Adaptation of the Beck Hopelessness Scale as a suicide risk screening tool among Nigerian patients with schizophrenia.

OBJECTIVES: We examined the adaptation of the Beck Hopelessness Scale (BHS) as a subjective suicide risk assessment tool in detecting Nigerian patients with schizophrenia who are at a high risk of suicide. METHODS: Schizophrenia patients (211) completed the BHS in addition to a sociodemographic questionnaire. They were objectively interviewed with the suicidality module of the Mini International Neuropsychiatric Interview (MINI) as the 'gold standard', against which the criterion validity of the BHS was examined. RESULTS: The receiver operating characteristics (ROC) curve of the 20-item BHS scale at a total cut-off score of 9 (sensitivity 0.889, specificity 0.916) against the patients' MINI Suicidality Module risk categorisation had an Area Under the Curve (AUC) of 0.96 (95% CI: 0.928-0.987), while, the four-item BHS scale demonstrated a ROC curve with an AUC of 0.92 (95% CI: 0.868-0.966) at a cut-off score of 1 (sensitivity 1.000, specificity 0.832). CONCLUSIONS: The BHS has proven to be valid in terms of its sensitivity and specificity in the identification of the high suicidal risk Nigerian schizophrenia outpatients.

The Yoruba version of the Beck Hopelessness Scale: psychometric characteristics and correlates of hopelessness in a sample of Nigerian psychiatric outpatients.

BACKGROUND: Previous studies from the developed western countries have repeatedly demonstrated that hopelessness positively correlates with an increased risk of suicide in the context of chronic mental disorders such as schizophrenia and affective disorders. Despite this persistently strong association, the construct of hopelessness in terms of its factorial structure and correlates has not been explored among Nigerian psychiatric outpatients. OBJECTIVE: The aim of this present study is to examine the psychometric characteristics of the Yoruba language culturally adapted version of the Beck Hopelessness Scale in a cross-sectional sample of psychiatric outpatients in South-western Nigeria. METHOD: The participants were 327 Nigerian adult outpatients receiving treatment for schizophrenia, bipolar and depressive disorders, consecutively recruited from the outpatient psychiatric clinics of a university teaching hospital in South-western Nigeria. The outpatients were recruited over a one year period. They completed the Yoruba translated version of the Beck Hopelessness Scale (BHS-Y), a sociodemographic and illness-related questionnaire, the Beck Depression Inventory-II (BDI-II). Their level of functioning was assessed with the Global Assessment of Functioning Scale (GAF), psychopathology was evaluated with the Positive and Negative Syndrome Scale (PANSS) and the level of disability measured with the World Health Organization Disability Assessment Schedule (WHODAS-II). Suicidality and confirmation of the diagnoses of schizophrenia, bipolar and depressive disorders were evaluated with the Mini International Neuropsychiatric Interview (MINI). The construct of hopelessness in terms of factorial structure, reliability, validity and correlates was explored. Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation was used to examine the factorial structure of the BHS-Y. Internal consistency was examined with Cronbach's alpha, and the construct validity of the scale was assessed using correlational analyses with the MINI suicidality module, BDI-II, GAF and WHODAS-II domain scores. We also tested the hypothesis that a shortened version of the BHS-Y will possess psychometric properties similar to the 20 item version. RESULTS: Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation showed that the construct of hopelessness among our outpatients was best explained by a 3 factor model. Reliability of the translated version of the scale was adequate as indicated by a Cronbach's alpha of 0.92. Construct validity was also satisfactory as reflected by the strong correlations with MINI suicidality, Beck Depression Inventory-II and Global Assessment of Functioning scores. The shortened 4 item single factor BHS-Y composed of items 8, 9, 13 and 15 demonstrated psychometric properties similar to those of the full item version. CONCLUSION: The Beck Hopelessness Scale (Yoruba Version) demonstrated satisfactory reliability and validity and therefore may be useful in measuring the construct of hopelessness and in clinical suicide risk assessments among Nigerian psychiatric outpatients. There is the need for more studies to further explore the psychometric features and correlates of this scale among other Nigerian ethnic groups in addition to other medical patients' populations.

Psychometric Properties and Correlates of the Beck Hopelessness Scale in Family Caregivers of Nigerian Patients with Psychiatric Disorders in Southwestern Nigeria.

OBJECTIVES: To examine the construct and correlates of hopelessness among family caregivers of Nigerian psychiatric patients. MATERIALS AND METHODS: This is a cross-sectional, descriptive study involving 264 family caregiver-patients' dyads recruited from two university teaching hospitals psychiatric clinics in Southwestern Nigeria. RESULTS: Exploratory factor analysis revealed a two-factor 9-item model of the Beck Hopelessness Scale (BHS) among the family caregivers. Confirmatory factor analysis of the model revealed satisfactory indices of fitness (goodness of fit index = 0.97, comparative fit index = 0.96, Chi-square/degree of freedom (CMIN/DF) = 1.60, root mean square error of approximation = 0.048, expected cross-validation index = 0.307, and standardized root mean residual = 0.005). Reliability of the scale was modestly satisfactory (Cronbach's alpha 0.72). Construct validity of scale was supported by significant correlations with the family caregivers' scores on the Zarit Burden Interview, mini international neuropsychiatric interview suicidality module, General Health Questionnaire-12 (GHQ-12), and Patient Health Questionnaire-9. The greatest variance in the family caregivers' scores on the BHS was contributed by their scores on the psychological distress scale (GHQ-12). CONCLUSIONS: The BHS has adequate psychometric properties among Nigerian psychiatric patients' family caregivers. There is the need to pay attention to the psychological well-being of the family caregivers of Nigerian psychiatric patients.