International Journal of Social                    Psychiatry                                                http://isp.sa...
FACTORS ASSOCIATED WITH HOPELESSNESS:                         A POPULATION STUDY                                          ...
HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS                                                      143   In gener...
144               INTERNATIONAL JOURNAL                           OF   SOCIAL PSYCHIATRY 50(2)two items, the missing item ...
HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS                                                      145In the mult...
146                   INTERNATIONAL JOURNAL                           OF   SOCIAL PSYCHIATRY 50(2)                        ...
HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS                                                                147 ...
148                    INTERNATIONAL JOURNAL                          OF   SOCIAL PSYCHIATRY 50(2)                        ...
HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS© 2004 SAGE Publications. All rights reserved. Not for commercial us...
150                 INTERNATIONAL JOURNAL                          OF   SOCIAL PSYCHIATRY 50(2)   The Beck Hopelessness Sc...
HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS                                                       151BECK, A.T....
152                 INTERNATIONAL JOURNAL                           OF   SOCIAL PSYCHIATRY 50(2)O’CONNOR, R.C., CONNERY, H...
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FACTORES ASOCIADOS A LA FALTA DE ESPERANZA

  1. 1. International Journal of Social Psychiatry http://isp.sagepub.com Ftors Associated with Hopelessness: A Population StudyKaisa Haatainen, Antti Tanskanen, Jari Kylmaä, Kirsi Honkalampi, Heli Koivumaa-Honkanen, Jukka Hintikka and Heimo Viinamaki International Journal of Social Psychiatry 2004; 50; 142 DOI: 10.1177/0020764004040961 The online version of this article can be found at: http://isp.sagepub.com/cgi/content/abstract/50/2/142 Published by: http://www.sagepublications.com Additional services and information for International Journal of Social Psychiatry can be found at: Email Alerts: http://isp.sagepub.com/cgi/alerts Subscriptions: http://isp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations (this article cites 32 articles hosted on the SAGE Journals Online and HighWire Press platforms): http://isp.sagepub.com/cgi/content/refs/50/2/142 Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  2. 2. FACTORS ASSOCIATED WITH HOPELESSNESS: A POPULATION STUDY ¨ KAISA HAATAINEN, ANTTI TANSKANEN, JARI KYLMA, KIRSI HONKALAMPI, HELI KOIVUMAA-HONKANEN, JUKKA HINTIKKA ¨ & HEIMO VIINAMAKI ABSTRACT Background: Hopelessness is associated with depression and suicidality in clinical as well as in non-clinical populations. However, data on the prevalence of hopelessness and the associated factors in general population are exiguous. Aims: To assess the prevalence and the associated factors of hopelessness in a general population sample. Methods: The random population sample consisted of 1722 subjects. The study questionnaires included the Beck Hopelessness Scale (HS), Beck Depression Inventory (BDI), Toronto Alexithymia Scale (TAS-20) and Life Satisfaction Scale (LS). Results: Eleven percent of the subjects reported at least moderate hopeless- ness. A poor financial situation (OR 3.64), poor subjective health (OR 2.87) and reduced working ability (OR 2.67) independently associated with hopelessness. Moreover, the likelihood of moderate or severe hopelessness was significantly increased in subjects dissatisfied with life (OR 5.99), with depression (OR 4.86), with alexithymia (OR 2.37) and with suicidal ideation (OR 1.85). Conclusions: This study demonstrated a moderately high prevalence of hope- lessness at the population level. Hopelessness appears to be an important indi- cator of low subjective well-being in the general population that health care personnel should pay attention to. Key words: hopelessness, population, risk INTRODUCTIONIn earlier studies, hopelessness has been found to be associated with depression (Beck et al.,1988b; Prezant & Neimeyer, 1988; Whisman et al., 1995; Nimeus et al., 1997), suicidality(Suominen et al., 1997; Malone et al., 2000; O’Connor et al., 2000) and physical sickness(Everson et al., 1997; Swindells et al., 1999). Furthermore, in non-clinical samples it hasbeen shown to be a predictor of depression (Rholes et al., 1985; Alford et al., 1995), and inclinical populations a predictor of long-term suicidality (Beck et al., 1985, 1990; Fawcett etal., 1987; Young et al., 1996).International Journal of Social Psychiatry. Copyright & 2004 Sage Publications (London, Thousand Oaks and New Delhi) www.sagepublications.com Vol 50(2): 142–152. DOI: 10.1177/0020764004040961 Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  3. 3. HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS 143 In general, baseline hopelessness, even without clinically verified depression, may predict afuture suicide attempt (Young et al., 1996). When persons prone to hopelessness becomedepressed, they experience higher levels of suicidal intent than do other depressed patients(Beck et al., 1985). There is also evidence that hopelessness might even be a more importantrisk factor for suicidality than depression (Kovacs et al., 1975; Beck et al., 1985, 1990, 1993;Salter & Platt, 1990). However, it should be noted that not all depressed patients are hopeless(Greene, 1989; Cannon et al., 1999), and hopelessness is not always a predictor of suicidalintent, either (Mendonca & Holden, 1996; Nimeus et al., 1997). At the population level, data on hopelessness among adult subjects are limited. To ourknowledge, few studies have been carried out in community-based population samples(Tanaka et al., 1996; Pillay & Sargent, 1999), and only a single study in a general population(Greene, 1981). According to this, hopelessness was associated with low socio-economicstatus and increasing age. However, this study was conducted as long as two decades ago,and its sample size (N ¼ 400), as well as the number of risk factors studied were relativelysmall. The purpose of our study was to assess the prevalence and the mean level of hopelessnessand to identify associated factors in a random sample of the Finnish population. Sociodemo-graphic background variables and psychiatric symptom scales were used to study theserelationships. MATERIAL AND METHODSStudy populationThe study was conducted in the district of Kuopio, which is located in the central-easternpart of Finland. Our population sample included 2945 subjects living in that area, aged25–64 years, randomly selected from the National Population Register. Study questionnaireswere mailed in May–June 1999. A total of 1767 questionnaires were returned. Due to incom-plete data, 45 subjects were excluded from the analysis. Thus, the final sample (n ¼ 1722)included 735 (43%) men and 987 (57%) women, giving a response rate of 58.5%. The meanage of the responding subjects was 45.9 (SD ¼ 10:5) years; men were older than women(46.7, SD ¼ 10:1 years vs. 45.3, SD ¼ 10:7 years, p ¼ 0:008). The subjects were mainlymarried or cohabiting (73.0%), were living in an urban area (74.4%) and were white-collarworkers (75.4%). The complete study design has been described in detail elsewhere (Honka-lampi et al., 2001). Approval for the study was obtained from the Ethics Committee ofKuopio University Hospital and the University of Kuopio.HopelessnessThe level of hopelessness was assessed by using the Beck Hopelessness Scale (HS), which is a20-item, self-administered rating scale designed to measure an adult’s negative expectanciesconcerning oneself and one’s future life. The Hopelessness Scale is based on three dimensionsof hopelessness: affective (e.g. lack of hope), motivational (giving up) and cognitive (lack offuture expectations) (Beck et al., 1974). The total score of HS ranges from 0 to 20, and thelevel of hopelessness increases with increasing scores. If a response was missing for one or Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  4. 4. 