Advertisement

Psychiatric Quarterly

, Volume 83, Issue 2, pp 241–255 | Cite as

Beck Hopelessness Scale: Exploring its Dimensionality in Patients with Schizophrenia

  • Yu-Chen Kao
  • Yia-Ping Liu
  • Chien-Wen Lu
Original Paper

Abstract

Hopelessness is a pre-eminent risk factor for suicide and non-fatal self-harm. Although the Beck Hopelessness Scale is often used for schizophrenia, its factor structure has been given relatively little consideration in this context. This study aimed to examine the reliability and validity of the Taiwanese version of the Beck Hopelessness Scale (BHS-T) in a chronic schizophrenia out-patient sample. One hundred and two (102) outpatients were evaluated using the translated Taiwanese version of the BHS (BHS-T), as well as several Beck-related symptom rating scales and the Positive and Negative Syndrome Scale (PANSS) for psycho-pathology. The patients were also evaluated for suicidal intent using the critical items of the Scale for Suicide Ideation (SSI) and suicide attempts. The psychometric properties of the BHS-T were also evaluated, including construct validity, internal consistency, test–retest reliability, convergence, and discriminative validity. The BHS-T showed good overall reliability and stability over time. This translated scale comprised a two-factor solution corresponding negative expectation and loss of motivation dimensions. Differences in mean hopelessness scores between participants with and without suicidal intent were significant. The results also indicated that, among individuals with schizophrenia, “negative expectation in the future” is more closely linked to suicide intent than “loss of motivation for the future”. The BHS-T is a reliable and valid instrument for measuring the multi-dimensionality of hopelessness and may complement clinical suicidal risk assessments in individuals with schizophrenia.

Keywords

BHS Hopelessness Suicide Schizophrenia Reliability Validity 

Notes

Conflict of interests

The authors declare no competing or conflicts of interests.

