The Third Paradigm: Hope in a Hopeless Age

Such research is necessary for establishing the mediational role of negative inferential styles in the relation between early abuse experiences, especially CEA and subsequent depression in a clinically meaningful manner. Several studies have examined other potential influences on the development of negative inferential styles. In particular, one found maternal negative self-schemata assessed during pregnancy to be associated with negative inferential styles in offspring 18 years later Pearson et al.

Moreover, support for a serial mediation model was found, with maternal cognitive vulnerability during pregnancy being mediated by offspring negative inferential styles in predicting depression in offspring. A temperamental style in early childhood characterized by withdrawal negativity i. Together, these two studies highlight the role of maternal influences on the emergence of negative inferential styles. Cognitive vulnerability as conceptualized in the hopelessness theory is of clinical relevance insofar as it can account for the etiology of depression.

Thus far, 18 studies have either assessed negative inferential styles in relation to depressive symptoms or episodes. Hong and colleagues found hopelessness to mediate the relation between negative inferential styles and hopelessness depression symptoms. Two of these studies Sutton et al. A few points should be noted in interpreting the findings from these studies.

First, both studies evaluating negative inferential styles relative to other cognitive vulnerability factors were cross-sectional. Consequently, the temporal relation between the constructs of interest remains unclear. Second, the mean depressive symptom levels across all these studies were generally in the mild to moderate range.

Thus, research is needed to determine the degree to which these findings extend to clinically significant samples and depression. However, age of depressive onset and proportion of life with depression were unrelated to negative inferential styles. The results described here are based on cross-sectional analyses. Consequently, they cannot provide insight regarding the degree to which negative inferential styles are predictive of future depressive episodes after accounting for known risk factors, such as past depression, and the extent to which this vulnerability factor is predictive of first depressive onset.

One recent study attempted to address this issue Nusslock et al. Negative inferential styles were associated with onset of major and minor depression. Nonetheless, this study is important in supporting the need for more work in this area. At its core, the hopelessness theory is a diathesis-stress model of depression.

The aforementioned studies therefore offer an incomplete evaluation of this relation between cognitive vulnerability and depression. Indeed, if a main effect for negative inferential styles, but not the hypothesized interaction with negative life events, were detected, such a finding would run contrary with the hopelessness theory. Remedying this issue, and representing the majority of empirical studies to date on the hopelessness theory are 28 studies assessing for the potential interaction between negative inferential styles and negative life events.

Several of these studies found support for this relationship using the weakest-link approach Abela, McGirr, et al. Another trend evident across several studies is that this interaction may be specific to depression relative to other symptoms of psychopathology Abela et al. A notable difference from earlier findings, however, was also observed. Specifically, unlike Metalsky and Joiner , Abela did not find evidence of mediation by hopelessness. A common limitation of these aforementioned studies is that a degree of caution should be taken generalizing findings involving mild dysphoria in non-clinical samples to more clinically severe populations.

Addressing this limitation, three studies evaluated the diathesis-stress component of the hopelessness theory in relation to clinically significant depression or in clinical or at-risk samples. Consistent with the hopelessness theory, cognitive vulnerability based on the weakest-link approach moderated the relation between daily hassles and depressive symptoms for girls, but not boys.

These findings are qualified, however, by the relatively low levels of depressive symptoms observed in the sample. Negative inferential styles did not predict depression by itself, but did when interacting with negative life events. Interestingly, however, neither the interaction between negative inferential styles and life events, nor the one between depressive self-schemata and life events was associated with depression when entered into the same analytical model.

As suggested by Hankin and colleagues , this finding may reflect significant overlap in conceptualization of cognitive vulnerability. It may also be a product of the small sample size preventing the detection of potentially small unique effects in two conceptually similar constructs. Additionally, temporality in the relation between negative life events and depressive episodes was uncertain due to both being concurrently assessed in the prospective phase of the study. It is therefore important for future studies to replicate current findings with clear temporal differentiation between life events and the depression they are hypothesized to precipitate.

A final methodological issue worth briefly mentioning is that with the exception of one study Stange et al. Although more economical and less labor-intensive than interview-based approaches, life events checklists are characterized by several limitations that complicate evaluations of the relation between stress, diathesis, and psychopathology e. Given that the one study to utilize an interview-based measure of life events was the lone study not to find evidence of a diathesis-stress interaction Stange et al.

Thus far, five studies have provided evaluations of hopelessness depression as conceptualized within the hopelessness theory. Two of these submitted symptoms of hopelessness depression to taxometric analysis. In addition to a taxometric analysis, Whisman and Pinto assessed the relation between hopelessness and symptoms of hopelessness depression. Significant bivariate correlations were observed for five of six hopelessness depression symptoms, and for two of four other depression symptoms. Hopelessness was more strongly correlated with the composite of hopelessness depression symptoms than other depressive symptoms.

Collectively, these findings provide mixed support for hopelessness depression as a distinct syndrome. Several qualifications are worth mentioning, however, for interpreting these findings. Interestingly, this systematic exclusion of individuals with milder symptom presentations may actually lead to a reduction in the ability to detect a hopelessness depression taxon if it exists. Additionally, in four studies, only six to seven of the 11 hopelessness depression symptoms were assessed, which limits the content validity of their measures of this construct. It is worth noting within this context that the fifth study, which generally provided the most support for hopelessness depression as a syndrome, was not subject to this restriction.

