Factor structure of the Beck Hopelessness Scale in individuals with advanced cancer

Addressing loneliness in older adults: predictors, protective factors, and implications for social work practice

Loneliness significantly impacts the mental well-being of older adults, prompting an examination of psychological predictors and buffering factors associated with it in this demographic. A cross-sectional study involving 246 community-dwelling older adults was conducted. The UCLA Loneliness Scale identified predictors of loneliness, including negative mood, hopelessness (negative future expectations and loss of motivation), and despair. Buffering factors included ego-integrity, personal growth, and purpose in life. Regression analysis revealed that negative mood, negative future expectations, and despair increased loneliness, with negative mood showing a strong association. Conversely, ego-integrity, personal growth, and purpose in life reduced loneliness. The study underscores the complex interplay of psychological factors shaping loneliness in older adults, highlighting the importance of addressing both risk and protective factors. Social work practitioners in healthcare settings can play a pivotal role in addressing loneliness among older adults by leveraging these factors.

To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research

Psychological variables substantially shape the risk of suicidal thoughts and behaviours (STBs). However, it is unclear to what extent they are considered in individuals with cancer. We synthesized the quantitative research landscape concerning psychological risk/protective factors of STBs in the (psycho-) oncological context. This pre-registered review (PROSPERO-ID CRD42022331484) systematically searched the databases PubMed/Medline, CINAHL, PsycInfo, Cochrane Library, and Web of Science (as well as the grey literature and preprints). Risk of bias (RoB) was estimated using the ROBINS-I tool. Of 11,159 retrieved records, 319 studies were eligible for inclusion. Of those, 163 (51.1%) had investigated psychological factors (affective: n = 155; social: n = 65; cognitive: n = 63; personality/individual differences: n = 37; life events: n = 6), in a combined 3,561,741 participants. The most common STBs were suicidal ideation (n = 107) or death wishes (n = 20) rather than behaviour (suicide deaths: n = 26; attempts: n = 14). Most studies had a serious RoB. Thus, a large body of research investigated STBs in cancer patients/survivors, but it rarely aligned with the theoretical or clinical developments in suicide research. We propose a conceptual model of STBs in cancer delineating moderation and mediation effects to advance the integration of the fields, and to inform future research and practice.

Beck Hopelessness Scale-20: Dimensionality and Nomological Validity Among Colombian School-Age Adolescents

To establish the validity of the BHS-20, a sample of 2064 adolescent students aged 14 and 17 years (M = 15.61, SD = 1.05) were invited to participate in the research. Cronbach's alpha (α) and McDonald's omega (ω) were computed to evaluate the internal consistency. Confirmatory factor analysis was used to test the dimensionality of the BHS-20. The Spearman correlation (rs) with depressive symptoms and risk of suicide scores of the Plutchik Suicide Risk Scale were computed to explore the nomological validity. The BHS-20 showed a high internal consistency (α = .81, ω = .93), an adequate one-dimensional structure with an excellent adjustment [χ2 S-B = 341, df = 170, p < .01, Comparative Fit Index = .99, RMSEA = .03] and acceptable nomological validity with depressive symptoms (rs = .47, p < .01) and scores for suicide risk (rs = .33, p < .01). In conclusion, current results suggest that the BHS-20 demonstrates validity and reliability among Colombian adolescent students.

Measuring hopelessness in advanced cancer: a secondary analysis of the Hopelessness Assessment in Illness questionnaire (HAI)

OBJECTIVE

Hopelessness, or a sense of despair about the future, has been a growing focus of psychological research among patients with serious medical illnesses. This study evaluated the psychometric properties of the Hopelessness Assessment in Illness (HAI) questionnaire, developed specifically for those facing a life-threatening illness. Participants were 344 advanced cancer patients (e.g. lung, breast, gastrointestinal, etc.) participating in two psychotherapy research trials.

DESIGN

Descriptive statistics characterised participants in regard to both demographic (age, gender, race, ethnicity, religiosity) and clinical characteristics (cancer type). Scale properties were assessed for internal consistency using Cronbach's coefficient alpha, item-total correlations, Principle Axis factor analysis, and its correlation to relevant psychological constructs. Nonlinear confirmatory factor analysis (CFA) assessed for latent construct variance by gender.

MAIN OUTCOME MEASURES

Psychometric properties of the Hopelessness Assessment in Illness questionnaire.

RESULTS

Results indicated strong internal consistency and temporal stability of the HAI, with significant correlations between the HAI and several theoretically related psychological constructs. CFA suggested the same single underlying factor for males and females.

CONCLUSIONS

The HAI demonstrated strong psychometric properties in the context of advanced cancer. Future research is needed to assess the utility of the HAI in more medically and geographically diverse populations.

