Article review
NR320-326 Mental Health Nursing
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el
Required Uniform Assignment: Scholarly Article Review
PURPOSE
The student will review, summarize, and critique a scholarly article related to a mental health topic.
COURSE OUTCOMES
This assignment enables the student to meet the following course outcomes.
CO 4. Utilize critical thinking skills in clinical decision-making and implementation of the nursing process for psychiatric/mental health clients.
(PO 4)
CO 5: Utilize available resources to meet selfidentified goals for personal, professional, and educational development appropriate to the mental
health setting. (PO 5)
CO 7: Examine moral, ethical, legal, and professional standards and principles as a basis for clinical decisionmaking. (PO 6)
CO 9: Utilize research findings as a basis for the development of a group leadership experience. (PO 8)
DUE DATE
Refer to Course Calendar for details. The Late Assignment Policy applies to this assignment.
TOTAL POINTS POSSIBLE: 100 points
REQUIREMENTS
1. Select a scholarly nursing or research article (published within the last five years) related to mental health nursing, which includes content related
to evidencebased practice.
*** You may need to evaluate several articles before you find one that is appropriate. ***
2. Ensure that no other member of your clinical group chooses the same article. Submit the article for approval.
3. Write a 23 page paper (excluding the title and reference pages) using the following criteria.
a. Write a brief introduction of the topic and explain why it is important to mental health nursing.
NR326 Mental Health Nursing
NR320-326 Mental Health Nursing
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el
b. Cite statistics to support the significance of the topic.
c. Summarize the article; include key points or findings of the article.
d. Discuss how you could use the information for your practice; give specific examples.
e. Identify strengths and weaknesses of the article.
f. Discuss whether you would recommend the article to other colleagues.
g. Write a conclusion.
4. Paper must follow APA format. Include a title page and a reference page; use 12point Times Roman font; and include intext citations (use citations
whenever paraphrasing, using statistics, or quoting from the article). Please refer to your APA Manual as a guide for intext citations and sample reference
pages.
5. Submit per faculty instructions by due date (see Course Calendar); please refer to your APA Manual as a guide for intext citations and sample
reference pages. Copies of articles from any Databases, whether PDF, MSWord, or any other electronic file format, cannot be sent via the Learning
Management System (Canvas) dropbox or through email, as this violates copyright law protections outlined in our subscription agreements. Refer to
the Policy page under the Resource tab in the shell for the directions for properly accessing and sending library articles electronically using permalinks.
NR320-326 Mental Health Nursing
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el
DIRECTIONS AND ASSIGNMENT CRITERIA
Assignment
Criteria
Points % Description
Introduction 10 10 An effective introduction establishes the purpose of the paper.
The introduction should capture the attention of the reader.
Article summary 30 30 Summary of article must include the following.
Statistics to support the significance of the topic
Key points and findings of the article
Discussion of how information from the article could be used in your practice (give
specific examples)
Article critique 30 30 Article critique must include the following.
Strengths and weaknesses of the article
Discussion of whether you would recommend the article to a colleague
Conclusion 15 15 The conclusion statement should be well defined and clearly stated. An effective
conclusion provides analysis and/or synthesis of information, which relates to the main
idea/topic of the paper. The conclusion is supported by ideas presented throughout the
body of your report.
Article Selection &
Approval
5 5 Article is relevant to mental health nursing practice and is current (within 5 years of
publication).
No duplicate articles within the clinical group.
Article submitted and approved as scholarly by instructor.