A related point is that the depressive symptom measures used in these studies were not originally designed to assess symptoms of hopelessness depression, which, in some cases, were based on items from several different instruments. Thus, although these studies are important in validating the need for more research in this area, these issues also particularly point to the need for future studies utilizing instruments specifically designed to measure hopelessness depression e.

Two studies to date have evaluated aspects of the hopelessness theory of suicide Abramson et al. It also should be noted that the definition of parasuicide employed in this study explicitly did not differentiate between suicidal behavior and NSSI. Although important in providing preliminary support for a relation between negative inferential styles and suicidal ideation, this study is qualified by several limitations that also warrant consideration. First, although a high-risk design was used, and as acknowledged in the study, the participants exhibited low levels of suicidal ideation, and thus generalization to clinically significant phenomena must be necessarily tempered.

Second, baseline levels of suicidal ideation were not covaried in the analyses, meaning it was unclear to what degree negative inferential styles temporally preceded ideation observed at the follow-up assessment. It is therefore essential for future research to evaluate negative inferential styles in relation to changes in suicidal ideation over a substantial follow-up period with a more clinically acute sample.

Given the exploratory nature of this study, future replication is required before firm conclusions may be reached regarding the existence of this association. None of the studies identified in the current review evaluated the model of recovery postulated in the hopelessness theory Abramson et al. Three studies, however, have examined positive inferential styles in relation to depression and related risk factors.

Additionally, healthy controls exhibited more positive inferential styles than did adults with affective illness Rose et al. For reasons previously noted, the cross-sectional nature of these studies indicates the need for caution in interpreting their findings. Following up on this study, Dobkin and colleagues examined negative inferential styles in the context of treatment.

Incidentally, this finding adds weight to the view that although a relatively stable vulnerability factor, negative inferential styles are not immutable, even in adulthood. Given the absence of a control condition, however, it was unclear to what degree the observed improvement in cognitive vulnerability was due to natural regression to the mean, CBT, AIF, or an increased sense of social support patients feel from receiving AIF. Although this study lends promise to the potential modifiability of negative inferential styles, the current findings await replication in a clinically depressed sample with more severe and rigid depressogenic cognitions.

Studies that included other forms of childhood abuse were consistent in finding no evidence that CPA and CSA were associated with cognitive vulnerability. Also common across these studies, however, were relatively low levels of abuse, particularly in the case of CPA and CSA. Therefore, it is imperative for future research to address this issue in longitudinal evaluations of the relation between childhood abuse and negative inferential styles before firm determinations can be made regarding the role of CPA and CSA.

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A few studies have examined cognitive correlates and characteristics of negative inferential styles. There is preliminary evidence that negative inferential styles are a vulnerability factor distinct from those featured in other prominent cognitive theories of depression i. It would be particularly informative for future studies to follow children prospectively to observe when negative inferential styles begin to emerge, and when they consolidate into a unitary risk factor so as to provide indicators of crucial windows for preventive efforts. Research prospectively assessing negative inferential styles prior to depressive onset, during depressive episodes, and while in remission may also allow for within-person analyses elucidating important aspects of this construct e.

General support was found for a relation between negative inferential styles and depression through an interaction with negative life events. Indeed, the aspect of the hopelessness theory that has received the most empirical support thus far is the diathesis-stress interaction. No studies as of yet, however, have evaluated the specific vulnerability hypothesis or the titration model. Additionally, the vast majority of the research in this area has involved generally mild depressive symptoms in non-clinical samples.

Although it is consistent with the hopelessness theory to find that individuals with negative inferential styles are more likely to have a past history of depression, the most central aspect of the hopelessness theory remains largely unexamined, whether negative inferential styles, in interaction with negative life events, prospectively predict the occurrence of depressive episodes, over and above traditional risk factors e.

Related to this issue, it is not known whether negative inferential styles, interacting with negative life events, are predictive of specific aspects of the course of depression, such as first depressive onset in addition to depressive recurrence, likelihood of depressive relapse, as well as severity and duration of depression. Additionally, there are few studies evaluating hopelessness as a mediator of the hypothesized interaction between negative inferential styles and negative life events on depression, with the current support being mixed.

Future work addressing these gaps in the literature is essential for validating the clinical relevance of the hopelessness theory. Given the observation made by some researchers Abramson et al. For example, among the studies included in the current review, one reported mixed support for the unique role of negative inferential styles in lifetime history of depression when compared to negative core beliefs Abela et al. Another detected evidence of significant overlap in the diathesis-stress components of the hopelessness theory and negative self-schemata, with none retaining significant association with major depression when examined in the same regression model Hankin et al.

A third found negative inferential styles, dysfunctional attitudes, and rumination to be relatively distinct cognitive vulnerability constructs in a set of exploratory and confirmatory factor analyses Hankin et al. Thus, the current state of the literature on this issue is inconclusive and awaits further clarification.

With regards to the construct of hopelessness depression, one of the most unexpected findings of the current review is that none of the studies under consideration examined clinically significant hopelessness depression i. The few studies involving hopelessness depression symptoms were consistent, however, in yielding support for a relationship with negative inferential styles.

These findings validate the need for more research with clinically significant hopelessness depression. The mixed support for hopelessness depression as a construct makes the proposed distinction of this cognitively mediated subtype of depression perhaps the one part of the theory for which the evidence base is currently most tentative. As noted above, this may largely be due to the issue of inadequate content validity in the existing research in this area. Indeed, there was a trend for greater support for the hopelessness depression construct with more comprehensive assessment of hopelessness depression symptoms.

Along with the previously mentioned need for studies evaluating the hopelessness depression construct using instruments specifically designed to measure it, it would be important to ascertain what proportion of individuals meeting criteria for hopelessness depression also satisfy criteria for DSM-5 American Psychiatric Association, major depression, considering the overlap in symptoms between the two sets of diagnostic criteria i. Such work would be important in establishing the degree to which these syndromes are overlapping yet still distinct phenomena; insofar as a substantial proportion of cases of hopelessness depression do not satisfy criteria for DSM-5 major depression and vice versa, a greater claim may be made for maintaining the diagnostic distinction.

Furthermore, research evaluating the specificity of negative inferential styles to hopelessness depression is required to validate its being a subtype of depression meaningfully distinct from DSM-5 major depression and other commonly recognized depression syndromes. More specifically, in addition to establishing negative inferential styles as a predictor of hopelessness depression episodes in general, it would be important to demonstrate this cognitive vulnerability is predictive of episodes of hopelessness depression that do not meet criteria for DSM-5 major depression, and is more predictive of hopelessness depression than DSM-5 major depression.

In a similar manner, to the extent that the explanatory and predictive value of cognitive vulnerability as conceived within the hopelessness theory lies in its specificity to depression rather than general psychopathology more broadly Abramson et al. Thus far, the evidence appears mixed, although there appears to be greater support for a degree of specificity in studies focusing on non-clinical samples and depressive symptoms rather than diagnoses. Resolution of this issue regarding specificity of negative inferential styles to depression awaits future investigation.

Research investigating the hopelessness theory of suicide is also currently quite limited. Again, longitudinal studies are needed to establish temporality, especially for negative inferential styles as a prospective predictor of suicidal ideation, suicide plans, attempts, and deaths by suicide as discrete outcomes, after accounting for established risk factors e. Even more understudied still is the model of recovery from hopelessness depression articulated in the hopelessness theory Abramson et al.

In fact, there have been no studies to date examining positive inferential styles in relation to recovery from clinically significant depression. To some extent this is a reflection of the greater focus that has been devoted to the cognitive risk component of the hopelessness theory, specifically the study of negative inferential styles. This is also due, in no small measure, to prior studies adopting a measure of positive attributional styles rather than inferential styles, and thus providing an inadequate assessment of this construct according to the hopelessness theory.

The marked homogeneity in measurements of negative inferential styles also warrants mention. Notwithstanding the benefit of this in that it facilitates direct comparisons across studies in the literature, there is a need to diversify the paradigms used for measuring this cognitive vulnerability. More specifically, with one notable exception Abela et al. Finally, we noted a considerable amount of conceptual confusion in the empirical literature between the reformulated learned helplessness theory Abramson et al.

For example, it was not uncommon for studies ostensibly of the hopelessness theory instead to provide an evaluation of the reformulated learned helplessness theory. Additionally, several studies referred to attributional styles when in fact providing assessments of inferential styles. Furthermore, the still-prevalent focus on attributional styles particularly as measured with the Attributional Style Questionnaire; Peterson et al. We would like to thank Lauren Alloy for her comments on an earlier draft of this article.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency. We present here the most recent criteria for this hypothesized disorder subtype Alloy et al. As no unique studies meeting our inclusion criteria were uncovered, we present here the results of our litereature search in PsycINFO. The addition of these terms yielded no additional search results, and thus, in the interest of parsimony, were removed from our search string.

Additional supporting information may be found in the online version of this article:. National Center for Biotechnology Information , U. Clin Psychol New York. Author manuscript; available in PMC Dec 1. Liu , 1, 2 Evan M. Kleiman , 3 Bridget A. Nestor , 1, 2 and Shayna M. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Clin Psychol New York.

See other articles in PMC that cite the published article. Open in a separate window. Developmental Antecedents to Negative Inferential Styles Although the hopelessness theory originally was largely silent on the antecedents of the development of cognitive vulnerability for depression, Rose and Abramson provided a developmental elaboration of this theory, in which negative early life experiences, particularly in the form of child maltreatment, figure prominently as a contributing factor to cognitive risk.

Diathesis-Stress According to the hopelessness theory, these three inferential styles function as cognitive diatheses, which by themselves should not be associated with increased likelihood for developing hopelessness and depression. Hopelessness and Hopelessness Depression Next in the causal chain leading to depression is hopelessness. Negative Inferential Styles and Self-Injurious Thoughts and Behavior In addition to depression, the hopelessness theory also has been proposed to account for suicidal ideation and behavior i.

