title: Hopelessness, depression, substance disorder, and suicidality--a 13-year community-based study.
abstract: BACKGROUND
  Most earlier studies of hopelessness as a risk factor for suicidal behavior were based on either clinical or restricted samples. Using a longitudinal study design with a community sample of more than 3,000 participants, we aimed to examine if hopelessness was a long-term predictor of suicidal behaviors.
  
  
  METHODS
  Using longitudinal data from the Baltimore Epidemiologic Catchment Area (ECA) Program, we assessed the association of hopelessness at baseline and incident suicidal behaviors in the 13-year follow-up period, adjusting for the presence of depression and substance use disorders. Suicide behaviors studied included completed suicide, self-reported attempted suicide, and suicide ideation.
  
  
  RESULTS
  Hopelessness was predictive of all three types of suicidal behaviors in the follow-up period, even after adjustment. Persons who expressed hopelessness in 1981 were 11.2 times as likely to have completed suicide over the 13-year follow-up interval (95% confidence interval [1.8, 69.1]). The association between suicidality and hopelessness was stronger and more stable than the association of suicidality with the presence of depression and substance use disorders.
  
  
  CONCLUSIONS
  Hopelessness was an independent risk factor for completed suicide, suicide attempts, and suicidal ideation. Intervention strategies that lower hopelessness may be effective for suicide prevention.
authors.affiliation: Dept. of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Kuo@ndri.org
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Kuo
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: William W
authors.initials: WW
authors.lastname: Eaton
mesh_terms: D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*