144 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 50(2)two items, the missing item was replaced with an arithmetic mean, while in the case of moremissing items the scale was regarded as incomplete data. Based on the original cut-off points, the subjects were classified into four groups: no hope-lessness at all (scores 0–3), mild hopelessness (scores 4–8), moderate hopelessness (scores9–14) and severe hopelessness (scores 15–20) (Beck & Steer, 1988). The alpha reliability coeffi-cient (Cronbach’s alpha) for the scale was 0.87 in our study.DepressionDepression was assessed using the 21-item Beck Depression Inventory (BDI) (Beck et al.,1961). The items of BDI contain four statements each, and reflect the intensity of a particulardepressive symptom. If a response was missing for one or two items, the missing item wasreplaced with an arithmetic mean, while in the case of more missing items the scale wasregarded as incomplete data. BDI was used as a continuous variable or as a class variable with four groups and the fol-lowing cut-off scores: no depression (scores <10), mild depression (scores 10–18), moderatedepression (scores 19–29) and severe depression (scores 30–63) (Beck et al., 1988a). In themultiple logistic regression analysis the BDI scores were dichotomised (depressive: scores 5 10 vs. not depressive: scores <10). Cronbach’s alpha was 0.91.Suicidal ideationSuicidal ideation refers to cognitions that can vary from transient thoughts about worthless-ness of life and death wishes to concrete plans for killing oneself and obsessive preoccupationwith self-destruction (Diekstra & Garnefski, 1995). The BDI suicidality item (item 9) can beused in screening for suicidal ideation (Hintikka et al., 2001). In this study, the answer alternatives (1) ‘I have thoughts of harming myself but I wouldnot carry them out’, (2) ‘I feel I would be better off dead’ and (3) ‘I would kill myself if Icould’ indicated the presence of suicidal ideation, and the answer alternative (0) ‘I don’thave any thoughts of harming myself ’ the absence of it. Item 9 was not included in thetotal score of BDI in the multivariate analysis to avoid overlapping of suicidality item inBDI and suicidal ideation.Life satisfactionLife satisfaction was estimated by means of a four-item scale (Koivumaa-Honkanen et al.,2000). The scale comprised the following questions: (1) ‘Do you feel that your life at presentis very interesting (score 1), fairly interesting (score 2), fairly boring (score 4) or very boring(score 5)?’ (2) ‘Do you feel that your life at present is very happy (score 1), fairly happy (score2), fairly unhappy (score 4) or very unhappy (score 5)?’ (3) ‘Do you feel that your life atpresent is very easy (score 1), fairly easy (score 2), fairly hard (score 4) or very hard (score5)?’ (4) ‘Do you feel that at the present moment you are very lonely (score 5), fairly lonely(score 4) or not at all lonely (score 1)?’ The item responses ‘cannot say’ as well as missingdata were scored as 3 in every question. Thus, the range of the sum score for life satisfactionwas 4–20, with increasing values indicating a decrease in life satisfaction. Total score was used to classify the subjects into the satisfied (scores 4–6), the slightly dis-satisfied (scores 7–11) and the dissatisfied (scores 12–20) (Koivumaa-Honkanen et al., 2000). Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  5. 5. HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS 145In the multiple logistic regression analysis life satisfaction was categorised into two classes(dissatisfied with life: scores 12–20 vs. others: scores 4–11). Cronbach’s alpha was 0.77.AlexithymiaThe prevalence of alexithymia was screened using the Finnish version (Joukamaa et al., 2001)of the 20-item Toronto Alexithymia Scale (TAS-20) (Bagby et al., 1994a, 1994b). TAS-20consists of three sub-factors: (1) difficulty in identifying feelings and distinguishing themfrom bodily sensations of emotions; (2) difficulty in describing feelings to others; and (3)an externally oriented style of thinking (Bagby et al., 1994a, 1994b). Each item was ratedon a five-point Likert scale, with total scores ranging from 20 to 100. If a response was miss-ing for one or two items, the missing item was replaced with an arithmetic mean, while in thecase of more missing items the scale was regarded as incomplete data. The total scores of the TAS-20 were categorised according to the recommendations ofBagby and Taylor (1997); thus a score 5 61 indicated alexithymia, and 4 51 no alexithymia.Subjects with a TAS-20 score between 52 and 60 were categorised into the intermediate group(Honkalampi et al., 2001). In the multiple logistic regression analysis alexithymia was cate-gorised into two classes (alexithymic: scores 5 61 vs. others: scores 20–60). Cronbach’salpha was 0.86.Background characteristicsThe