Empirical Evaluations of the Hopelessness Theory Literature Search Strategy The current systematic review focused on all published studies that have assessed elements of the hopelessness theory. Negative Inferential Styles Characteristics Three studies have attempted to delineate properties of negative inferential styles as a construct. Developmental Antecedents to Negative Inferential Styles Altogether, nine studies to date have assessed potential antecedents of depressogenic inferential styles.

Negative Inferential Styles and Depression Cognitive vulnerability as conceptualized in the hopelessness theory is of clinical relevance insofar as it can account for the etiology of depression. Life Events and the Hopelessness Theory At its core, the hopelessness theory is a diathesis-stress model of depression. Hopelessness depression Thus far, five studies have provided evaluations of hopelessness depression as conceptualized within the hopelessness theory.

Negative Inferential Styles and Self-Injurious Thoughts and Behavior Two studies to date have evaluated aspects of the hopelessness theory of suicide Abramson et al. Positive Inferential Styles, Adaptive Inferential Feedback, and Recovery from Depression None of the studies identified in the current review evaluated the model of recovery postulated in the hopelessness theory Abramson et al. Acknowledgements We would like to thank Lauren Alloy for her comments on an earlier draft of this article.

Footnotes 1 The symptom profile for hopelessness depression has been revised since the initial formulation of the hopelessness theory i. Supporting Information Additional supporting information may be found in the online version of this article: The hopelessness theory of depression: A test of the diathesis—stress and causal mediation components in third and seventh grade children. Journal of Abnormal Child Psychology. A multi-wave longitudinal study. Behaviour Research and Therapy. A test of integration of the activation hypothesis and the diathesis-stress component of the hopelessness theory of depression.

British Journal of Clinical Psychology. Hopelessness depression in children: An examination of the symptom component of the hopelessness theory. Cognitive Therapy and Research. Operationalizing cognitive vulnerability and stress from the perspective of the hopelessness theory: A multi-wave longitudinal study of children of affectively ill parents. The British Journal of Psychology. Depressogenic inferential styles, negative events, and depressive symptoms in youth: An attempt to reconcile past inconsistent findings. A test of the integration of the hopelessness and response styles theories of depression in middle adolescence.

Journal of Clinical Child and Adolescent Psychology. A test of the integration of the hopelessness and self-esteem theories of depression in schoolchildren. Cognitive vulnerability to hopelessness depression: A chain is only as strong as its weakest link.

Conceptualizing cognitive vulnerability to depression in youth: A comparison of the weakest link and additive approaches. International Journal of Cognitive Therapy. A test of the diathesis-stress component in the interpersonal and achievement domains. Cognitive vulnerability to depressive symptoms in adolescents in urban and rural Hunan, China: A multiwave longitudinal study. Journal of Abnormal Psychology. Negative cognitive style and past history of major depressive episodes in university students.

The hopelessness theory of suicidality. Kluwer Academic Publishing; Boston: A theory-based subtype of depression. Learned helplessness in humans: Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression. Cognitive vulnerabilities and depression versus other psychopathology symptoms and diagnoses in early adolescence. Diagnostic and Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders: A cognitive-interpersonal model of adolescent depression: The impact of family conflict and depressogenic cognitive styles.

Predicting changes in depressive symptoms from pregnancy to postpartum: The role of brooding rumination and negative inferential styles. Suicides and serious suicide attempts: Two populations or one? Clinical, experimental, and theoretical aspects.

Cognitive models of depression. Journal of Cognitive Psychotherapy. Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. American Journal of Psychiatry. Infant positive and negative emotionality: One dimension or two? Psychiatric comorbidity among referred juveniles with major depression: Social origins of depression. The Free Press; New York: Symptoms of depression and anxiety in children: Specificity of the hopelessness theory. Transactional relationships among cognitive vulnerabilities, stressors, and depressive symptoms in adolescence.

Attributional style and depressive symptoms in adolescents: An examination of the role of various indicators of cognitive vulnerability. Cognitive vulnerability to depression in children: An idiographic, longitudinal examination of inferential styles. Emergence of attributional style and its relation to depressive symptoms. A longitudinal look at the relation between depression and anxiety in children and adolescents.

Journal of Consulting and Clinical Psychology. A direct comparison between suicide attempters and suicide completers. Journal of Affective Disorders. Adaptive inferential feedback partner training for depression: Cognitive and Behavioral Practice. Inducing hope in people may be a promising avenue for suicide prevention.

People react differently to stressors in life, with some individuals deliberately putting an end to their lives in the face of adversity and others endeavouring to proceed. The key to this difference has given rise to suicidology, the scientific study of suicide. Over the last few decades, suicidology has focused on the relationship between various risk factors in particular negative cognitive factors and suicide [ 1 — 5 ]. For example, the association between suicidal ideation and psychopathological constructs such as depressive symptoms and hopelessness have been addressed extensively [ 6 — 8 ].

Although the presences of these psychopathological constructs are strong predictors of suicidality, it should not be overlooked that some individuals deal with their hardship in a positive way. The positive elements that motivate people to adopt coping strategies instead of suicidal behaviour in the face of adversity, like any other content associated with a decrease in suicide, may be conceptualized as Papageno effect [ 9 ]. His suicidal act is immediately stopped by three child-spirits who later on advise Papageno of a coping strategy.

