evelyn J. Bromet, Stony Brook University, Stony Brook, NY, USA; ShellyBakst and Jonathan Rabinowitz, Bar Ilan University, Ramat Gan, Israel.
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  • This study was supported in part by National Institute of Mental Health grant MH44801 (E. J. Bromet) and a grant from the American Foundation for Suicide Prevention (E. D. Klonsky). We thank Dr. Charles Rich for assistance in the design of this study. We are indebted to the project psychiatrists, interviewers, data team, and mental health professionals in Suffolk County for their outstanding support. We are particularly indebted to the study participants for contributing their time and valuable input throughout the course of the study.

Address correspondence to E. D. Klonsky, Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada; E-mail: edklonsky@psych.ubc.ca

Abstract

Little is known about the longitudinal relationship of hopelessness to attempted suicide in psychotic disorders. This study addresses this gap by assessing hopelessness and attempted suicide at multiple time-points over 10 years in a first-admission cohort with psychosis (= 414). Approximately one in five participants attempted suicide during the 10-year follow-up, and those who attempted suicide scored significantly higher at baseline on the Beck Hopelessness Scale. In general, a given assessment of hopelessness (i.e., baseline, 6, 24, and 48 months) reliably predicted attempted suicide up to 4 to 6 years later, but not beyond. Structural equation modeling indicated that hopelessness prospectively predicted attempted suicide even when controlling for previous attempts. Notably, a cut-point of 3 or greater on the Beck Hopelessness Scale yielded sensitivity and specificity values similar to those found in nonpsychotic populations using a cut-point of 9. Results suggest that hopelessness in individuals with psychotic disorders confers information about suicide risk above and beyond history of attempted suicide. Moreover, in comparison with nonpsychotic populations, even relatively modest levels of hopelessness appear to confer risk for suicide in psychotic disorders.

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