title: Enhanced measurement sensitivity of hopeless ideation among older adults at risk of self-harm: Reliability and validity of Likert-type responses to the Beck Hopelessness Scale.
abstract: OBJECTIVE
  Responses to the Beck Hopelessness Scale (BHS) have been identified as a significant predictor of suicide-related ideation and self-harm, of note, to a greater degree than severity of depressive symptoms. The BHS is the most widely used instrument to assess this construct, yet concern has been expressed about the traditional true/false response format of this instrument. For this study, we obtained responses from older adults to a revised four-point Likert-type BHS response format.
  
  
  METHODS
  A national sample of 117 older Canadians at risk of self-harm was recruited from multiple sources for this study over a one-year period. Most participants were women (65%) with an average age of 68.47 years (SD = 9.02, range 50-92).
  
  
  RESULTS
  Exploratory factor analysis suggests the existence of two factors labeled Powerlessness/Disappointment and Negative Future Expectancies. Concurrent validity of this two-factor model of BHS responses is provided vis-a-vis suicide-related ideation subsequent to statistical control for socio-demographic factors, physical health, and depressive symptomatology. Of note, the relative contribution to the measurement of BHS factors is proportionately equal and greater than all other independent variables.
  
  
  CONCLUSIONS
  We contend that this revised BHS response format may be appropriate for use in clinical and research applications though replication with other samples and populations is warranted.
authors.affiliation: Department of Health Studies and Gerontology, University of Waterloo, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Neufeld
authors.forename: Norm
authors.initials: N
authors.lastname: O'Rourke
authors.forename: Martha
authors.initials: M
authors.lastname: Donnelly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003863:Depression / Q000503:physiopathology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D018570:Risk Assessment / Q000379:methods; D016728:Self-Injurious Behavior / Q000175:diagnosis*; D059020:Suicidal Ideation