Papageno eventually copes positively with the suicidal crisis after adopting the coping strategy. Niederkrotenthaler and his colleagues [ 9 ] studied the associations between media content and suicide rates and they found that coverage on positive coping in adverse circumstances in media reports about suicidal ideation has a Papageno effect and decreases suicide.

Existing models of psychopathology and suicidality, with a focus on the association between psychopathological constructs and suicide, cannot account for the Papageno effect exerted by the positive elements which motivate people to face their adverse circumstances in a positive way. This limitation has led to a positive psychology movement for the use of positive psychological constructs in the investigation of psychopathology and suicidality [ 10 — 13 ]. For example, there is on-going interest in incorporating the concept of resilience into the suicidality paradigm [ 10 , 14 ].

Johnson and her colleagues [ 10 ] performed an extensive review of 77 suicidality studies that investigated the role of at least one positive psychological construct a. Using this framework, the buffering effect of a wide range of positive psychological constructs on suicidal thoughts and behaviours can be explored. Kleiman and his colleagues [ 15 ] examined the roles of gratitude and grit as resilience factors against suicidal ideations and they found that gratitude and grit interacted that individuals with higher levels of gratitude and grit at baseline have fewer suicidal ideations over time.

In another study [ 16 ], Kleiman and his colleagues further provided evidence for the role of gratitude in buffering the association between suicidal ideation and its high risk factors, hopelessness and depressive symptoms. Yet, they did not examine the role of grit in buffering suicide risks associated with hopelessness and depressive symptoms in a similar way. The construct of grit defined as the extent of perseverance and passion in pursuit of long-term goals [ 17 ] is closely related to the components of hope consisting of goal-directed determination and planning of ways to meet goals [ 18 ].

In the present investigation, a relatively less studied but promising resilience factor based on the adaptive cognitive style of hope will be explored for its buffering impact on suicidal ideation using the buffering framework. The notion that hope may buffer individuals against suicidal ideation is built on empirical findings in the literature suggesting that hope buffers individuals against psychopathology [ 19 — 21 ] and that hope contributes to better outcomes in a variety of negative situations [ 18 , 22 — 26 ].

The broad benefits of having high level of hope, along with the relevant findings in the literature that hope buffers individuals against psychopathology as well as suicidality, suggest that hope is a promising factor to be examined under the buffering framework for suicidality. According to the theory of hope proposed by Snyder and his fellows [ 18 ], low-hope individuals fail to generate alternative pathways either to achieve a blocked goal or to formulate new attainable goals, and thus are prone to suicidal ideation in the face of stressors.

However, it is inadequate if we simply test whether high-hope individuals are being associated with lower suicidal ideation than low-hope individuals. As pointed by Johnson and her colleagues [ 10 ] in conceptualizing the buffering framework, the validation of proposed resilience factors should go beyond examining the bivariate association between resilience factors and their outcomes. Even though high hope is found to be associated with reduced suicidal ideation, it does not necessarily establish the positive effect of hope as a resilience factor. It may simply demonstrate a reduced risk to its associated risk factor such as hopelessness which results in reduced suicidal ideation.

In other words, it is not clear whether it is the hope construct or hopelessness construct that should be targeted for research in predicting suicidal ideation and psychotherapy in reducing suicidal ideation. Underlying this problem is a more fundamental question concerning whether hope is simply the inverse of hopelessness, which is a controversial topic to a number of researchers, psychologists and psychiatrists in the field [ 19 , 30 — 33 ].

Low hope characterized by having a lack of positive expectancies for the future may easily be taken as hopelessness—a state of having increased negative expectancies for the future [ 34 — 35 ]. Hope and hopelessness have been considered to be similar constructs since both tap future-oriented expectancies [ 36 — 37 ], making them appear to be opposite ends of a single bipolar spectrum.

However, having increased negative expectancies was not equivalent to having reduced positive expectancies, as illustrated by the findings of a study conducted by MacLeod, Rose, and Williams [ 38 ]. In the study, they analysed the patterns of future-orientated expectancies of a group of recent suicide attempters and found that compared with matched controls, recent suicide attempters were having fewer positive future expectancies but no greater negative future expectancies.

While these findings suggest that positive future expectancies encompassed by the hope construct and negative future expectancies encompassed by the hopelessness construct may differ qualitatively, empirical research on the factor structure of both constructs is needed before concluding whether hope and hopelessness constitute opposite ends of a single factor or two separate factors. The present study was conducted for this purpose and the significance of this study lies on an empirical investigation of the two constructs and their relationship to suicidal ideation.

This study goes beyond the examination of a direct association between hope and suicidal ideation to investigate hope as a resilience factor which buffers the strength of the association between hopelessness and suicidal ideation. The rationale for this investigation is based on the buffering framework of Johnson and her colleagues [ 10 ] which proposes that a resilience factor should be viewed as a separate dimension to the risk factor, and that the resilience factor i.