References

  1. 1.
    Beck AT, Weissman A, Lester D, et al.: The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology 42:861–865, 1974.PubMedCrossRefGoogle Scholar
  2. 2.
    Beck AT, Weissman A: The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology 47:861–863, 1974.CrossRefGoogle Scholar
  3. 3.
    Shahar G, Bareket L, Rudd MD, et al.: In severely suicidal young adults, hopelessness, depressive symptoms, and suicidal ideation constitute a single syndrome. Psychological Medicine 36:913–922, 2006.PubMedCrossRefGoogle Scholar
  4. 4.
    Kim CH, Jayathilake K, Meltzer HY: Hopelessness, neuro-cognitive function function, and insight in schizophrenia: Relationship to suicidal behavior. Schizophrenia Research 60:71–80, 2003.PubMedCrossRefGoogle Scholar
  5. 5.
    Joiner TE, Brown JS, Wingate LR: The psychology and neurobiology of suicidal behavior. Annual Review of Psychology 56:287–314, 2005.PubMedCrossRefGoogle Scholar
  6. 6.
    Lysaker PH, Davis LW, Hunter NL: Neuro-cognitive, social and clinical correlates of two domains of hopelessness in schizophrenia. Schizophrenia Research 70:277–285, 2004.PubMedCrossRefGoogle Scholar
  7. 7.
    Lysaker PH, Salyers MP, Tsai J, et al.: Clinical and psychological correlates of two domains of hopelessness in schizophrenia. Journal of Rehabilitation Research and Development 45(6):911–920, 2008.PubMedCrossRefGoogle Scholar
  8. 8.
    Sher L: Alcoholism and suicidal behavior: A clinical overview. Acta Psychiatrica Scandinavica 113(1):13–22, 2006.PubMedCrossRefGoogle Scholar
  9. 9.
    Conner KR, Duberstein PR: Predisposing and precipitating factors for suicide among alcoholics: empirical review and conceptual integration. Alcoholism: Clinical and Experimental Research 28(5 Suppl):6S–17S, 2004.CrossRefGoogle Scholar
  10. 10.
    Nisenbaum R, Links PS, Eynan R: Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: Multi-level analyses applied to experience sampling methodology. Journal of Abnormal Psychology 119(2):433–439, 2010.PubMedCrossRefGoogle Scholar
  11. 11.
    Pompili M, Iliceto P, Innamorati M, et al.: Suicide risk and personality traits in physically and/or sexually abused acute psychiatric inpatients: A preliminary study. Psychological Reports 105(2):554–568, 2009.PubMedCrossRefGoogle Scholar
  12. 12.
    Rosenfeld B, Gibson C, Kramer M, et al.: Hopelessness and terminal illness: The construct of hopelessness in patients with advanced AIDS. Palliative & Supportive Care 2:43–53, 2004.CrossRefGoogle Scholar
  13. 13.
    McClan CS, Rosenfeld B, Breibart W: Effects of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 361(9369):1603–1608, 2003.CrossRefGoogle Scholar
  14. 14.
    Abbey JG, Rosenfeld B, Pessin H, et al.: Hopelessness at the end of life: The utility of the hopelessness scale with terminally ill cancer patients. British Journal of Health Psychology 11:173–183, 2006.PubMedCrossRefGoogle Scholar
  15. 15.
    Nissim R, Flora DB, Cribbie RA, et al.: Factor structure of the beck hopelessness scale in individuals with advanced cancer. Psycho-oncology 19(3):255–263, 2010.PubMedCrossRefGoogle Scholar
  16. 16.
    Williams CB, Galanter M, Dermatis H, et al.: The importance of hopelessness among university students seeking psychiatric counseling. Psychiatry Quarterly 79(4):311–319, 2008.CrossRefGoogle Scholar
  17. 17.
    Haatainen KM, Tanskanen A, Kylma J, et al.: Life events are important in the course of hopelessness-A 2 year follow-up study in a general population. Social Psychiatry and Psychiatry Epidemiology 38(8):436–441, 2003.CrossRefGoogle Scholar
  18. 18.
    Yip PSF, Cheung YB Quick assessment of hopelessness: A cross-sectional study. Health Quality Life Outcomes 4:13, 2006.CrossRefGoogle Scholar
  19. 19.
    Westermeyer JF, Harrow M, Marengo JT: Risk for suicide in schizophrenia and other psychotic and non-psychotic disorders. Journal of Nervous and Mental Disease 170:259–266, 1991.Google Scholar
  20. 20.
    Bengtsson-Tops A, Hansen L: Clinical and social needs of schizophrenic out-patients living in the community: The relationship between needs and subjective quality of life. Social Psychiatry and Psychiatry Epidemiology 34(10):513–518, 1999.CrossRefGoogle Scholar
  21. 21.
    Brekke JS, Long JD: Community-based psychological rehabilitation and prospective change in functional, clinical, and subjective experience variables in schizophrenia. Schizophrenia Bulletin 26(3):667–680, 2000.PubMedCrossRefGoogle Scholar
  22. 22.
    Kruger A: Schizophrenia: Recovery and hope. Psychiatric Rehabilitation 24:29–37, 2000.Google Scholar
  23. 23.
    Wright ER, Gronfein WP, Owen TJ: De-institutionalization, social rejection and the self-esteem of former mental patients. Journal of Health and Social Behavior 41:68–90, 2000.PubMedCrossRefGoogle Scholar
  24. 24.
    Roe D: A prospective study on the relationship between self-esteem and functioning during the first year after being hospitalized for psychosis. Journal of Nervous and Mental Disease 191(1):45–49, 2003.PubMedCrossRefGoogle Scholar
  25. 25.
    Hoffamn H, Kupper Z, Kunz B: Hopelessness and its impact on rehabilitation outcome in schizophrenia-an exploratory study. Schizophrenia Research 43:147–158, 2000.CrossRefGoogle Scholar
  26. 26.
    Davis LW, Nees MA, Huncer NL: Hopelessness as a predictor of work functioning among patients with schizophrenia. Psychiatric Services 55(4):434–436, 2004.PubMedCrossRefGoogle Scholar
  27. 27.
    Lysaker PH, Clements CA, Wright DW: Neuro-cognitive correlates of helplessness, hopelessness and well being in schizophrenia. Journal of Nervous and Mental Disease 189:457–462, 2001.PubMedCrossRefGoogle Scholar
  28. 28.
    Hill RD, Gallagher D, Thompson LW, et al.: Hopelessness as a measure of suicidal intent in the depressed elderly. Psychology and Aging 3:230–232, 1988.PubMedCrossRefGoogle Scholar
  29. 29.
    Steer RA, Kumar G, Beck AT: Hopelessness in adolescent psychiatric inpatients. Psychological Reports 72:559–564, 1993.PubMedCrossRefGoogle Scholar