Grammar/Spelling/
Mechanics/APA
format
10 10 Correct use of Standard English grammar and sentence structure
No spelling or typographical errors
Document includes title and reference pages
Citations in the text and reference page
Total 100 100
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el
GRADING RUBRIC
Assignment
Criteria
Outstanding or Highest
Level of Performance
A (92100%)
Very Good or High Level of
Performance
B (8491%)
Competent or Satisfactory
Level of Performance
C (7683%)
Poor, Failing or
Unsatisfactory Level of
Performance
F (075%)
Introduction (10
points)
Introduction is present and
distinctly establishes the
purpose of paper
Introduction is appealing and
promptly captures the
attention of the reader
10 points
Introduction is present and
generally establishes the
purpose of paper
Introduction has appeal and
generally captures the
attention of the reader
9 points
Introduction is present and
generally establishes the
purpose of paper
8 points
No introduction
07 points
Article summary (30
points)
Statistics presented strongly
support the significance of the
topic
Key points and findings of the
article are clearly stated
Thoroughly discusses how
information from the article
could be used in your practice
by giving two or more specific,
relevant examples
2830 points
Statistics presented
moderately support the
significance of the topic
Key points and findings of the
article are vaguely stated
Adequately discusses how
information from the article
could be used in your practice
by giving two or more specific,
relevant examples
2627 points
Statistics presented weakly
support the significance of the
topic
Key points and findings of the
article are stated in a manner
that is confusing or difficult to
understand.
Briefly discusses how
information from the article
could be used in your practice
by giving examples that are
not specific, yet are relevant
2325 points
Statistics presented do not
support the significance of the
topic OR no statistics are
presented.
Key points and findings of the
article are incorrectly
presented OR missing
Briefly discusses how
information from the article
could be used in your practice
by giving examples that are
neither specific, nor relevant
OR implications to practice
not discussed
022 points
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el
Article critique (30
points)
The strengths and weaknesses
are welldefined and clearly
stated.
Provides a thorough review of
whether or not they
recommend the article
28-30 points
The strengths and weaknesses
are adequate and clearly
stated.
Provides a general review of
whether or not they would
recommend the article
26-27 points
The strengths and weaknesses
are brief and clearly stated.
Provides a brief review of
whether or not they would
recommend the article.
23-25 points
The strengths and weaknesses
are unclear or not stated.
Provides an unclear or no
insight as to whether or not
they would recommend the
article.
0-22 points
.
Assignment
Criteria
Outstanding or Highest
Level of Performance
A (92100%)
Very Good or High Level of
Performance
B (8491%)
Competent or Satisfactory
Level of Performance
C (7683%)
Poor, Failing or
Unsatisfactory Level of
Performance
F (075%)
Conclusion (15
points)
The conclusion statement is
welldefined and clearly
stated.
Conclusion demonstrates
comprehensive analysis or
synthesis of information from
the article.
The conclusion is strongly
supported by ideas presented
throughout the body of the
paper.
15 points
The conclusion statement is
general and clearly stated.
Conclusion demonstrates
comprehensive analysis or
synthesis of information from
the article.
The conclusion is strongly
supported by ideas presented
throughout the body of the
paper.
13-14 points
The conclusion statement is
general and clearly stated.
Conclusion demonstrates
adequate analysis or synthesis
of information from the article.
The conclusion is adequately
supported by ideas presented
throughout the body of the
paper.
12 points
The conclusion statement is
vague or not stated.
Conclusion demonstrates
inadequate analysis or
synthesis of information from
the article.
The conclusion is inadequately
supported by ideas presented
throughout the body of the
paper.
011 points
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el
Article Selection &
Approval
(5 points)
ALL Items MET
Article is relevant to mental
health nursing practice and is
current (within 5 years of
publication).
No duplicate articles within the
clinical group.
Article submitted and
approved as scholarly by
instructor.
5 points
ONE item NOT MET
Article is relevant to mental
health nursing practice and is
current (within 5 years of
publication).
No duplicate articles within the
clinical group.
Article submitted and
approved as scholarly by
instructor.
4 points
2 or more items NOT MET
Article is relevant to mental
health nursing practice and is
current (within 5 years of
publication).
No duplicate articles within the
clinical group.
Article submitted and
approved as scholarly by
instructor.
03 points
Assignment
Criteria
Outstanding or Highest
Level of Performance
A (92100%)
Very Good or High Level of
Performance
B (8491%)
Competent or Satisfactory
Level of Performance
C (7683%)
Poor, Failing or
Unsatisfactory Level of
Performance F
(075%)
Grammar/Spelling/
Mechanics/APA
Format
(10 points)
References are submitted
with assignment.
