The association between depression and suicide when hopelessness is controlled for

Abstract

ObjectiveWe retested the relationship between major depression and suicide with hopelessness as a control variable, with the hypothesis that the strong relationship between depression and suicide will decrease or disappear when hopelessness is controlled for. Also, hopelessness can be accounted for by psychological strains that resulted from social structure coupled with individual characteristics. MethodThis was a case–control psychological autopsy study, in which face-to-face interviews were conducted to collect information from proxy informants for suicide victims and living subjects in rural Chinese 15–34years of age who died of suicide (n=392) and who served as community living controls (n=416). Major depression was assessed by the Chinese version of the Structured Clinical Interview for DSM-IV (SCID). Hopelessness was measured by Beck Hopelessness Scale. ResultsA strong association between major depression and suicide was observed after adjustment for socio-demographic characteristics. When hopelessness was added to the analysis, the depression–suicide relationship was significantly decreased in all the six regression models. ConclusionsAlthough depression, as well as other mental illness, is a strong risk factor for suicide, depression and suicide are both likely to be related to hopelessness, which in turn could be a consequence of psychological strains that resulted from social structure and life events. Future studies may examine the causal relations between psychological strains and hopelessness.