The General Hopelessness Scale: Development of a measure of hopelessness for non-clinical samples

Noting concerns about the non-clinical efficacy of the Beck Hopelessness Scale (BHS), specifically the instrument's ability to discriminate between lower levels of hopelessness, this paper describes the development of the General Hopelessness Scale (GHS) for use with general samples. Following a literature review an item pool assessing the breadth of the hopelessness construct domain was created. This was then placed in survey form and assessed within two independent studies. Study 1 (N = 305, 172 women, 133 men, Mage = 28.68) explored factorial structure, item performance, and convergent validity of the GHS in relation to standardised measures of self-esteem and trait hopelessness. In Study 2 (N = 326, 224 women, 102 men, Mage = 26.52), scrutiny of the GHS occurred using confirmatory factor analysis and invariance tests, alongside item performance and convergent validity analyses relative to measures of affect, optimism, and hope. Factor analysis (using minimum average partial correlations and exploratory factor analysis) within Study 1 revealed the existence of four dimensions (Negative Expectations, Hope, Social Comparison, and Futility), which met Rasch model assumptions (i.e., good item/person fit and item/person reliability). Further psychometric assessment within Study 2 found satisfactory model fit and gender invariance. Convergent validity testing revealed moderate to large associations between the GHS and theoretically relevant variables (self-esteem, trait hopelessness, affect, optimism, and hope) across Study 1 and 2. Further examination of performance (reliability and ceiling and floor effects) within Study 1 and 2 demonstrated that the GHS was a satisfactory measure in non-clinical settings. Additionally, unlike the BHS, the GHS does not assume that administrators are trained professionals capable of advising on appropriate interventions.

Reverse-Coded Items Do Not Work in Spanish: Data From Four Samples Using Established Measures

The potential for suboptimal psychometric performance of reverse-coded items may be particularly pronounced when scales are translated and administered in Spanish with these problems exacerbated in youth respondents. This is a significant concern, given the rapid rise in Hispanic-American and Spanish-speaking individuals in the US and their rightful, growing representation in psychological research and clinical care. The aim of this study was to examine the psychometric performance of reverse-coded items across four Spanish-speaking samples spanning developmental stages including youth, college students, and parents (N = 1,084; Adolescents n = 107; M = 19.79; SD = 2.09; 41.1% female; Caregivers n = 58; M = 40.79; SD = 7.94; 60.3% female; Spanish-speaking adults in the US n = 157; M = 33.4; SD = 9.5; 68.8% female; and College students living in Latin America n = 783; M = 21.04; SD = 3.13; 69.2% female) and four scales (Big Five Inventory; Strengths and Difficulties Questionnaire; Difficulties in Emotion Regulation Scale; Beck Hopelessness Scale); we expected reverse-coded items would demonstrate inadequate item–total correlations and their inclusion would compromise scale internal consistency. Hypotheses were supported with evidence of poor psychometric performance for at least two reverse-coded items on each instrument, such that un-reversing the items improved their item–total correlations. Across every instrument, alpha was either improved by excluding reverse-coded items or by including them in an un-reversed fashion and, overall, there was a moderate, negative effect of reverse-coded items on scale alphas. In growing consensus with previous authors, we recommend that reverse-coded items not be included in Spanish scales.

Cultural adaptation of meaning-centered psychotherapy for latino families: a protocol

INTRODUCTION

Literature suggests couple-based interventions that target quality of life and communication can lead to positive outcomes for patients with cancer and their partners. Nevertheless, to date, an intervention to address the needs of Latino families coping with advanced cancer has not been developed. Meta-analytic evidence suggests that culturally adapted evidenced-based intervention targeting a specific cultural group is four times more effective. Our goal is to culturally adapt a novel psychosocial intervention protocol entitled 'Caregivers-Patients Support to Latinx coping advanced-cancer' (CASA). We hypothesised that combine two evidence-based interventions and adapting them, we will sustain a sense of meaning and improving communication as patients approach the end of life among the patient-caregiver dyad.

METHODS AND ANALYSIS

To culturally adapt CASA, we will follow an innovative hybrid research framework that combines elements of an efficacy model and best practices from the ecological validity model, adaptation process model and intervention mapping. As a first step, we adapt a novel psychosocial intervention protocol entitled protocol entitled 'Caregivers-Patients Support to Latinx coping advanced-cancer' (CASA). The initial CASA protocol integrates two empirically based interventions, meaning-centred psychotherapy and couple communication skills training. This is an exploratory and prepilot study, and it is not necessary for a size calculation. However, based on recommendations for exploratory studies of this nature, a priori size of 114 is selected. We will receive CASA protocol feedback (phase 1b: refine) by conducting 114 questionnaires and 15 semistructured interviews with patients with advanced cancer and their caregivers. The primary outcomes of this study will be identifying the foundational information needed to further the develop the CASA (phase IIa: proof-of-concept and phase IIb: pilot study).

ETHICS AND DISSEMINATION

The Institutional Review Board of Ponce Research Institute approved the study protocol #1907017527A002. Results will be disseminated through peer-reviewed publications.

[Hopelessness as a predictor of loneliness in older adults]

BACKGROUND AND OBJECTIVE

Hopelessness is characterized by a set of negative cognitive schemas about the future, conceptualized on the basis of three dimensions: affective, motivational and cognitive. This construct is linked to loneliness, the incidence of which in older adults is increasingly high. The aim of this research is to test whether hopelessness factors predict levels of loneliness in older adults.