Used appropriate APA format
and are free of errors.
Includes title and reference
pages.
Grammar and mechanics are
free of errors.
10 points
References are submitted
with assignment.
Used appropriate APA format
and has one type of error.
Includes title and reference
pages.
Grammar and mechanics have
one type of error.
9 points
References are submitted
with assignment.
Used appropriate APA format
and has two types of errors.
Includes title and reference
pages.
Grammar and mechanics have
two types of errors.
8 points
No references submitted with
assignment.
Attempts to use appropriate
APA format and has three or
more types of errors.
Includes title and reference
pages.
Grammar and mechanics have
three or more types of errors.
07 points
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el
Total Points Possible = 100 points
COURSE OUTCOMES
DUE DATE
REQUIREMENTS
DIRECTIONS AND ASSIGNMENT CRITERIA
GRADING RUBRIC O R I G I N A L P A P E R
Co-morbid PTSD and suicidality in individuals with schizophrenia
and substance and alcohol abuse
Nicholas Tarrier Alicia Picken
Received: 14 December 2009 / Accepted: 27 July 2010 / Published online: 15 August 2010
Springer-Verlag 2010
Abstract
Background Suicide risk is high in schizophrenic patients
and is further elevated in dual diagnosis patients. Suicide
behaviour is a continuum from ideation, plans to attempts.
Exposure to traumatic stress and co-morbid PTSD is ele-
vated in schizophrenic patients. Suicide behaviour is also
common in non-psychotic PTSD patients. This study aimed
to investigate the effect of trauma and co-morbid PTSD on
suicide behaviour in dual diagnosis patients and whether
co-morbid PTSD would further elevate suicide risk.
Method This was a cross-sectional study in which suicide
behaviour was compared in those with and without
co-morbid PTSD in 110 patients suffering schizophrenia
and alcohol and/or substance abuse.
Results 100 (91%) reported at least one traumatic event
with an average of 4.3 events. 31 (28%) patients met
criteria for full PTSD. Current suicidal ideation was
reported by 39 (35%) and 23 (21%) reported plans
and ideation, 69 (63%) reported at least one previous
suicide attempt. Suicide behaviour was significantly asso-
ciated with an increasing number of traumatic events.
Suicidality was significantly associated and elevated with
co-morbid PTSD. Analysis indicated that the effect of
trauma on suicide behaviour appeared to be mediated by
hopelessness.
Conclusions Suicide behaviour was not associated with
exposure to trauma per se but was associated with incre-
mental exposure to traumatic experiences. Consistent with
the study hypotheses, co-morbid PTSD further adds to the
risk of suicide behaviour in an already vulnerable group.
Keywords Schizophrenia Dual diagnosis PTSD
Trauma Suicide behaviour
Introduction
The aim of this study was to investigate whether co-morbid
PTSD was associated with increased suicide behaviour in a
sample of patients suffering schizophrenia with already
elevated vulnerability to suicide risk by nature of co-morbid
substance and alcohol abuse.
Suicide risk in schizophrenia is high, and is a significant
public health concern and a major cause of premature death
[13, 14, 21]. Most recent estimates indicate 4.9% of
schizophrenic patients will commit suicide during their
lifetime [43]. Suicidal ideation and planning are important
steps that lead to self-harm and may lead to death or hospi-
talisation [10, 27, 33]. Suicidal ideation and attempts are
common with as many as half of all patients with schizo-
phrenia experiencing suicidal ideation at any point in time or
having a history of suicide attempts [21, 22, 26, 33, 42, 54], as
well as increasing the risk for completed suicide the expe-
rience of frequent suicidal ideation leading to plans, intent
and attempts are themselves clinically important and con-
stitute cognitive, emotional and behavioural aspects of
suicide behaviour [12, 28]. The term suicide behaviour
subsumes a continuum from suicide ideation through plan-
ning, intent and attempts that may or may not lead to com-
pleted suicide [12]. Although the majority of those who
experience suicide ideation do not go onto successfully
complete suicide, all aspects of the suicide behaviour con-
tinuum are considered to have clinical importance [28].