subjects reported data on the following factors of their sociodemographic back-ground (classification in parentheses): marital status (married ¼ 1; single, divorced orwidowed ¼ 0); years of education (high i.e. 5 9 ¼ 0; low i.e. <9 years ¼ 1); subjective eva-luation of working ability (good ¼ 0; reduced or unable to work ¼ 1); place of residence(urban ¼ 0; rural ¼ 1); subjective evaluation of financial situation (good or fairly good =0; fairly poor or poor ¼ 1); and subjective evaluation of general health (good or fairlygood ¼ 0; fairly poor or poor ¼ 1).Statistical analysisSubjects with moderate or severe hopelessness (HS score of 5 9; n ¼ 193) were comparedwith the others (HS score < 9; n ¼ 1529). The statistical methods used included Pearson’schi-squared test for categorical variables, the independent-samples t-test, Pearson’s two-tailed correlation analysis, analysis of variance for continuous variables and multiple logisticregression analysis (method: enter) to identify factors independently associated with hope-lessness (HS score 5 9). Data analysis was conducted with SPSS 10.0. All statistical testswere two-tailed. RESULTSA total of 149 subjects (8.7%) reported moderate and 44 subjects (2.6%) severe hopelessness.The mean score on the Hopelessness Scale was 3.9 (SD ¼ 3:6, ranging from 0 to 20;n ¼ 1722). The prevalence of hopelessness according to gender and age is shown in Table 1. Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  6. 6. 146 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 50(2) Table 1Prevalence (%) of hopelessness according to gender and age in a general population sample (N ¼ 1722) of eastern FinlandLevel of Mena Womenbhopelessness Age group (years) Age group (years)(HS scores) 25–34 35–44 45–54 55–64 Total 25–34 35–44 45–54 55–64 TotalNot at all (0–3) 76 68 60 51 62 73 64 58 41 59Mild (4–8) 16 21 27 35 26 21 25 33 43 31Moderate (9–14) 7 8 10 11 9 5 7 7 14 8Severe (15–20) 1 3 3 3 3 1 5 2 2 2(N) (106) (190) (260) (179) (735) (195) (263) (307) (222) (987)a Linear-by-linear association between levels of hopelessness and age groups, 2 ¼ 13:84, d:f: ¼ 1, p 0:0005b Linear-by-linear association between levels of hopelessness and age groups, 2 ¼ 30:97, d:f: ¼ 1, p 0:0005There was a trend of increasing prevalence of hopelessness with age. Among women, thosewho reported moderate or severe hopelessness were significantly older than the others(48.2, SD ¼ 10:1 years vs. 45.0, SD ¼ 10:7 years, t ¼ 2:947, d:f: ¼ 985, p ¼ 0:003). In men,the difference did not reach statistical significance (48.5, SD ¼ 9:3 years vs. 46.5, SD ¼10.2 years, t ¼ 1:785, d:f: ¼ 733, p ¼ 0:075). Reduced working ability (subjective evaluation), a poor financial situation (subjectiveevaluation) and poor subjective health (subjective evaluation) were significantly associatedwith hopelessness among all subjects. Hopelessness was significantly associated with beingsingle, divorced or widowed in men and with low education in women. Place of residencedid not have any association with hopelessness (Table 2). The prevalence of hopelessness increased with increasing severity of depression. Moderateor severe hopelessness was found in 88.0% of the subjects with severe depression. Further-more, subjects with suicidal ideation, with dissatisfaction with life or with alexithymia hadan increased prevalence of moderate to severe hopelessness (Table 3). All the background factors from Tables 1 and 2 that were found to be significantly asso-ciated with hopelessness were chosen as covariates in the multiple logistic regressionmodel. The risk of at least moderate hopelessness was significantly increased in subjects witha poor financial situation, with poor subjective health and with a reduced working abilitycompared with the respective reference groups (Table 4, model A). Even though intercorrelations between satisfaction with life, depression, alexithymia andsuicidality were rather high (from 0.27 to 0.69), these psychiatric factors were deliberatelyforced into the same multiple logistic regression model. In this model all the factors were inde-pendently associated with hopelessness (dissatisfaction with life OR 5.99, 95% CI 3.78–9.49;depression OR 4.86, 95% CI 2.95–8.02; alexithymia OR 2.37, 95% CI 1.46–3.84; suicidalideation OR 1.85, 95% CI 1.13–3.03) after adjusting for covariates shown in Table 4,model B. In addition, poor subjective health maintained its association with hopelessnesswhile the other factors did not. Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  7. 7. HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS 147 Table 2Prevalence (%) of hopelessness (HS-score 5 9) in relation to gender and other sociodemographic factors in a general population sample of eastern Finland Men Women Total (N ¼ 735) (N ¼ 987) (N ¼ 1722)Marital statusMarried or cohabiting 9.8 9.7 9.7Single, divorced or widowed 19.5 12.9 15.3 ( p ¼ 0:001Þ ( p ¼ 0:144Þ ( p ¼ 0:002ÞEducation5 9 years 10.8 9.2 9.8 9 years 16.7 18.6 17.6 ( p ¼ 0:059Þ ( p ¼ 0:003Þ ( p 0:0005ÞSubjective evaluation of working abilityGood 5.5 5.4 5.4Reduced or unable to work 22.6 20.8 21.6 ( p 0:0005Þ ( p 0:0005Þ ( p 0:0005ÞPlace of residenceUrban 11.2 10.5 10.8Rural 14.2 11.0 12.4 ( p ¼ 0:252Þ ( p ¼ 0:812Þ ( p ¼ 0:337ÞSubjective evaluation of financial situationGood or fairly good 6.3 7.5 7.0Fairly poor or poor 32.5 25.3 28.8 ( p 0:0005Þ ( p 0:0005Þ ( p 0:0005ÞSubjective evaluation of general healthGood or fairly good 7.5 7.4 7.5Fairly poor or poor 38.7 35.4 37.0 ( p 0:0005Þ ( p 0:0005Þ ( p 0:0005Þ DISCUSSIONOur results give new information about factors associated with hopelessness in a generalpopulation. This information may help health care personnel to recognise hopelessnessmore effectively than earlier. Our study demonstrates three notable factors significantly asso-ciated with hopelessness. We found that the likelihood of moderate to severe hopelessnesswas about three-and-a-half-fold higher when the financial situation was poor, nearly three-fold higher when subjective health was poor and about two-and-a-half-fold higher whenworking ability was reduced. In contrast to the previous findings of Greene (1981), the posi-tive relationship between hopelessness and increasing age was not observed in our study in themultivariate model. Further, life dissatisfaction, depressive symptoms, alexithymia and suicidal ideationproved to be the most potent factors associated with moderate to severe hopelessness. Allthese symptom scales measure separate aspects of one’s well-being. Moreover, as all these Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  8. 8. 148 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 50(2) Table 3Prevalence (%) of hopelessness (HS-score 5 9) in relation to depression, suicidal ideation, life satisfaction and alexithymia in a general population sample of eastern Finland Men Women Total (N ¼ 735) (N ¼ 987) (N ¼ 1722)Depression (BDI scores)None (0–9) 3.4 2.9 3.1Mild (10–18) 38.5 24.2 30.4Moderate (19–29) 70.4 65.1 66.7Severe (30–63) 92.3 83.3 88.0 ( p 0:0005Þ ( p 0:0005Þ ( p 0:0005ÞSuicidal ideation (BDI-item 9)No 6.9 7.6 7.3Yes 40.7 43.5 42.0 ( p 0:0005Þ ( p 0:0005Þ ( p 0:0005ÞLife satisfaction (LS scores)Satisfied (4–6) 1.1 0.4 0.7Slightly dissatisfied (7–11) 4.3 6.3 5.5Very dissatisfied (12–20) 51.9 45.0 48.2 ( p 0:0005Þ ( p 0:0005Þ ( p 0:0005ÞAlexithymia (TAS-20 scores)Non-alexithymic ( 4 51) 4.4 4.7 4.6Intermediate group (52–60) 19.3 22.0 20.5Alexithymic ( 5 61) 43.0 51.9 47.3 ( p 0:0005Þ ( p 0:0005Þ ( p 0:0005Þpsychiatric factors at the same time were significantly associated with hopelessness, hopeless-ness could be viewed as a cluster of different clinical manifestations, and accordingly a usefulindicator of low subjective well-being. Among sociodemographic factors, poor subjectivegeneral health only remained significantly associated with hopelessness as examining socio-demographic and psychiatric factors concurrently. To our knowledge, none of the previousstudies has in a general population explored the relationship between hopelessness andreports of life satisfaction, depressive symptoms, alexithymia and suicidal ideation. This study shows reliable prevalence rates of hopelessness in a general population. In ourstudy, the prevalence of moderate to severe hopelessness was close to the figure of 11.5%reported by Greene (1981). Nevertheless, due to methodological differences, caution isneeded in comparing the results of these studies. In Greene’s study, the cut-off point wastwo points higher than the original one reported by Beck and Steer (1988), which was usedin our study. Thus, we can prudently assume that the prevalence of hopelessness in Irelandin the 1980s was higher than that in Finland at the end of the 1990s. The mean score of hope-lessness in our sample was also slightly lower than that of Irish people (3.9 vs. 4.5) (Greene,1981). In addition to the different points in time of the two studies, the results might alsoreflect cultural differences between Finland and Ireland. Moreover, the sample size inGreene’s study was relatively small. Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