MATERIAL AND METHODS

138 non-institutionalized persons from Valencia city between 65-90 years old participated, with a mean age of 73.67 (SD=4.8), and 59.4% were women. The Beck Hopelessness Scale (BHS) and University of California Los Angeles Loneliness Scale (UCLA) were administered to assess participants.

RESULTS

The motivational and cognitive factors acted as statistically significant predictors of loneliness, while the affective factor was not presented as a significant factor. The final model obtained an R²adj=.442, F(3, 87)=23.97, p<.001.

CONCLUSIONS

Loneliness is a phenomenon of great concern in the field of gerontology due to its high incidence and impact. The results indicate that hopelessness, specifically loss of motivation and negative expectations about the future, are critical issues for the development of feelings of loneliness in older adults. Thus, it is relevant to pay attention to these variables in order to apply loneliness prevention programs.

Escala de Desesperanza de Beck (BHS): ventajas de una administración adaptativa

La escala de Desesperanza de Beck (BHS) es usada con frecuencia como screening para la detección de riesgo suicida y/o depresión aun cuando, por su extensión de 20 ítems, resulta poco eficiente. En este trabajo se analiza si una estrategia de administración adaptativa podría abreviar el tiempo de aplicación de la BHS. Participaron 783 individuos de población general (50.9% mujeres). Se seleccionó aleatoriamente un 70% de los casos para calibrar los ítems con el Modelo Logístico de 2 parámetros de la Teoría de Respuesta al Ítem. Se eliminaron dos elementos que presentaron funcionamiento inadecuado. El 30% restante de la muestra se utilizó para simular una administración adaptativa de los 18 ítems calibrados. Se compararon dos modalidades de interrupción: a) al administrar 9 ítems y b) al alcanzar un error de estimación ≤ 0.35 o administrar 9 ítems (criterio mixto). Bajo ambas condiciones se registraron correlaciones de .95 con el nivel de Desesperanza estimado a partir de los 18 ítems. No obstante, la interrupción basada en el criterio mixto no mostró un impacto adicional en la eficiencia de la medida. Al igual que la versión de 18 ítems, las aplicaciones adaptativas estimaron con más precisión los niveles elevados del rasgo. La medición adaptativa no afectó las evidencias de validez al estudiar la asociación del rasgo con facetas del Neuroticismo y dimensiones sintomatológicas. Se concluye que una administración adaptativa de 9 ítems puede abreviar considerablemente la BHS sin perjudicar la validez y confiabilidad de la medida.

Evidencias de validez factorial de la Escala de desesperanza de Beck en español con muestras clínicas y no clínicas

El propósito del presente estudio fue evaluar la estructura interna de la adaptación al español de Escala de Desesperanza de Beck et al. (1974), dada su utilidad y relevancia en la predicción de conductas suicidas. Para esto, se analizaron las respuestas a la escala de 1260 estudiantes universitarios (M = 4.79; DT = 4.29) y de una muestra clínica en la que participaron 150 jóvenes con intento de suicidio de alta letalidad (M = 8.51; DT = 2.38). Se examinó la estructura interna por medio del Análisis factorial confirmatorio (AFC) en tres fases: en la primera, se comparó el modelo original con cuatro modelos encontrados en las diferentes adaptaciones al español; en la segunda, se tomaron en cuenta modelos que analizan la aquiescencia; y en la tercera, se hizo una validación cruzada de esos modelos con población clínica. Los resultados señalan que la escala es unidimensional tanto en el caso de las muestras clínicas (χ2 = 154.84, gl = 135, p < 0.001, CFI = 0.99, TLI = 0.99,RMSEA = 0.03) como en la población universitaria; sin embargo, a esta última se le añadió un factor de método para el tratamiento de la aquiescencia (χ2 = 252.14, gl = 134, p < 0.001, CFI = 0.95, TLI = 0.94, RMSEA = 0.03). Los resultados muestran la importancia de utilizar análisis y modelos que consideren la naturaleza de los datos y las características de la muestra para aportar evidencias más sólidas para la validez de constructo.

Measuring elderly people's quality of life through the Beck Hopelessness Scale: a study with a Spanish sample

OBJECTIVES

Hopelessness is a key element of suicidal intent. It can instill a pessimistic outlook on the future, leading an individual to believe that suicide is the only answer to their problems. Hopelessness operates as a modulating variable between depression and suicidal behavior. The aim of this study was to confirm the factor structure of the Beck Hopelessness Scale (BHS) in a non-clinical sample.

METHOD

Three hundred and sixty-two Spanish individuals, aged over 60, free of cognitive impairment and depressive symptoms, completed the BHS scale. Participants were tested using confirmatory factor analysis (CFA), using one-, two- and three-factor models.

RESULTS

The one- and two-factor models presented adequate fit indices. Specifically, the indices of the two-factor models were better than those of the one-factor model. The two-factor model, without items 4, 9 and 14, provided the best fit, given that the indices obtained in the CFA and their internal consistency were better than those of the other models.