N. Tarrier (&) A. Picken
Division of Clinical Psychology, School of Psychological
Sciences, University of Manchester, Zochonis Building,
Oxford Road, Manchester M13 9PL, UK
e-mail: [emailprotected]
123
Soc Psychiatry Psychiatr Epidemiol (2011) 46:10791086
DOI 10.1007/s00127-010-0277-0
Suicide risk has been associated with a wide range of
factors, including depression, hopelessness, low self-
esteem, insight, substance misuse, persistent psychotic
symptoms, agitation or motor restlessness, fear of mental
deterioration, poor adherence to treatment and recent loss
[10, 17, 19, 27, 54, 55]. Hopelessness is one of the most
consistently identified risk factors for suicidal behaviour
[16, 54] and is associated with suicide risk independently
of depression [18].
Estimates of co-morbid substance abuse in schizo-
phrenic patients are high, between almost 50 and 65% [15,
50]. Even low levels of substance misuse have been shown
to have a detrimental effect on clinical outcome [15]. The
most frequently reported substance used being alcohol, and
cannabis the most frequently used drug [5, 11, 29, 58].
Consistent results indicate frequent poly-substance use,
the most common combination being alcohol and cannabis
[5, 29]. There are strong indications that outcomes,
including elevated risk of suicidal behaviour are poorer for
those people with schizophrenia who abuse drugs and
alcohol [20, 27, 36].
There is a strong indication that suicide behaviour is
high in non-psychotic PTSD patients [53]. In a recent
review of 65 studies in which assessments of PTSD and
suicide behaviour were available there was a clear rela-
tionship between PTSD and suicidal thoughts and behav-
iours irrespective of the type of trauma experienced or how
the sample was recruited [44]. Thus, there is evidence that
PTSD in general is associated with elevated suicidal
behaviour. The question arises as to whether co-morbid
PTSD in schizophrenic patients would further elevate sui-
cide risk. Exposure to trauma in those suffering schizo-
phrenia appears higher than in the general population with
estimates of over 90% of having suffered at least one
traumatic event [24, 32, 39, 45]. Those diagnosed with
schizophrenia and psychotic disorders are not only more
likely to be exposed to traumatic events, but they are also
more likely to suffer from PTSD as a result. Prevalence
rates of PTSD in patients suffering from severe mental
illness are reported ranging from 14 to 43% [39, 41, 49, 56]
as compared to rates of PTSD in the general population
which are estimated at 114% for lifetime prevalence
(APA 1995, p. 437). PTSD in patients suffering schizo-
phrenia and other psychotic disorders may result from their
exposure to external traumatic events. There are also
increasing accounts in the literature of PTSD resulting
from the experience of the symptoms of the illness them-
selves [34, 37, 38] that is a response to an internal event.
There are numerous conceptual and practical difficulties in
diagnosing PTSD in patients suffering from psychosis [51,
52]. In spite of these difficulties Mueser et al. [40]
reviewed the evidence for the reliability and validity of the
assessment of trauma and PTSD in those suffering from
severe mental illness and concluded that such assessment
could be performed rigorously.
The current study was carried out to investigate whether
co-morbid PTSD would be associated with an increase in
suicide behaviour in a sample with elevated risk as a result
drug and/or alcohol abuse. Specifically, we hypothesised
that those suffering co-morbid PTSD would show signifi-
cantly greater levels of suicide behaviour than those
without co-morbid PTSD.
