Hopelessness across phases of bipolar I or II disorder: a prospective study.
BACKGROUND
Hopelessness, a key risk factor for suicidal behaviour overall, has been studied little among bipolar disorder (BD) patients. For purposes of prevention, it is important to know whether it is predominantly a patient's permanent trait or merely reflects the highly variable illness states. We investigated the degree to which hopelessness is trait- or state-related during the course of BD.


METHODS
The Jorvi Bipolar Study (JoBS) is a naturalistic prospective study representing psychiatric in- and outpatients with DSM-IV BD I and II. Repeated measurements with the Beck Hopelessness Scale of 188 patients at baseline, 6 months and 18 months were analysed using a linear regression model with general estimation equations. Factors covarying with hopelessness during follow-up were investigated.


RESULTS
Levels of hopelessness varied markedly between illness phases, being highest in depressive and mixed phases, and lowest in euthymia, hypomania or mania. Hopelessness was independently associated with concurrent severity of depression (estimate 0.231, p<0.001), anxiety (0.105, p<0.001), fewer manic symptoms (-0.096, p=0.001) and comorbid personality disorder (1.741, p=0.001). However, the strongest predictor of degree of hopelessness during follow-up was previous hopelessness (0.403, p<0.001).


CONCLUSIONS
After baseline, relatively few patients had manic, hypomanic, mixed or depressive mixed phases. Hopelessness was measured at only three time-points.


CONCLUSIONS
Level of hopelessness varies markedly between patients in different phases of BD, but is also, to a degree, a permanent feature. Among BD patients, hopelessness appears to be both a trait- and state-related characteristic.
Valtonen
Hanna M
HM
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
Suominen
Kirsi
K
Haukka
Jari
J
Mantere
Outi
O
Arvilommi
Petri
P
Leppämäki
Sami
S
Isometsä
Erkki T
ET
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology*; D002605:Character; D015897:Comorbidity; D003469:Culture; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology; D010555:Personality Inventory / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology