The article, “ The association between depression and suicide when hopelessness is controlled for,” seeks to retest the association between suicide and depression using hopelessness as a controlled variable. The hypothesis considered in this article was, the strong association between suicide and major depression decreases or disappears when hopelessness is controlled for. Zhang’s article is also based on the assertion that psychological strains coupled with individual characteristics can be used to account for hopelessness. While Zhang’s article provides preliminary evidence to show that hopelessness is related to both suicide and depression, there are several shortcomings which are related to generalizability of results and sample.
Summary & Purpose
According to Zhang (2013), the incidence rate of suicide in Chinese rural areas is three times higher when compared to rates in urban areas. Therefore, Chinese youth aged between 15-34 years from six rural counties across three provisions were used as samples for the study. Zhang established a case-control design and psychological autopsy methodologies in a bid to meet the purpose of the study, which was to reevaluate the effects of hopelessness on the close correlation between suicide and depression. The researcher used face-to-face interviews to obtain relevant data from 392 representative informants for victims of suicide and 416 participants who served as controls for the study. At least two informants were interviewed for each suicide case, and information from both informants was integrated using the psychological autopsy method.
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Moreover, participants were requested to provide demographic information on their level of education, sex, age, income, marital status, and physical health. Zhang then utilized the Beck Hopelessness scale to assess hopelessness and the Structured Clinical Interview for DSM-IV Chinese version to assess major depression among controls participants. The Coping Response Inventory and the Dickman Impulsivity Inventory were used to measure coping skills and determine impulsivity personality traits among controls and suicides. The results of the study revealed that victims of suicides with depression diagnosis also had higher hopelessness scores. Moreover, suicide victims from both genders had low income, poor physical health, and were less educated when compared to controls.
Design & Method for Hypothesis Testing
Zhang utilized the Chi-square test together with Paired t-test as primary descriptive analyses for statistical analysis in the study. According to Jiang et al. (2018), statistical analyses seek to compare psychological and socio-demographic controls and suicides by sex. Six logistic regression models were then utilized to test the effect of hopelessness on the close correlation between suicide and depression. The relationship between suicide and depression in all six regression models decreased significantly after hopelessness was included in the analysis. Therefore, it was hypothesized that suicide is highly correlated with major depression, although this correlation disappears when hopelessness in controlled for. This design and method for the study were correct since they focused on a wide range of parameters for study.
Variables
The independent variables for this study included, hopelessness mean, mean age, level of income, physical health condition, depression, coping mean, religion, and currently married. These variables were defined as either risk factors or protecting factors for suicide. Depression, poor health conditions, and a lower level of education were designed as risk factors for suicide while religion, currently married status, good physical health, and reduced stress coping were defined as protecting factors. Except “currently married,” all other independent variables for the study were taken into six separate multiple logistic regression models in a bid to test the effects of hopelessness on the depression-suicide correlation.
Ethics
Zhang’s article was approved by the Institutional Review Boards across the Chinese and American universities involved in the study. The interviews adhered to ethical guidelines of research studies since the research provide informed consent with details of the interviewees’ rights. All participants of the study read and signed informed consent before the face-to-face interviews. There was also a provision for the interviewee to stop or discontinue the interview if he or she feels distressed at any point during the interview. Moreover, all the interviewers for this study were public healthcare practitioners and mental health professionals who held participants’ information privacy and confidentiality with high regard. Additionally, all informants and controls were interviewed in private locations separately. Based on these elements, it is quite evident that the study is ethically sound since it adheres to relevant ethical standards and guidelines for research.
The article’s author discusses hopelessness as a critical issue that can be used to predict suicides within contemporary society. However, Zhang’s study had several limitations. The psychological autopsy method for data collection would reliable if it included information from professional medical practitioners on suicidal patients ( Efstathiou et al., 2018) . However, due to poor infrastructure in rural China, the researchers did not acquire psychological autopsy information from multiple sources. Moreover, each of the two proxy informants for each victim of suicide provided variable details on the victim due to recall-bias, among other factors. According to O'Connor and Kirtley (2018), interviews on suicides should be conducted within two weeks after the suicide incident. If the interviews were done less than two weeks after a suicide incident, then information from the two informants for every suicide victim would be consistent. Despite its limitations, this article provides preliminary evidence to show the effect of hopelessness on the close correlation between suicide and major depression.
References
Efstathiou, V., Papadopoulou, A., Christodoulou, C., Gournellis, R., Michopoulos, I., Ferentinos, P., ... & Douzenis, A. (2018). The Relationship between Hopelessness and Clinical Characteristics of Hospitalized Patients with Recent Suicide Attempt. Issues in mental health nursing , 39 (10), 876-882.
Jiang, H., Niu, L., Hahne, J., Hu, M., Fang, J., Shen, M., & Xiao, S. (2018). Changing of suicide rates in China, 2002–2015. Journal of affective disorders , 240 , 165-170.
O'Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational–volitional model of suicidal behavior. Philosophical Transactions of the Royal Society B: Biological Sciences , 373 (1754), 20170268.
Zhang, J., & Li, Z. (2013). The association between depression and suicide when hopelessness is controlled for. Comprehensive Psychiatry , 54 (7), 790-796.