Method
Participants
This study opportunistically recruited patients who were
participating in a multi-centred clinical trial of motiva-
tional-CBT (the MIDAS trial, see [5]). Only those partic-
ipants in the study sites in the north west of England were
recruited. 110 participants were recruited from 4 NHS
trusts in the north west of England between October 2004
and April 2007. Participants were first recruited into the
clinical trial and consented to further assessment for the
purposes of this study. Assessments were carried out at the
6-month assessment point of the trial. Ethical permission
was obtained from the NHS Eastern MREC. Participants
were recruited into the study if they met the following
inclusion criteria: (1) DSM-IV diagnostic criteria for
schizophrenia, schizophreniform or schizoaffective disor-
der, (2) were English speaking, (3) had contact with mental
health services, (4) were able to give informed consent and
(5) met minimum levels of substance use of 28 units of
alcohol and/or using drugs on at least 2 days a week, in at
least half of the weeks of the past three months and met
criteria for dependence or abuse assessed by the Structured
Clinical interview for DSM. Participants were excluded if
there was an organic cause for their psychosis. All partic-
ipants were living in the community at the time of
recruitment and had current contact with mental health
services; they were referred to the study by their care
coordinators.
Measures
Positive and Negative Symptom Scale (PANSS)
The PANSS [30] was used as a measure of severity of
schizophrenia. The PANSS is a semi-structured interview
which assesses positive, negative and general symptoms
using a 7-point rating scale over 30 items. Kay et al. [31]
demonstrated that the PANSS had good psychometric
properties. It is commonly used measure in schizophrenia
research.
1080 Soc Psychiatry Psychiatr Epidemiol (2011) 46:10791086
123
Calgary Depression Scale (CDS)
The CDS [1] is a 9-item semi-structured interview
designed for use with individuals with a diagnosis of
schizophrenia. The scale assesses levels of depressive
symptoms independent of positive and negative symptoms
of schizophrenia and any effects of medication. The scale
has good psychometric properties [13].
Beck Hopelessness Scale (BHS)
The BHS [9] was used as a secondary measure of suicide
risk. The BHS assesses both the presence of negative future
expectancies and lack of positive future expectancies and
predicts suicide and non-fatal self-harm [35]. Respondents
agree, true or false with 20 statements, responses are scored
0 or 1. The range of scores is from 0 to 20. The scale has
good psychometric properties [9] and has been used with
psychiatric outpatients [7]. McMillan et al. [35] in a meta-
analysis of studies which had utilised the BHS found that
the standard cutoff point for the BHS, scores of 14 and
above, identified those at risk of self-harm and a group with
higher risk of suicide, sensitivity was 0.78 and 0.80,
respectively. In a sample of individuals with first episode
schizophrenia, the mean score on the BHS was 7.6, stan-
dard deviation 4.1.
Beck Suicide Scale (BSS)
The BSS [8] was used as the primary outcome measure of
suicide behaviour. It is a 21-item scale in which each item
is scored on three points (0, 1 or 2). The first five items
consist of screening questions and are completed by all
individuals. Items 4 and 5 indicate current desire for sui-
cide. If the individual scores 0 on these two items then they
omit items on ideation and plans and complete questions
regarding previous attempts. Individuals who respond
positively to items 45 are asked further questions to
determine their level of risk. Pinninti et al. [46] demon-
strated that the BSS had good psychometric properties
when used with patients with schizophrenia. The BSS
significantly discriminated between those who had previ-
ous attempts and those who had never attempted suicide
and also identified those who were still considered a sui-
cide risk.
Posttraumatic Stress Diagnostic Scale (PDS)
The presence of PTSD was assessed using the PDS [23].
The structure and content of the PDS mirror the DSM-IV
diagnostic criteria for PTSD. The participants rated on a
03 scale on how much each PTSD symptom has bothered
them in the last 3 months. In the first instance, respondents
were asked to read through a list of traumatic events and to
mark any event they had witnessed or experienced. Owing
to recent findings [56] indicating traumas specific to the
schizophrenia population, such as involuntary hospitalisa-
tion, distressing psychotic symptoms and treatments, these
experiences were also added to the list of traumatic expe-
riences. They were then asked which of the experiences
had affected them the most and to briefly describe the
event. This event is the index event which is referred to
when asking about resulting posttraumatic symptoms. They
were asked questions to ascertain whether the index event
met criterion A for PTSD diagnoses. These refer to whether
a persons life was in danger, they were physically injured,
felt threatened or helpless. The PDS has good psychometric
properties [23]. The PDS showed good consistency with a
semi-structured interview the Clinician Administered
PTSD Scale for Schizophrenia [25] in a subsample [45].