CONCLUSION

The validation of the BHS for a population of Spanish older adults provides a reliable and valid measure of hopelessness and could be useful in clinical practice and research as an effective tool for the early detection of suicidal behaviors.

Psychometric Adaptation of the Beck Hopelessness Scale as a Self-Rated Suicide Risk Screening Instrument Among Nigerian University Students

BACKGROUND

Globally, suicide is the most important cause of mortality among adolescents and young adults. The factor that correlates most significantly with suicide is hopelessness.

OBJECTIVE

The aim is to explore the psychometric adaptation of the Beck Hopelessness Scale (BHS) as a suicide risk evaluation tool among Nigerian university students.

DESIGN

A total of 554 Nigerian students completed the BHS and the Depression Anxiety Stress Scale (DASS). Suicide risk level among them was determined by interviewing them with the Mini International Neuropsychiatric Interview Suicidality module.

RESULTS

Cronbach's alpha for the 16-item BHS was 0.87. It exhibited satisfactory concurrent validity with the Mini International Neuropsychiatric Interview (MINI) Suicidality module and the subscales of the DASS among the students. The 2-factor model of the BHS-16 exhibited satisfactory indices of fitness (goodness of fit index = 0.930; parsimonious goodness of fit index = 0.601; comparative fit index = 0.934; incremental fit index = 0.936; Tucker-Lewis index = 0.910; root mean square error of approximation = 0.059; χ²/ df = 1.9). Receiver operating characteristics curve indicated that the best cutoff score for those categorized as high suicide risk was 7 (sensitivity 0.700, specificity 0.908, AUC = 0.897).

CONCLUSIONS

The BHS has satisfactory psychometric properties as a suicide risk screening tool among Nigerian university students.

Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief

CONTEXT

Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level.

OBJECTIVES

The objectives of this study are to 1) summarize palliative care assessment tools completed by or with patients or caregivers and 2) identify needs for future tool development and evaluation.

METHODS

We completed 1) a systematic review of systematic reviews; 2) a supplemental search of previous reviews and Web sites, and/or 3) a targeted search for primary articles when no tools existed in a domain. Paired investigators screened search results, assessed risk of bias, and abstracted data. We organized tools by domains from the National Consensus Project Clinical Practice Guidelines for Palliative Care and selected the most relevant, recent, and highest quality systematic review for each domain.

RESULTS

We included 10 systematic reviews and identified 152 tools (97 from systematic reviews and 55 from supplemental sources). Key gaps included no systematic review for pain and few tools assessing structural, cultural, spiritual, or ethical/legal domains, or patient-reported experience with end-of-life care. Psychometric information was available for many tools, but few studies evaluated responsiveness (sensitivity to change) and no studies compared tools.

CONCLUSION

Few to no tools address the spiritual, ethical, or cultural domains or patient-reported experience with end-of-life care. While some data exist on psychometric properties of tools, the responsiveness of different tools to change and/or comparisons between tools have not been evaluated. Future research should focus on developing or testing tools that address domains for which few tools exist, evaluating responsiveness, and comparing tools.

Obsessive-Compulsive Tendencies, Self/Other Perception, Personality, and Suicidal Ideation in a Non-clinical Sample

Research on the risk factors for SI in adults with OC tendencies is limited, and it is still unclear whether the association between OC tendencies and SI in non-clinical individuals exists. The goal of the present study was to test the associations between OC tendencies, self/other perception, personality traits, depressive symptoms and SI among a non-clinical adult population. We investigated an Italian sample of 337 adults, who were administered a set of self-report questionnaires to assess obsessive-compulsive tendencies, depression, self/other perception, personality traits, and hopelessness. Confirmatory factor analyses (CFA) were performed. In the final model we found that personality, obsessive-compulsive factor and suicidal ideation were significantly correlated with each other: personality correlated negatively with obsessive-compulsive factor and suicidal ideation, while obsessive-compulsive factor and suicidal ideation resulted as strongly positively associated. Our results highlight the importance of assessing OC tendencies, negative self/other perception and SI. Understanding their role and interplay will allow for the development and implementation of more advanced prevention and treatment policies.

Psychological Vulnerability and Subjective Happiness: The Mediating Role of Hopelessness

The current study examined the mediating role of hopelessness on the relationship between psychological vulnerability and subjective happiness. It was anticipated that hopelessness may act as a mediator in the relationship between psychological vulnerability and subjective happiness. Two hundred sixty-nine (150 women and 119 men) university students completed the Psychological Vulnerability Scale, the Subjective Happiness Scale and the Beck Hopelessness Scale. Data have been collected in the 2013-2014 academic year. The present study was designed as a cross-sectional study. Correlational results indicated that psychological vulnerability and hopelessness were significantly negatively associated with subjective happiness. Results using structural equation modelling showed that hopelessness fully mediated the relationship between psychological vulnerability and subjective happiness. Implications for future research and limitations of the present study are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