In line with the positive psychology movement, Snyder and his colleagues [ 18 ] developed a theory of hope a. Agency is a sense of determination in achieving goals, which is the motivational component of hope. People with high agency thinking have a strong motivation and great drive to achieve their goals, even when they face difficulties. People with high pathways thinking are more likely to generate more than one pathway to reach a particular goal.

Hope is the sum of agency thinking and pathways thinking; both components interact and sustain each other [ 39 ]. These persons misconstrue their experiences in negative ways and anticipate dire outcomes resulting from their problems. Thus, the hope construct has additive value to the hopelessness construct and they together could serve as a new framework through which outcome variables such as suicidal ideation in the present study can be examined.

The concept of hope and hopelessness as two separate constructs is depicted in Fig 1. Instead of being opposite poles of one spectrum, hope and hopelessness have their own bipolar spectra. A person can have a raised sense of agency and problem-solving abilities i. For example, Person A has seasonal affective disorder and he is now having its symptoms during the seasonal change. He oversleeps and overeats, and he has heightened pessimistic feelings about his future.

However, along with hopelessness, Person A has some hope as determined by his past successful experiences of coping with seasonal affective disorder and his present attempts to make adjustment to his oversleeping and overeating behaviours and pessimistic thoughts. Indeed, the difference in temporal focus between the two constructs also provides a basis for individuals to have hope and hopelessness at the same time. Whereas hopelessness focuses on the anticipation of future experiences or consequences, hope focuses on past and present experiences of successful goal pursuit.

Other examples of individuals having hope and hopelessness at the same time may come from cancer patients who find ways to make sense out of everyday although they might experience pain, sorrow and sadness. Sullivan [ 32 ] did a review on literatures concerning hope and hopelessness at the end of life of these patients and discussed the dynamics of the two constructs during the dying process.

He pointed out that hope was still possible at the end of life a hopeless condition with varieties of goal: If one of the goals could not be met e. The phenomenon of high hope and high hopelessness will be further discussed within the context of suicidal ideation in the following section. As hope and hopelessness are two separate constructs, they can interact with each other in four different combinations to result in either high or low likelihood of suicidal ideation as depicted in Fig 2. In particular, the effect of hope in buffering the likelihood of suicidal ideation is evident when individuals are at high levels of hopelessness i.

On the other hand, when the level of hopelessness is low i. The moderating effect of hope on hopelessness and suicidal ideation can be explained by the buffering framework [ 10 ] in that a resilience factor i. As discussed earlier, previous studies [ 34 , 43 , 45 ] have shown hopelessness to be strongly associated with suicidal ideation and behaviors.

The contemporary view of hopelessness suggests that negative affects embodied by hopelessness may lead to the employment of maladaptive coping styles [ 49 ]. A maladaptive coping style, and thus unsuccessful coping with hopelessness, may in turn result in suicidal ideation. At the same time, hope with its equal emphasis on agency and pathways thinking may act on the coping process [ 50 ] to buffer individuals at substantial levels of hopelessness against the development of suicidal ideation, or reduce the negative impact of hopelessness on suicidal ideation.

When a person fails to generate alternative pathways to achieve a blocked goal or formulate new attainable goals, suicidal ideation might arise. As an individual with high hope is better able to generate more strategies for coping with negative stressors, hope is likely to have a moderating effect on the relationship between hopelessness and suicidal ideation.

In addition, as high-hope individuals have more goals and can generate more pathways to achieve them, they would be better able to redirect their goals when they encounter goal blockage in adversity. Hence, high-hope individuals are less likely to develop suicidal ideation even when they are experiencing high levels of hopelessness because they can pursue other goals and rebound from their negative emotional state.

Conversely, low-hope individuals who are at high levels of hopelessness are more likely to develop suicidal ideation because of the absence of hope in reducing the negative impact of hopelessness on suicidal ideation. In summary, the present study made use of empirical data to examine the constructs of hope and hopelessness. It was hypothesized that hope and hopelessness are better fitted as two correlated but distinct factors than one single factor H 1.

A moderation model of hope buffering the relationship between hopelessness and suicidal ideation was also tested. It was hypothesized that the interaction between hope and hopelessness predicted decreased suicidal ideation H 2. Data was collected as part of a population-based household survey in a prevalence study conducted by the Hong Kong Jockey Club Centre for Suicide Research and Prevention of the University of Hong Kong. The participants provided their written informed consent to participate in this study.

Consent form covering the main points of the study were read to and signed by each participant. Confidentiality of the data was explained to each participant that the information would be used for research purposes only. The participants were informed their rights to terminate the interview survey at any time without any negative consequences. This consent procedure was approved by the Research Ethics Committee stated above. The Frame of Quarters is a complete and up-to-date registry of residential addresses in Hong Kong, which is useful for conducting population-based household surveys.

Once a residential address was selected from the Frame of Quarters, a member of that household was randomly selected and invited to respond to the survey. The detailed procedures of the household survey have been reported previously [ 52 — 53 ]. Only local residents were eligible to participate in this study. Domestic helpers from overseas countries were excluded from the targeted population.