  30. 30.
    Tanaka E, Sakamoto S, Ono Y, et al.: Hopelessness in a community population: Factorial structure and psychosocial correlates. Journal of Social Psychology 138:581–590, 1998.PubMedCrossRefGoogle Scholar
  31. 31.
    Beck AT, Steer RA, Kovacs M, et al.: Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation. American Journal of Psychiatry 142:559–563, 1985.PubMedGoogle Scholar
  32. 32.
    Glanz LM, Haas GL, Sweeney JA: Assessment of hopelessness in suicidal patients. Clinical Psychology Review 15(1):49–64, 1995.CrossRefGoogle Scholar
  33. 33.
    Beck AT, Brown G, Berchick RJ, et al.: Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. American Journal of Psychiatry 147:190–195, 1990.PubMedGoogle Scholar
  34. 34.
    American Psychiatry Association: Diagnostic and statistical manual of mental disorders, 4th edn. Washington (DC): American Psychiatric Press, 2000.Google Scholar
  35. 35.
    Beck AT, Kovacs M, Weissman M: Assessment of suicidal intention: The scale for suicidal ideation. Journal of Consulting and Clinical Psychology 47:343–352, 1979.PubMedCrossRefGoogle Scholar
  36. 36.
    Sokero PT, Melartin TK, Rytsala HJ: Suicidal ideation and attempts among psychiatric patients with major depressive disorder. Journal of Clinical Psychiatry 64:1094–1100, 2003.PubMedCrossRefGoogle Scholar
  37. 37.
    Beck AT, Rush AJ, Shaw BF, et al.: Cognitive therapy of depression. New York: Guilford Press, 1979.Google Scholar
  38. 38.
    Beck AT, Steer R, Garbin M: Psychometric properties of the beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review 8:77–110, 1988.CrossRefGoogle Scholar
  39. 39.
    Endler NS, Rutherford A, Denisoff E: Beck depression inventory: Exploring it dimensionality in a nonclinical population. Journal of Clinical Psychology 55:1307–1312, 1999.PubMedCrossRefGoogle Scholar
  40. 40.
    Kay SR, Fizbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13:261–276, 1987.PubMedGoogle Scholar
  41. 41.
    Bell MD, Lysaker PH, Beam-Goulet JL, et al.: Five-component model of schizophrenia: Assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Research 52:295–303, 1994.PubMedCrossRefGoogle Scholar
  42. 42.
    Emsley R, Rabinowitz J, Torreman M: The factor structure for the positive and negative syndrome scale (PANSS) in recent-onset psychosis. Schizophrenia Research 61:47–57, 2003.PubMedCrossRefGoogle Scholar
  43. 43.
    Portney LG, Watkins MP: Foundations of clinical research: Applications to practice, 2nd edn., Upper Saddle River, Prentice-Hall, 2000.Google Scholar
  44. 44.
    Nunnally JC, Bernstien IH: Psychometric Theory 3rd Edn., New York, MacGraw-Hill, 1994.Google Scholar
  45. 45.
    Marshall GN, Wortman CB, Kusulas JW, et al.: Distinguishing optimism from pessimism: Relations to fundamental dimensions of mood and personality. Journal of Personality and Social Psychology 62:1067–1074, 1992.CrossRefGoogle Scholar
  46. 46.
    Aish AM, Wasserman D: The Dimensionality of Beck’s Hopelessness Scale. Report 3. Centre for Suicide Research and Prevention. Karolinska Institution: Stockholm, 2000.Google Scholar
  47. 47.
    Steer RA, Beck AT: Factors of the beck hopelessness scale: Factor artifact? Multivariate Experimental Research 11:131–144, 1997.Google Scholar
  48. 48.
    Steed L: Further validity and reliability evidence for beck hopelessness scale scores in a nonclinical population. Educational and Psychological Measurement 61:303–316, 2001.CrossRefGoogle Scholar
  49. 49.
    Nekanda-Trepka CJS, Bishop S, Blackburn IM: Hopelessness and depression. British Journal of Clinical Psychology 22:49–60, 1983.PubMedCrossRefGoogle Scholar
  50. 50.
    Markus HR, Kitayama S: Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review 98:224–253, 1991.CrossRefGoogle Scholar
  51. 51.
    Lasker PH, Lancaster RS, Lysaker JT: Narrative transformation as an outcome in the psychotherapy of schizophrenia. Psychology and Psychotherapy 76:285–300, 2003.CrossRefGoogle Scholar
  52. 52.
    Bower GH: Mood and memory. American Journal of Psychology 36(2);129–148, 1981.CrossRefGoogle Scholar
  53. 53.
    Kissane D, Clarke D, Street A: Demoralization syndrome, a relevant psychiatric diagnosis for palliative care. Journal of Palliative Care 17:12–21, 2001.PubMedGoogle Scholar
  54. 54.
    Awad AG, Vorunganti LNP, Heslegrave RJ: A conceptual model of quality of life in schizophrenia: description of preliminary clinical validation. Quality of Life Research 6:21–26, 1997.PubMedCrossRefGoogle Scholar
  55. 55.
    Bradshaw W, Brekke JS: Subjective experience in schizophrenia: Factors influencing self-esteem, satisfaction with life and subjective distress. American Journal of Orthopsychiatry 69:254–260, 1999.PubMedCrossRefGoogle Scholar
  56. 56.
    Aguilar EJ, Haas G, Manzanera FJ: Hopelessness and first-episode psychosis: A longitudinal Study. Acta Psychiatrica Scandinavica 96:25–30, 1997.PubMedCrossRefGoogle Scholar
  57. 57.
    Harkavy-Friedman JM, Restifo K, Malaspina D, et al.: Suicidal behavior in schizophrenia: Characteristics of individuals who had and had not attempted suicide. American Journal of Psychiatry 256:1276–1278, 1999.Google Scholar
  58. 58.
    Dyer JAT, Kreitman N: Hopelessness, depression and suicidal intent in para-suicide. British Journal of Psychiatry 144:127–133, 1984.PubMedCrossRefGoogle Scholar
  59. 59.
    Schwartz RC, Smith SD: Suicidality and psychosis: The predictive potential of symptomatology and insight into illness. Journal of Psychiatry Research 38:185–191, 2004.CrossRefGoogle Scholar
  60. 60.
    Chen KK, Leung CM, Lo WH, et al.: Risk factors of suicide among schizophrenics. Acta Psychiatrica Scandinavica 81:220–224, 1990.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PsychiatrySongshan Armed Forces General HospitalTaipei, TaiwanPeople’s Republic of China
  2. 2.Department of PhysiologyNational Defense Medical CenterTaipei, TaiwanPeople’s Republic of China

Personalised recommendations