The Beck Hopelessness Scale

Abstract. The aim of the present study was to examine the construct and cross-cultural validity of the Beck Hopelessness Scale (BHS; Beck, Weissman, Lester, & Trexler, 1974 ). Beck et al. applied exploratory Principal Components Analysis and argued that the scale measured three specific components (affective, motivational, and cognitive). Subsequent studies identified one, two, three, or more factors, highlighting a lack of clarity regarding the scale’s construct validity. In a large clinical sample, we tested the original three-factor model and explored alternative models using both confirmatory and exploratory factor analytical techniques appropriate for analyzing binary data. In doing so, we investigated whether method variance needs to be taken into account in understanding the structure of the BHS. Our findings supported a bifactor model that explicitly included method effects. We concluded that the BHS measures a single underlying construct of hopelessness, and that an incorporation of method effects consolidates previous findings where positively and negatively worded items loaded on separate factors. Our study further contributes to establishing the cross-cultural validity of this instrument by showing that BHS scores differentiate between depressed, anxious, and nonclinical groups in a Hungarian population.

Dimensionality, Stability, and Validity of the Beck Hopelessness Scale in Cancer Patients Receiving Curative and Palliative Treatment

CONTEXT

Hopelessness is a clinically important construct in patients with advanced illness.

OBJECTIVES

To evaluate the dimensionality, stability, and validity of the Beck Hopelessness Scale (BHS) in cancer patients receiving either curative or palliative treatment.

METHODS

Following a longitudinal design, we assessed a sample of cancer patients receiving either curative or palliative treatment (N = 315) at baseline and at follow-up after 12 months (N = 158). In addition to hopelessness, we measured depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), and health-related quality of life (Short-Form Health Survey-8). We analyzed dimensionality, stability, and construct validity of the BHS using confirmatory factor analysis, exploratory factor analysis and correlational analysis.

RESULTS

Independent of treatment intention, confirmatory factor analyses resulted in unsatisfactory model fits. Exploratory factor analysis yielded a two-factor solution in both groups receiving curative or palliative treatment. Factor 1 reflected pessimistic/resigned beliefs (Cronbach alpha ≥ 0.85), Factor 2 reflected positive beliefs toward the future (Cronbach alpha = 0.73). Both subscales showed significant associations with anxiety, depression, and decreased health-related quality of life. The factorial structure was partially replicated in patients being reexamined after 12 months (CMIN/DF = 2.130, Standardized Root Mean Square Residual = 0.0716, Comparative Fit Index = 0.904, Tucker-Lewis-Index = 0.883, Root Mean Square Error of Approximation = 0.085). Hopelessness scores were significantly higher in patients reporting suicidal ideation according to the Patient Health Questionnaire-9.

CONCLUSION

Our study demonstrates psychometric limitations of the BHS in patients receiving both curative and palliative treatment, suggesting reduced utility in cancer populations. Given the clinical importance of the construct, a cancer-specific approach to capture the unique meaning of hopelessness in patients with severe medical illness is recommended.

Future-directed thinking in first-episode psychosis

OBJECTIVES

This study employed the Future Thinking Task (MacLeod et al., 2005, Br. J. Clin. Psychol., 44, 495) to investigate whether future-directed thinking in first-episode psychosis is significantly different from that of matched controls, and to identify its correlates in this patient group.

DESIGN

Cross-sectional, mixed-model, case-control design.

METHOD

Participants were 30 patients with first-episode psychosis and 27 matched controls. The Future Thinking Task was used to assess future-directed thinking in both groups. Anxiety and depression were also measured as well as self-report measures of hopelessness, suicide ideation and a measure of negative symptoms.

RESULTS

Individuals with psychosis were impaired in future-directed thinking in both positive and negative domains, particularly with respect to the coming year. Increased self-reported hopelessness was associated with reduced positive future thinking and increased negative future thinking. Increased positive future thinking was also associated with reduced severity of negative symptoms, whilst negative future thinking was associated with suicide ideation.

CONCLUSIONS

Individuals with first-episode psychosis show a reduction in positive future thinking in line with that seen in other clinical groups, but this is accompanied by an unexpected reduction in negative future thinking. The findings suggest a general disengagement with the future in this group that may affect recovery and functioning.

PRACTITIONER POINTS

Individuals with first-episode psychosis may benefit from interventions to help them engage with their future, in particular in the mid-range, up to 1 year. The Future Thinking Task may be a helpful addition to the assessment of suicide risk in those with first-episode psychosis. Decreased positive future thinking was associated with increased severity of negative symptoms, indicating a potential new treatment angle for this resistant aspect of psychosis. The cross-sectional design of this study does not allow for conclusions about the causal relationship between psychosis and future-directed thinking. This study investigated future-directed thinking in individuals with a range of psychotic illnesses employing a trans-diagnostic approach; therefore, conclusions cannot be drawn about the nature of future-directed thinking in individual psychotic disorders.

Depression and hopelessness in patients with acute leukemia: the psychological impact of an acute and life-threatening disorder

OBJECTIVE

Acute leukemia (AL) is a life-threatening cancer associated with substantial morbidity and mortality, particularly in older adults. Given that there has been little research on the psychological impact of such malignancies with acute onset, we assessed the prevalence and correlates of depression and hopelessness in patients with AL.

METHODS

Three hundred forty-one participants were recruited within 1 month of diagnosis or relapse and completed the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Memorial Symptom Assessment Scale, and other psychosocial measures. Multivariate regression analyses identified correlates of depression and hopelessness.

RESULTS

17.8% reported clinically significant depressive symptoms (BDI-II ≥ 15), 40.4% of which were in the moderate-severe range (BDI-II ≥ 20). 8.5% reported significant symptoms of hopelessness (BHS ≥ 8). Depression was associated with greater physical symptom burden (adjusted R(2)  = 48.4%), while hopelessness was associated with older age and lower self-esteem (adjusted R(2)  = 45.4%). Both were associated with poorer spiritual well-being.

CONCLUSIONS

Clinically significant depressive symptoms were common early in the course of AL and related to physical symptom burden. Hopelessness was less common and associated with older age and lower self-esteem. The results suggest that whereas depression in AL may be related to disease burden, the preservation of hope may be linked to individual resilience, life stage, and realistic prognosis.Copyright © 2015 John Wiley & Sons, Ltd.

Beck Hopelessness Scale (BHS)

The Beck Hopelessness Scale (BHS) is an instrument for assessing cognitive thoughts among suicidal persons. Previous studies have identified different factor structures of the BHS. However, results were not conclusive. The aim of this study was to test the factor structure of the BHS in a sample of Italian individuals (N = 509) from the community, and secondarily to investigate correlations between the BHS, depression (Beck Depression Inventory Second Edition), and personality traits (Zuckerman-Kuhlman-Aluja Personality Questionnaire). Following recommendations of previous investigations, we utilized a 5-point response format. We applied a second-order Confirmatory Factor Analyses and tested for the model invariance. The results suggest that besides a single second-order factor, a second-order three-factor solution is also reasonable, in line with Beck’s theorization.

Beck Hopelessness Scale: Psychometric Properties Among Rural Chinese Suicide Attempters and Non-Attempters

The authors recruited 401 suicide attempters from general hospitals and 409 matched non-attempters to evaluate the psychometric properties of the Beck Hopelessness Scale (BHS) in rural China. All participants completed the BHS, Center for Epidemiologic Studies Depression Scale (CES-D), and Trait Anxiety Inventory (TAI). Suicide attempters had higher BHS scores than non-attempters. Cronbach's alpha coefficients were satisfactory and BHS scores significantly correlated to CES-D and TAI scores. Confirmatory factor analysis supported a four-factor model for suicide attempters and a five-factor model for non-attempters. The BHS is satisfactory in assessing hopelessness among suicide attempters in rural China.

Resting-state EEG delta power is associated with psychological pain in adults with a history of depression

Psychological pain is a prominent symptom of clinical depression. We asked if frontal alpha asymmetry, frontal EEG power, and frontal fractal dimension asymmetry predicted psychological pain in adults with a history of depression. Resting-state frontal EEG (F3/F4) was recorded while participants (N=35) sat upright with their eyes closed. Frontal delta power predicted psychological pain while controlling for depressive symptoms, with participants who exhibited less power experiencing greater psychological pain. Frontal fractal dimension asymmetry, a nonlinear measure of complexity, also predicted psychological pain, such that greater left than right complexity was associated with greater psychological pain. Frontal alpha asymmetry did not contribute unique variance to any regression model of psychological pain. As resting-state delta power is associated with the brain's default mode network, results suggest that the default mode network was less activated during high psychological pain. Findings are consistent with a state of arousal associated with psychological pain.

The Yoruba version of the Beck Hopelessness Scale: psychometric characteristics and correlates of hopelessness in a sample of Nigerian psychiatric outpatients

BACKGROUND

Previous studies from the developed western countries have repeatedly demonstrated that hopelessness positively correlates with an increased risk of suicide in the context of chronic mental disorders such as schizophrenia and affective disorders. Despite this persistently strong association, the construct of hopelessness in terms of its factorial structure and correlates has not been explored among Nigerian psychiatric outpatients.

OBJECTIVE

The aim of this present study is to examine the psychometric characteristics of the Yoruba language culturally adapted version of the Beck Hopelessness Scale in a cross-sectional sample of psychiatric outpatients in South-western Nigeria.

METHOD

The participants were 327 Nigerian adult outpatients receiving treatment for schizophrenia, bipolar and depressive disorders, consecutively recruited from the outpatient psychiatric clinics of a university teaching hospital in South-western Nigeria. The outpatients were recruited over a one year period. They completed the Yoruba translated version of the Beck Hopelessness Scale (BHS-Y), a sociodemographic and illness-related questionnaire, the Beck Depression Inventory-II (BDI-II). Their level of functioning was assessed with the Global Assessment of Functioning Scale (GAF), psychopathology was evaluated with the Positive and Negative Syndrome Scale (PANSS) and the level of disability measured with the World Health Organization Disability Assessment Schedule (WHODAS-II). Suicidality and confirmation of the diagnoses of schizophrenia, bipolar and depressive disorders were evaluated with the Mini International Neuropsychiatric Interview (MINI). The construct of hopelessness in terms of factorial structure, reliability, validity and correlates was explored. Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation was used to examine the factorial structure of the BHS-Y. Internal consistency was examined with Cronbach's alpha, and the construct validity of the scale was assessed using correlational analyses with the MINI suicidality module, BDI-II, GAF and WHODAS-II domain scores. We also tested the hypothesis that a shortened version of the BHS-Y will possess psychometric properties similar to the 20 item version.