Moreover, only those aged 20 years or above were included in the target population of this study because one of the measures, the Adult Suicidal Ideation Questionnaire ASIQ [ 54 ] , was designed for respondents aged 20 years and above. Participants were being asked their past suicidal behavior and 30 respondents reported having suicide attempt s in the year preceding administration of the survey. The data of these respondents with suicide attempt in the year preceding administration of the survey were also included in the present study for they are the population of interest. Using the above inclusion criteria, a total of samples were obtained.

The characteristics of the participants including age group, gender, marital status, employment status and highest educational qualification are reported in Table 1. The age and gender distribution of our sample was similar to that of and thus representative of the population aged between 20 and 59 years in Hong Kong. Three measures were adapted in the present study: Hope was measured by the Hope Scale by Snyder et al. It consists of two subscales: The original inventory for the Hope Scale [ 18 ] contains twelve items in which four items are distracters.

For the sake of not making the questionnaire lengthy in the population-based survey, the four distracters were not administered in the present study. A 4-point Likert scale was used, from 1 definitely false to 4 definitely true , with higher scores representing the higher levels of hope. The Chinese version of the Hope Scale from previous studies [ 22 — 23 ] was used in the present investigation. The internal consistency of the scale has been validated in both clinical and community samples e.

The Chinese version of the BHS, translated and validated by Shek [ 56 ], was used in the present study. A higher score in the scale implies a higher level of state hopelessness. The ASIQ is a item, self-reported measure of the severity of suicidal ideation in adults. The 7-point scale describes the frequency of the cognitive occurrence of suicidal ideation during the past month, ranging from 0 never had the thought to 6 almost everyday. A higher score on the scale indicates a higher level of suicidal ideation. Two major statistical analyses were conducted to test the two hypotheses in the present study.

Several goodness-of-fit indices were reported: Chi-square goodness-of-fit test statistics, comparative fit index CFI [ 58 ] , incremental fit indices of non-normed fit index NNFI [ 59 ] , and residual based indices of root mean square error of approximation RMSEA [ 60 ]. The following criteria were applied to determine the goodness-of-fit of factor structural models: For model comparison, chi-square difference test was used to compare nested models; Akaike information criterion AIC and consistent Akaike information criterion CAIC were considered for non-nested model comparisons.

AIC and CAIC measure the parsimonious fit that taking both the model fit and the number of parameter estimated into consideration. Negative binomial regression analyses were conducted using IBM SPSS Statistics 20 to test the hypothesis that hope is a moderator in the relationship between hopelessness and suicidal ideation, such that the interaction between hope and hopelessness predicted suicidal ideation. It should be noted that positive skewness for suicidal ideation was expected for our data because suicidal ideation has a low base-rate of occurrence in the general population.

Three negative binomial regression models were fitted to predict suicidal ideation. The first model had the main effect of hopelessness only, and hope was added as another main effect in the second model. The third model had an interaction term of hope and hopelessness in addition to the two main effects. Hope and hopelessness were centered and the interaction term of hope and hopelessness were calculated based on multiplying the centered values of hope and hopelessness in order to avoid possible problems with multi-collinearity.

A significant increase in chi-square statistics by analysing the deviance of the negative binomial models would provide further evidence for improved fit over the previous model. All study variables were significantly correlated in the expected direction. On a related note, the correlations between sub-factors of hope and hopelessness only ranged from-. With little variance in common, hope and hopelessness cannot be considered equivalent constructs.

Confirmatory factor analysis was conducted to test whether hope and hopelessness fit better into a model as a single construct manifested as two opposite directions of one construct or two separate constructs manifested as two distinct but correlated constructs. The factor structures of hope and hopelessness were tested.

Two sets of alternative measurement models which manifested different combinations between the construct of hope 8 items in total and hopelessness 20 items in total were proposed at first-order and second-order levels. The first set of measurement models evaluated was first-order factor models: The one-factor model assumes all 28 items 8 items from the Hope Scale and 20 items from the Beck Hopelessness Scale reflect a single dimensional factor, while the two-factor model assumes that two correlated dimensions Hope and Hopelessness underlie the responses to the 28 items.

Associated Data

The other set of measurement models being evaluated were second-order factor models: A single second-order factor model and a two second-order factor model. The single second-order factor model is a higher-order model in which a single second-order factor named as Future Oriented Cognition underlies the covariation among the five first-order latent factors of hope Agency and Pathways and hopelessness Affective, Motivational and Cognitive components.

The two second-order factor model is a higher-order model consisting of two negatively correlated second-order factors Hope and Hopelessness. The first of these underlies the covariation between the first-order factors Agency and Pathways , and the second underlies the covariation between the first-order factors Affective, Motivational and Cognitive components.

The Hopelessness Theory of Depression: A Quarter Century in Review

The two second-order factor model was thus taken as the best-fitted model of hope and hopelessness. The correlation between the two second-order factors was-. This is consistent with our hypothesis that hope and hopelessness fitted significantly better to the data as two distinct but correlated factors rather than one unidimensional factor in both first-order and second-order measurement models.

Three negative binomial regression models were tested. Results of the negative binomial analyses are summarized in Table 3. This shows that hope was a significant moderator for the effect of hopelessness on suicidal ideation. The deviances of the three negative binomial regression models are shown in Table 4.