  9. 9. HAATAINEN ET AL.: FACTORS ASSOCIATED WITH HOPELESSNESS© 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. Table 4 Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 Risk factors for hopelessness ( 5 9 scores) in multiple logistic regression models of a general population sample of eastern Finland Model A Model B Variables Wald Odds 95% CI a p-value Wald Odds 95% CI a p-value ratio ratio Poor financial situation (subjective) 51.21 3.64 2.56–5.19 0.0005 2.04 1.39 0.89–2.17 ÀNS Poor general health (subjective) 23.52 2.87 1.88–4.40 0.0005 4.38 1.76 1.04–2.97 À0.036 Reduced working ability (subjective) 18.81 2.67 1.71–4.17 0.0005 1.57 1.41 0.83–2.40 ÀNS Single, divorced or widowed 2.87 1.36 0.95–1.93 0.090 0.00 1.00 0.65–1.54 ÀNS Age (years) 0.34 0.99 0.98–1.01 0.562 0.16 1.00 0.97–1.02 ÀNS Low education 0.12 1.08 0.69–1.69 0.728 2.36 1.52 0.89–2.58 ÀNS Male gender 0.00 1.01 0.72–1.40 0.970 0.01 0.98 0.65–1.49 ÀNS Life dissatisfaction (LS scores 12–20) 58.21 5.99 3.78–9.49 0.0005 Depression (BDI scores 5 10) 38.37 4.86 2.95–8.02 0.0005 Alexithymia (TAS scores 5 61) 12.32 2.37 1.46–3.84 0.0005 Suicidal ideation (BDI item 9) 6.04 1.85 1.13–3.03 À0.014 a CI ¼ Confidence interval 149
  10. 10. 150 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 50(2) The Beck Hopelessness Scale is occasionally considered to be less reliable for samples inwhich the level of hopelessness is expected to be low than it is for psychiatric patients(Durham, 1982; Young et al., 1992). We have explicit arguments to oppose this view. Thealpha reliability coefficient in our study was high, our sample size was the largest of itskind and the age range of the random population sample covered the entire period of adult-hood. The response rate in our study was satisfactory as we are dealing with a postal survey,and we suggest that our results give a reasonable estimate of the level of hopelessness and thefactors associated with it in an adult population. We did not conduct any interviews, which can be conceived as a limitation. However, as wewere particularly interested in subjective approximations, we used self-report methods (HS,BDI, LS and TAS-20) and subjective assessments of health, working ability and financialsituation. On the other hand, as the subjects responded anonymously, we have no reasonto doubt that self-report assessments have been confounded by social desirability that haswidely been debated in several studies (Linehan Nielsen, 1981, 1983; Holden et al., 1989;Ivanoff Jang, 1991). The information a cross-sectional study gives may be limited, since hopelessness may bedynamic, not static (Abramson et al., 1989; Beck et al., 1990; Young et al., 1996). Whetherhopelessness is more temporary than stable when a general population is under examinationshould be studied further. In conclusion, the present study broadens the picture of hopeless-ness and the factors associated with it. Hopelessness can be profiled as an important indicatorof low subjective well-being in the general population that should be recognised in everydaymental health work. Thus, as we will be facing subjects with a poor financial situation, poorsubjective health or reduced working ability, we are due to be aware of the possibility ofhopelessness. REFERENCESABRAMSON, L.Y., METALSKY, G.I. ALLOY, L.B. (1989) Hopelessness depression: a theory-based sub- type of depression. Psychological Review, 96, 358–372.ALFORD, B.A., LESTER, J.M., PATEL, R.J., BUCHANAN, J.P. GIUNTA, L.C. (1995) Hopelessness predicts future depressive symptoms: a prospective analysis of cognitive vulnerability and cognitive content specificity. Journal of Clinical Psychology, 51, 331–339.BAGBY, R.M. TAYLOR, G.J. (1997) Measurement and validation of the alexithymia construct. In Disorders of Affect Regulation. Alexithymia in Medical and Psychiatric Illness (ed. G.J. Taylor, R.M. Bagby J.D.A. Parker). Cambridge: Cambridge University Press.BAGBY, R.M., PARKER, J.D.A. TAYLOR, G.J. (1994a) The twenty-item Toronto Alexithymia Scale – I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.BAGBY, R.M., TAYLOR, G.J. PARKER, J.D.A. (1994b) The twenty-item Toronto Alexithymia Scale – II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38, 33–40.BECK, A.T. STEER, R.A. (1988) Manual for the Beck Hopelessness Scale. San Antonio, TX: Psychological Corp.BECK, A.T., STEER, R.A. GARBIN, M.G. (1988a) Psychometric properties of the Beck Depression Inven- tory: twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.BECK, A.T., RISKIND, J.H., BROWN, G. STEER, R.A. (1988b) Levels of hopelessness in DSM-III disorders: a partial test of content specificity in depression. Cognitive Therapy and Research, 12, 459–469.BECK, A.T., STEER, R.A., BECK, J.S. NEWMAN, C.F. (1993) Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide and Life-Threatening Behavior, 23, 139–145. Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
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  12. 12. 152 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 50(2)O’CONNOR, R.C., CONNERY, H. CHEYNE, W.M. (2000) Hopelessness: the role of depression, future directed thinking and cognitive vulnerability. Psychology, Health and Medicine, 5, 155–161.PILLAY, A.L. SARGENT, C.-A. (1999) Relationship of age and education with anxiety, depression, and hopelessness in a South African community sample. Perceptual and Motor Skills, 89, 881–884.PREZANT, D.W. NEIMEYER, R.A. (1988) Cognitive predictors of depression and suicide ideation. Suicide and Life-Threatening Behavior, 18, 259–264.RHOLES, W.S., RISKIND, J.H. NEVILLE, B. (1985) The relationship of cognitions and hopelessness to depression and anxiety. Social Cognition, 3, 36–50.SALTER, D. PLATT, S. (1990) Suicidal intent, hopelessness and depression in a parasuicide population: the influence of social desirability and elapsed time. British Journal of Psychiatry, 29, 361–371. ¨ ¨SUOMINEN, K., ISOMETSA, E., HENRIKSSON, M., OSTAMO, A. LONNQVIST, J. (1997) Hopeless- ness, impulsiveness and intent among suicide attempters with major depression, alcohol dependence, or both. Acta Psychiatrica Scandinavica, 96, 142–149.SWINDELLS, S., MOHR, J., JUSTIS, J.C., BERMAN, S., SQUIER, C., WAGENER, M.M. SINGH, N. (1999) Quality of life in patients with human immunodeficiency virus infection: impact of social support, coping style and hopelessness. International Journal of STD and AIDS, 10, 383–391.TANAKA, E., SAKAMOTO, S., ONO, Y., FUJIHARA, S. KITAMURA, T. (1996) Hopelessness in a community population in Japan. Journal of Clinical Psychology, 52, 609–615.WHISMAN, M.A., MILLER, I.W., NORMAN, W.H. KEITNER, G.I. (1995) Hopelessness depression in depressed inpatients: symptomatology, patient characteristics, and outcome. Cognitive Therapy and Research, 19, 377–398.YOUNG, M.A., HALPER, I.S., CLARK, D.C., SCHEFTNER, W. FAWCETT, J. (1992) An item- response theory evaluation of the Beck Hopelessness Scale. Cognitive Therapy and Research, 16, 579–587.YOUNG, M.A., FOGG, L.F., SCHEFTNER, W., FAWCETT, J., AKISKAL, H. MASER, J. (1996) Stable trait components of hopelessness: baseline and sensitivity to depression. Journal of Abnormal Psychology, 105, 155–165.Kaisa Haatainen, MHSc, researcher, Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.Antti Tanskanen, MD, senior lecturer, Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.Jari Kylma, PhD, senior lecturer, Department of Nursing Science, University of Kuopio, Kuopio, Finland. ¨Kirsi Honkalampi, PhD, senior researcher, Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.Heli Koivumaa-Honkanen, MD, senior lecturer, Department of Psychiatry, Kuopio University Hospital, Kuopio,Finland.Jukka Hintikka, MD, senior lecturer, Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.Heimo Viinamaki, MD, professor, Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland. ¨Correspondence to Kaisa Haatainen, MHSc, Research and Development Unit 4977, Department of Psychiatry,Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland.Email: kaisa.haatainen@kuh.fi Downloaded from http://isp.sagepub.com at UNIV NACIONAL DE COLOMBIA on July 30, 2008 © 2004 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.

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