RESULTS

Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation showed that the construct of hopelessness among our outpatients was best explained by a 3 factor model. Reliability of the translated version of the scale was adequate as indicated by a Cronbach's alpha of 0.92. Construct validity was also satisfactory as reflected by the strong correlations with MINI suicidality, Beck Depression Inventory-II and Global Assessment of Functioning scores. The shortened 4 item single factor BHS-Y composed of items 8, 9, 13 and 15 demonstrated psychometric properties similar to those of the full item version.

CONCLUSION

The Beck Hopelessness Scale (Yoruba Version) demonstrated satisfactory reliability and validity and therefore may be useful in measuring the construct of hopelessness and in clinical suicide risk assessments among Nigerian psychiatric outpatients. There is the need for more studies to further explore the psychometric features and correlates of this scale among other Nigerian ethnic groups in addition to other medical patients' populations.

Factors associated with hopelessness in epileptic patients

AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life (QOL).

METHODS: Sixty-nine participants were administered the following psychometric instruments: Beck Depression Inventory-II, Beck Hopelessness Scale (BHS), and QOL in Epilepsy (QOLIE)-89. Patients were dichotomized into two categories: those affected by epilepsy with generalized tonic-clonic seizures vs those having epilepsy with partial seizures.

RESULTS: The groups differed on the QOLIE Role Limitation/Emotional dimension. Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems than patients with other types of epilepsy (89.57 ± 25.49 vs 72.86 ± 36.38; t₆₃ = -2.16; P < 0.05). All of the respondents reported moderate to severe depression, and 21.7% of patients with generalized seizures and 28.6% of patients with other diagnoses had BHS total scores ≥ 9 indicating a higher suicidal risk. The study did not control for years of the illness.

CONCLUSION: Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems compared to patients with other types of seizures. Patients at increased suicide risk as evaluated by the BHS were older than those who had a lower suicidal risk. Future studies are required to further investigate the impact of hopelessness on the outcome of epileptic patients.

Assessment of spiritual suffering in the cancer context: A systematic literature review

OBJECTIVE

An important goal of cancer medicine is relief of patients' suffering. In view of the clinical challenges of identifying suffering patients, we sought to identify valid instruments for assessing the spiritual suffering of people diagnosed with cancer.

METHOD

A systematic review of the literature was conducted in the Medline, Embase, the Cochrane Library, and PsycINFO databases seeking assessment instruments that measure either suffering or one of its synonyms or symptoms. The psychometric properties of the identified measures were compared.

RESULTS

A total of 90 articles were identified that supplied information about 58 measures. The constructs examined were: suffering, hopelessness/demoralization, hope, meaning, spiritual well-being, quality of life where a spiritual/existential dimension was included, distress in the palliative care setting and pain, distress or struggle of a spiritual nature. The Pictorial Representation of Illness and Self Measure (PRISM) (patient completed) was the most promising measure identified for measuring the burden of suffering caused by illness due to its ease of use and the inclusion of a subjective component.

SIGNIFICANCE OF RESULTS

Although the appropriateness of any measure for the assessment of spiritual suffering in cancer patients will depend on the context in which it is intended to be utilized, the PRISM is promising for measuring the burden of suffering due to illness.

Identifying suicidal symptoms in prostate cancer survivors using brief self-report

PURPOSE

Prostate cancer (PC) survivors are at elevated risk for completed suicide even many years post-treatment. Despite this risk, practical and efficient methods for assessing these symptoms have not been established. We sought to determine if suicidal symptoms could be effectively and efficiently identified in a cohort of PC survivors, and whether these men were receptive to emotional health interventions.

METHODS

Six hundred fifty-six PC survivors, an average of 5 years post-diagnosis, completed eight self-report items about suicidal symptoms and behavior in the past 7 days, and 12 months, as well as medical utilization and interest in emotional health support.

RESULTS

Between 3.6 and 17.9% of PC survivors endorsed a single suicidal ideation item, and denied all other ideation. All survivors who endorsed serious suicidal ideation/behavior also endorsed either passive or active ideation. 58.3% of survivors denied any suicidal symptoms within the past week, but endorsed it within the past year. Most survivors had medical provider contact within the past year and were open to receiving information about emotional health interventions.

CONCLUSIONS

Suicidal ideation in PC survivors cannot be accurately evaluated using only a one-item screen, or by inquiring within a single time frame.

IMPLICATIONS FOR CANCER SURVIVORS

In both research and clinical settings, the evaluation for suicidal ideation in PC survivors should utilize multiple questions, across several time periods. It is possible to skip queries about serious ideation/behavior if passive or active ideation is denied. Once identified, medical providers should refer these men to psychosocial providers who can offer emotional support.