Procedure
Participants were referred and screened for eligibility (see
[5] for further procedural details). During baseline assess-
ments for the MIDAS study, demographic information was
collected and the PANSS was carried out and individuals
were randomised into the intervention or control arm. At
6-month follow-up, participants completed the CDS, BHS,
BSS and PDS measures for the present study. All measures
were administered in a single session by trained research
assistants.
All research assistants who administered the PANSS
were fully trained before assessing any participants and
compared to a gold standard expert assessor. Interclass
correlations between each assessor and the gold standard
were calculated and the means were 0.89, 0.84, 0.83 and
0.84 for the positive, negative and general subscales and
total PANSS scores, respectively. These scores demon-
strate good inter-rater reliability.
Statistical analysis
Appropriate non-parametric tests were used throughout
when data were not normal and could not be transformed.
KruskallWallis and MannWhitney tests were used to
examine differences in suicide scores between those who
reported PTSD and those who did not and also between
individuals reporting different index events. Spearmans
correlations were carried out to examine associations
between suicide scores and a variety of demographic and
psychological characteristics before logistic regression
analysis were carried out to identify predictor variables for
suicidality. A meditational analysis was performed on the
effect of hopelessness (the mediator) on the relationship of
traumatic stress (IV, the independent variable) on suicide
Soc Psychiatry Psychiatr Epidemiol (2011) 46:10791086 1081
123
behaviour (DV, the dependent variable). Conventionally in
a meditational analysis, it is necessary to show that the IV
predicts the DV, the IV predicts the mediator, the mediator
predicts the DV, but the IV does not predict the DV when
the effects of the mediator are controlled [4]. The boot-
strapping method of mediational analysis was used to
assess variables that mediate the relationship between
PTSD severity and suicidality. The bootstrapping method
is preferable to other methods of mediational analysis as it
does not make assumptions of normality in the data used
and has been recommended for use in small samples.
Preacher and Hayes [48] method was used to calculate the
effects of posttraumatic stress on suicidality as mediated by
hopelessness.
Results
From a total of 166 potentially eligible participants from
the Manchester trial centre, 126 individuals consented to
the study and 110 completed the assessments.
Sample characteristics
The characteristics of the sample with and without PTSD
are presented in Table 1.
Prevalence of suicidality
Current suicidal ideation was reported by 39 (35%) patients
and 23 (21%) reported both plans and ideation. At least one
previous suicide attempt was reported by 69 (63%) indi-
viduals with 62 (89%) reporting that at the time of the
attempt their wish to die was moderate or high.
The mean BSS total score was 5.62 (SD 7.44, median 3,
range 034) for the whole sample. In the subsample of
ideators, the mean was 13.15 (SD 7.98, median 12, range
334) and in non-ideators the mean was 1.48 (SD 1.62,
median 0, range 04). Individuals were categorised into
whether they reported suicidal ideation or not, reported
plans or not and whether they have attempted suicide in the
past. The BSS scores for the total sample are in agreement
with those reported by Pinninti et al. [46], whereas the
scores for the 35% who reported ideation are in agreement
with those reported by Beck and Steer [6] for a similar
population.
Occurrence of traumatic events and PTSD
One hundred of the 110 (91%) participants reported at least
one event with an average of 4.3 events and 31 (28%) met
full criteria for PTSD. Comparisons between the group
(PTSD and non-PTSD) indicated that scores on the total
PANSS, positive and general subscales, Calgary Depres-
sion Scale, Beck Hopelessness Scale and Beck Suicide
Scale were significantly higher in the PTSD group. There
were no other significant differences between the two
groups (see Table 1 for characteristics of the PTSD and
non-PTSD groups) (these results are presented in detail in
Picken and Tarrier [45].
Relationship between co-morbid PTSD and suicide
behaviour
The PTSD group reported significantly more suicidal ide-
ation plans and behaviour (median 6) as measured by the
BSS than those without PTSD (median 2: U = 673,
p 0.01) (see Table 1). There were significant associa-
tions between suicide behaviour, as measured by the BSS,
and the number of traumatic events (q = 0.25, p 0.01)
and the severity of PTSD symptoms (q = 0.41, p 0.01)
(see Table 2). MannWhitney tests were carried out for
paired comparison for the four different types of events no
significant differences were found.
