Independent Association between Hopelessness and Suicidality in Patients with Major Depressive Disorder

Uvod Jedan od najvećih izazova i najzahtjevnijih poslova psihijatrijske medicinske sestre jest skrb za suicidalne bolesnike. Suicidalnost je sloţen fenomen, pa je i prepoznavanje suicidalnosti zahtjevno. Prediktivna valjanost i prije svega osjetljivost raspoloţivih algoritama za procjenu rizika od suicida je praktično nedovoljna, te u svakodnevnom kliničkom radu liječnici i medicinske sestre moraju obraćati posebnu paţnju i na moguće rane, subjektivne znakove suicidalnosti. Jedan od ranih, subjektivnih znakova koji nije uključen u formalne algoritme i čija uloga nije u potpunosti razjašnjena jest i osjećaj beznađa. Cilj Ispitati povezanost beznađa sa suicidalnošću neovisno o teţini depresivnih simptoma kod osoba/bolesnika s dijagnosticiranim velikim depresivnim poremećajem (VDP). Materijali i metode Provedeno je presječno istraţivanje na Klinici za psihijatriju Kliničkog bolničkog centra Sestre milosrdnice u Zagrebu tijekom proljeća 2019. godine na susljednom uzorku veličine 58 ispitanika oba spola i dobi od 18 do 65 godina s potvrđenom dijagnozom VDP. Glavni ishod bila je povezanost rezultata na Beckovoj ljestvici beznađa (BHS) i Beckovoj ljestvici suicidalne ideacije (BSS) neovisno o rezultatu Beckovog inventara depresije-II (BDI-II). Rezultati Naše istraţivanje potvrdilo je povezanost beznađa mjerenog pomoću BHS sa suicidalnom ideacijom mjerenom pomoću BSS, kao i povezanost obje te varijable s teţinom depresivnih simptoma mjerenih pomoću BDI-II, ali nije potvrdilo našu hipotezu o povezanosti rezultata na BHS s rezultatima na BSS neovisno o rezultatu na BDI-II. Zaključak Na temelju ovog istraţivanja ne moţe se tvrditi kako beznađe doprinosi riziku od suicidalne ideacije neovisno o teţini depresivnih simptoma. Međutim, nuţna su daljnja istraţivanja koja će u obzir uzeti heterogenost VDP, odnosno višedimenzionalnost instrumenata kojima ga mjerimo te provjeriti našu hipotezu sada ne iz perspektive VDP kao jednog i jedinstvenog kliničkog entiteta, već iz perspektive različitih njegovih dimenzijaIntroduction One of the biggest challenges and the most demanding psychiatric nurse jobs is the care for suicidal patients. Suicidality is a complex phenomenon, so suicidality identification is demanding as well. Predictive validity and, above all, the sensitivity of the available suicide risk assessment algorithms is practically insufficient, and in daily clinical work, doctors and nurses must pay special attention to possible early, subjective signs of suicidal behavior. One of the early, subjective signs that is not included in formal algorithms and whose role is not fully clarified is the feeling of hopelessness. Objective To investigate the association of hopelessness with suicidal behavior regardless of the severity of depressive symptoms in individuals/patients diagnosed with major depressive disorder (MDD). Materials and methods A cross-sectional research was conducted at the Department for Psychiatry of the University Hospital Center Sestre milosrdnice in Zagreb during the spring of 2019, on a sample of 58 participants of both genders and ages 18 to 65, with a confirmed diagnosis of MDD. The main outcome was the association between the results of Beck's Hopelessness Scale (BHS) and Beck's Suicidal Ideation Scale (BSS) independently of the outcome of Beck's Depression Inventory-II (BDI-II). Results Our study has confirmed the relationship of hopelessness measured by BHS with a suicidal ideation measured by BSS, as well as the correlation of both of these variables with the severity of depression symptoms measured by BDI-II, but did not confirm our hypothesis on the correlation of results on BHS with results on the BSS independently of the result on BDI-II. Conclusion Based on this investigation, can not be concluded that hopelessness contribute to the suicidal ideation risk independently of depression symptoms severity. Further studies that will take into account: heterogeneity of MDD and multidimensionality of instruments for MDD objectivisation are needed. Also, further investigations that will reevaluate our hypothesis not from perspective of MDD as one, unique clinical entity but from perspective of MDD’s various dimensions are needed and expected in the future