Depression and affective temperaments are associated with poor health-related quality of life in patients with HIV infection

INTRODUCTION

Human immunodeficiency virus (HIV) represents one of the most chronic and debilitating infections worldwide. Hopelessness and affective temperaments (mood that is characteristic of an individual's habitual functioning) may play important roles in the health-related quality of life (HRQoL) of patients with HIV. The purpose of this study was to examine affective temperaments in a sample of patients with HIV, the impact of hopelessness on HRQoL, and associations among HRQoL, hopelessness, and affective temperaments.

METHODS

The study involved 88 participants who were administered the short- form health survey (SF-36), the Beck hopelessness scale (BHS), the suicidal history self-rating screening scale (SHSS), the Gotland male depression scale (GMDS), and the temperament evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A).

RESULTS

Patients with a poorer HRQoL reported more severe depression and hopelessness than patients with a higher HRQoL. Patients with a poorer HRQoL also had higher scores on all dimensions of the TEMPS-A with a depressive component compared to patients with a higher HRQoL. The small sample size in this study limits the generalizability of the findings.

CONCLUSION

Patients with a poorer HRQoL were more depressed and also at an increased risk of suicide as indicated by the more severe hopelessness they reported compared to patients with higher HRQoL. These patients were also more likely to have depressive affective temperaments than those with a higher HRQoL.

Beck Hopelessness Scale: exploring its dimensionality in patients with schizophrenia

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.

A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations

CONTEXT

Despite the need to accurately measure spiritual outcomes in diverse palliative care populations, little attention has been paid to the properties of the tools currently in use.

OBJECTIVES

This systematic review aimed to appraise the psychometric properties, multifaith appropriateness, and completion time of spiritual outcome measures validated in multicultural advanced cancer, HIV, or palliative care populations.

METHODS

Eight databases were searched to identify relevant validation and research studies. A comprehensive search strategy included search terms in three categories: palliative care, spirituality, and outcome measurement. Inclusion criteria were: validated in advanced cancer, HIV, or palliative care populations and in an ethnically diverse context. Included tools were evaluated with respect to psychometric properties (validity, reproducibility, responsiveness, and interpretability), multifaith appropriateness, and time to complete.

RESULTS

A total of 191 articles were identified, yielding 85 tools. Twenty-six tools (representing four families of measures and five individual tools) met the inclusion criteria. Twenty-four tools demonstrated good content validity and 12 demonstrated adequate internal consistency. Only eight tools demonstrated adequate construct validity, usually because specific hypotheses were not stated and tested. Seven tools demonstrated adequate test-retest reliability; two tools showed adequate responsiveness, and two met the interpretability criterion. Data on the religious faith of the population of validation were available for 11 tools; of these, eight were tested in multifaith populations.

CONCLUSION

Results suggest that, at present, the McGill Quality of Life Questionnaire, the Measuring the Quality of Life of Seriously Ill Patients Questionnaire, and the Palliative Outcome Scale are the most appropriate multidimensional measures containing spiritual items for use in multicultural palliative care populations. However, none of these measures score perfectly on all psychometric criteria, and their multifaith appropriateness requires further testing.

The measurement of spirituality in palliative care and the content of tools validated cross-culturally: a systematic review

CONTEXT

Despite the need to assess spiritual outcomes in palliative care, little is known about the properties of the tools currently used to do so. In addition, measures of spirituality have been criticized in the literature for cultural bias, and it is unclear which tools have been validated cross-culturally.

OBJECTIVES

This systematic review aimed to identify and categorize spiritual outcome measures validated in advanced cancer, human immunodeficiency virus (HIV), or palliative care populations; to assess the tools' cross-cultural applicability; and for those measures validated cross-culturally, to determine and categorize the concepts used to measure spirituality.

METHODS

Eight databases were searched to identify relevant validation and research studies. An extensive search strategy included search terms in three categories: palliative care, spirituality, and outcome measurement. Tools were evaluated according to two criteria: 1) validation in advanced cancer, HIV, or palliative care and 2) validation in an ethnically diverse context. Tools that met Criterion 1 were categorized by type; tools that also met Criterion 2 were subjected to content analysis to identify and categorize the spiritual concepts they use.

RESULTS

One hundred ninety-one articles were identified, yielding 85 tools. Fifty different tools had been reported in research studies; however, 30 of these had not been validated in palliative care populations. Thirty-eight tools met Criterion 1: general multidimensional measures (n=21), functional measures (n=11), and substantive measures (n=6). Nine measures met Criterion 2; these used spiritual concepts relating to six themes: Beliefs, practices, and experiences; Relationships; Spiritual resources; Outlook on life/self; Outlook on death/dying; and Indicators of spiritual well-being. A conceptual model of spirituality is presented on the basis of the content analysis. Recommendations include consideration of both the clinical and cultural population in which spiritual instruments have been validated when selecting an appropriate measure for research purposes. Areas in need of further research are identified.

CONCLUSION

The nine tools identified in this review are those that have currently been validated in cross-cultural palliative care populations and, subject to appraisal of their psychometric properties, may be suitable for cross-cultural research.