Thus, the best model in predicting suicidal ideation is the model with two main effects hope and hopelessness and an interaction effect between hope and hopelessness. The interaction between variables is plotted in Fig 3. Level of hope as measured by the Hope Scale moderates the relationship between hopelessness as measured by the Beck Hopelessness Scale and suicidal ideation as measured by the Adult Suicidal Ideation Questionnaire. For individuals high on hope scoring one standard deviation above the mean on the Hope Scale , there is smaller increase in suicidal ideation at higher levels of hopelessness than individuals low on hope scoring one standard deviation below the mean on the Hope Scale.

The present study contributed to the exploration of whether hope and hopelessness constitute a single bipolar construct or two distinct constructs. The empirical findings of the present study suggest that it would be more appropriate to conceive of hope and hopelessness as distinct but related constructs. This observation supports our argument that the hope esp. Furthermore, this result is consistent with current findings that agency seems to be a more central component of hope than pathways [ 66 ]. It is intriguing that some people choose to end their lives under adversity, while others choose to take their hardships as a challenge and find meaning in their life despite high levels of hopelessness.

As hypothesized H 2 , the moderating effect of hope on the association between hopelessness and suicidal ideation was significant. From the interaction plot see Fig 3 , it can be observed that the level of hope moderates the relationship between hopelessness and suicidal ideation.

Those scoring one standard deviation above the mean on hope high-hope individuals demonstrated a smaller relationship between hopelessness and suicidal ideation than those scoring one standard deviation below the mean low-hope individuals. Therefore, hope as a resilience factor reduces the negative impact of hopelessness as a risk factor on suicidal ideation and buffers individuals against the development of suicidal ideation in the face of hopelessness.

Although there is extensive evidence supporting the relationship between hopelessness and suicidality [ 43 , 45 ], hopelessness may not develop into suicidal ideation if hope is present. Although high-hope individuals may feel depressed, they are likely to rebound from the state of hopelessness when confronting adversity by formulating new goals or redirecting their goals; they may interpret goal blockage as a challenge and seek alternative pathways to re-channel their motivation toward achieving their goals.

Conversely, goal blockage in adversity could be disastrous to low-hope individuals as they might fail to generate new goals or find alternative ways to achieve their goals. They may feel hopeless in such a situation and perceive suicide as the only way out, thus resulting in suicidal ideation. The clarification of hope and hopelessness as separate dimensions, with hope being a resilience factor which can buffer the strength of the association between a risk factor e. Research in suicidality has mainly focused on identifying risk factors and populations at high risk for suicide.

Positive psychological constructs, such as hope, have been largely neglected in the field [ 67 ]. In fact, hope is a well-researched construct in other disciplines like sociology and religion.

For instance, Stack and Kposowa [ 68 ] proposed that a belief in an afterlife of some religions is fundamental to promoting human hopefulness which may lead to lower suicidality. The findings of the present study suggest that hope can moderate the association between hopelessness and suicidal ideation, and that by instilling and strengthening hope we may be able to lower the risk of suicide.

Hope can be further contributed to the design of interventions utilizing the public health approach [ 69 ] by using the concept of hope to facilitate the early prevention of suicide and to benefit other public health e. As stated by Snyder [ 40 ], hope theory has the potential for large-scale application and can be used to reduce the risk of, and inoculate segments of society against despair.

If community-based prevention programmes involving the promotion of hope are developed, they may help reduce the population at risk. Apart from promoting hope as an early intervention, hope may also be applied in providing timely intervention for those who are at high risk. Research has shown that the instillation of positive psychological constructs such as hope [ 25 ] and optimism [ 48 , 71 ] in psychotherapy may also be effective for high-risk groups, including suicide attempters and survivors in suicide prevention programmes as well as in depressive patients.

Hope training in the form of cognitive behavioral therapy CBT which involves the generation of agency and the provision of new pathways to those of high-risk for suicide or depression may be effective in reducing the risk of suicidal intent and depressive symptoms. The present study has several limitations which need to be considered when generalizing the findings. Firstly, all the variables in present study, including the measures of suicidal ideation ASIQ , were self-reported.

Items of the ASIQ were included in a self-completion questionnaire in order to protect privacy. However, this is not dissatisfactory, as other population-based surveys conducted in Hong Kong on relatively less sensitive topics also obtained similar response rates [ 72 ]. Thirdly, the target sample only included individuals aged between 20 and 59 years on account of the design of the ASIQ. Thus, the results of the present study may not be generalizable to other age groups.

The Hopelessness Theory of Depression: A Quarter Century in Review

Future studies should investigate whether the moderating effect of hope on hopelessness and suicidal ideation is also present in samples of the young and elderly. In addition, the study is limited as it utilized a cross-sectional design to investigate correlations, which cannot be used to demonstrate the causal effect of hope in reducing hopelessness and suicidal ideation.

Although strict experimental control may not be feasible, future studies should use an experimental approach to examine the effect of different levels of hope on hopelessness and suicidal ideation. It is important to distinguish and clarify the constructs of hope and hopelessness, that they may be distinct constructs rather than simple correlates or polar opposites of future expectation.

Researchers and clinicians need to realize the negative-type constructs are not simply polar opposites of positive-type constructs, that two entities must be considered as unique groups of variables.