Predictor variables for suicidal ideation, plans
and behaviour
Analyses were carried out to identify predictor variables
for the presence of suicide risk. First, Spearmans corre-
lations were calculated between suicide risk as measured
by the BSS, psychological variables and sample charac-
teristics. These correlations are given in Table 2.
Only depression, hopelessness, number of events expe-
rienced and total PTSD symptom severity were signifi-
cantly associated with suicide scores.
A logistic regression was then performed using the
significant variables in the first regression block and all
other variables in the second block. A dichotomous vari-
able was created of those participants who reported current
ideation and plans vs. no current ideation or plans, 39
individuals versus 71, respectively.
Hopelessness (B = 0.21, SE = 0.07, p = 0.00,
Exp(B) = 1.23) was the only significant predictor, with, as
expected, increases in hopelessness being associated with
greater levels of current suicidal ideation and plans.
Mediation
In the mediational analysis the independent variable was
the scores on the PDS (traumatic stress), the dependent
variable was BSS scores, for ideation and plans but not past
behaviour (suicide behaviour) and the mediator was BHS
scores (hopelessness). To demonstrate the mediating effect
of hopelessness on the relationship between traumatic
stress and suicide behaviour, it was necessary to
1082 Soc Psychiatry Psychiatr Epidemiol (2011) 46:10791086
123
demonstrate that (1) the PDS was significantly associated
with suicide behaviour, (2) the PDS was significantly
associated with the BHS, (3) the BHS was significantly
associated with suicide behaviour, (4) the association
between the PDS and suicide behaviour was non-significant
or greatly reduced when the effects of the BHS were
controlled. These conditions were demonstrated (see
Table 3).
The relationship between PDS and BSS was found to be
highly significant when frequency or severity of PTSD
symptoms were considered. However, when the effect of
hopelessness was controlled for the relationship was no
Table 1 Sample characteristics
of the total sample and divided
into those with and without
PTSD
* p 0.01
PTSD (n = 31) Non-PTSD (n = 79) Total sample (n = 110)
Gender
Male 30 (97%) 69 (87%) 99 (90%)
Female 1 (3%) 10 (13%) 11 (10%)
Age
Mean (SD) 36 (9.33) 39 (10.20) 38 (10.00)
Median 34 38 37
Range 2052 1861 1861
Ethnicity
White 29 (94%) 71 (90%) 100 (91%)
Black Caribbean 0 2 (2.5%) 2 (2%)
Black Other 0 2 (2.5%) 2 (2%)
Indian 0 1 (1%) 1 (1%)
Pakistani 0 1 (1%) 1 (1%)
Other 2 (6%) 2 (2.5%) 4 (4%)
Diagnosis
Schizophrenia 28 (90%) 59 (75%) 87 (79%)
Schizoaffective 1 (3%) 12 (15%) 13 (12%)
Schizophreniform 0 1 (1%) 1 (1%)
Psychosis NOS 2 (7%) 7 (9%) 9 (8%)
Years since onset
Mean (SD) 11 (8.34) 14 (10.65) 13 (10.14)
Hospitalisations
Mean (SD) 4 (5.79) 3 (3.02) 4 (3.00)
Substance
Alcohol 17 (55%) 46 (58%) 63 (57%)
Cannabis 8 (26%) 21 (27%) 29 (26%)
Crack cocaine 2 (6%) 3 (4%) 5 (5%)
Heroin 0 2 (2%) 2 (2%)
Amphetamine 4 (13%) 7 (9%) 11 (10%)
PANSS scores
Positive: mean (SD) 18.2 (4.7)* 15.6 (5.4)* 16.6 (5.3)
Negative: mean (SD) 13.7 (3.7) 14.3 (4.9) 14.1 (4.6)
General: mean (SD) 36.2 (7.5)*
