583921 research-article2015
ISP0010.1177/0020764015583921International Journal of Social PsychiatryTarsafi et al.
E CAMDEN SCHIZOPH
Article
The defeat-entrapment theory versus Beck’s hopelessness theory of depression and suicidality: A cross-national analysis in Iran and the United States
International Journal of Social Psychiatry 1–4 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764015583921 isp.sagepub.com
Mahdieh Tarsafi1, Seyed Mohammad Kalantarkousheh1 and David Lester2
Abstract Background: The defeat-entrapment theory has been proposed to explain both depression and suicidal behavior. Methods: Measures of defeat, entrapment, hopelessness and depression were administered to Iranian and American students. Results: Scores on measures of hopelessness, defeat, entrapment and depression were strongly associated. In both nations, scores for defeat and entrapment were stronger predictors of past suicidal ideation and attempted suicide. Overall, the Iranian respondents had higher scores on the measures of defeat, entrapment, hopelessness and depression, but less often reported prior suicidal ideation. Conclusion: The defeat-entrapment theory of depression and suicidal behavior appears to have validity in both Iran and America. Keywords Depression, defeat, entrapment, hopelessness
There are many competing psychological theories of suicidal behavior but, typically, research studies test predictions from only one theory. Rarely does research test competing theories to examine which is more successful in explaining suicidal behavior. The present article compares two major theories of suicidal behavior (defeat-entrapment theory and hopelessness theory) for their ability to predict suicidal behavior. Based on a theory of evolutionary psychology, Gilbert and Allan (1998) proposed that feelings of being defeated and trapped in circumstances from which one cannot escape results in depression. Defeat refers to subjective feelings of being brought down in status or fortune. Entrapment refers to the belief that there is no escape, either because of one’s own limitations or because the environment does not permit an escape. In a sample of 302 undergraduate students, Gilbert and Allan found that scores on measures of defeat and entrapment were associated with scores on a measure or depression (Pearson correlations ranging from .64 to .73). A similar model has been proposed by Williams (1997) to explain suicidal behavior. Lester (2012) found that scores on the defeat and entrapment scales were associated with scores on a measure of depression and with a lifetime history of suicidal ideation or attempted suicide. Taylor et al. (2010) examined the
relationship between defeat and entrapment in a sample of patients with schizophrenia. They found that defeat and entrapment accounted for a large amount of the variance in suicidal ideation and behavior (31%). Taylor, Gooding, Wood, and Tarrier (2011) have recently reviewed research on this theory and found good support for an association between defeat/entrapment and depression, while Taylor, Gooding, Wood, Johnson, and Tarrier (2011) found that defeat, but not entrapment, predicted suicidal ideation in British college students. The cognitive process most central to Aaron Beck’s theory of suicide is hopelessness (Wenzel & Beck, 2008). Hopelessness was defined by Beck, Weissman, Lester, and Trexler (1974) as negative expectations for the future, and Beck, Brown, Berchick, Stewart, and Steer (1990) found that a score of 9 or higher on the scale predicted 16 of 17 psychiatric patients who later died by suicide. Wenzel and 1Department
of Counseling Faculty of Psychology and Education Sciences, Allameh Tabataba’i University, Tehran, Iran 2The Richard Stockton College of New Jersey, Galloway, NJ, USA Corresponding author: David Lester, Psychology Program, The Richard Stockton College of New Jersey, 101 Vera King Farris Drive, Galloway, NJ 08205, USA. Email: [email protected]
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International Journal of Social Psychiatry
Beck (2008) noted that trait hopelessness may not be relevant to all suicides but only for those who engage in premeditated suicidal actions. The majority of research is conducted on ‘weird’ samples, that is, students from Western, Educated, Industrialized, Rich and Democratic nations (Henrich, Heine, & Norenzayan, 2010). Researchers assume that results from these samples are generalizable to individuals in all nations, but this is not necessarily a valid assumption. In the case of suicide, Lester (2005) found that the predictors of suicide rates in WEIRD nations do not predict suicide rates in non-WEIRD nations. The present study sought to compare these two approaches to predicting and understanding suicidal behavior (hopelessness versus defeat-entrapment) in non-clinical populations in two very different nations, Iran and the United States.
Method
The Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) consists of 21 items each answered on a scale of intensity ranging from 0 to 3, so that the range of possible scores is 0–63. The scale has been used in many research studies with a record of excellent reliability and validity (Reinecke & Franklin-Scott, 2005). In addition, all participants were asked their age, sex and two questions: (1) I have had thoughts of killing myself in the past and (2) In the past, I have attempted suicide, each answered yes versus no.
Results The mean scores (with SDs), along with Cronbach’s alpha reliabilities for both the American and Iranian samples are shown in Tables 1 and 2.
Participants
Iranian versus American students
The participants were convenience samples of undergraduate student in Iran and the United States. In the United States, 194 students (149 women and 45 men; mean age 21.6 years, standard deviation (SD) = 5.2 years) enrolled in psychology courses were administered a questionnaire anonymously while in class. In Iran, 146 undergraduates students (105 women and 41 men; mean age 21.0 years, SD = 1.7 years) enrolled in counseling courses were administered the questionnaire while in class. For the Iranian students, the scales were translated into Farsi, and back-translation was used in order to check the accuracy of the translation. The questionnaires had not previously been administered to Iranian students. The study was approved by the Institutional Review Boards at the two institutions. There were no missing data.
The scores of the Iranian and American students are shown in Table 1, where it can be seen that the Iranian respondents obtained significantly higher scores on all of the scales – depression, hopelessness, defeat and entrapment. However, the two groups of respondents did not differ in a history of suicide attempts, while the American students more often reported a history of suicidal ideation.
Questionnaire The defeat and entrapment scales (Gilbert & Allan, 1998) have three subscales: internal entrapment (e.g. ‘I want to get away from myself’), external entrapment (‘I feel trapped by other people’) and defeat (‘I feel defeated by life’), with 6, 10 and 16 items, respectively, answered with anchors 1 (never) and 4 (almost all the time). The ranges of possible scores are 6–24 for internal entrapment, 10–40 for external entrapment and 16–64 for defeat. Gilbert and Allan (1998) reported high Cronbach’s alpha reliabilities for the scales (0.93, 0.88 and 0.94) and single factor structures for each of the scales. The scores from the scales also had good construct validity, for example, significant correlations with measures of submissive behavior. The Beck Hopelessness Scale (Beck et al., 1974) contains 20 items answered with a true–false format. A typical item is ‘My future seems dark to me’. The scale has been used in many studies with demonstrated reliability and validity (Reinecke & Franklin-Scott, 2005). The range of possible scores is 0–20.
Predicting suicidal behavior The Pearson correlations between the variables are reported in Table 3. For the dichotomous variables, point-biserial correlations and phi coefficients were used. A factor analysis (with a principal components extraction – see Table 4) indicated that all the scores (for depression, hopelessness, defeat and entrapment) were highly inter-correlated and loaded on one factor. Multiple regressions were carried out separately for the Iranian and United States samples using logistic regression for the dichotomous variables (suicidal ideation and attempt) and linear regression for depression. For predicting depression, hopelessness, defeat and entrapment, all contributed significantly to the prediction in both countries (see Table 5). For predicting suicidal ideation, for both countries, only entrapment was statistically significant in the regression analyses (see Table 5). For a history of attempting suicide, defeat was the significant predictor for Iranian students and entrapment for American students.
Discussion The present study found that measures of hopelessness and of defeat and entrapment were significantly inter-related. Furthermore, all three variables were associated with measures of depression and suicidal ideation. Interestingly, this
Downloaded from isp.sagepub.com at Duke University Libraries on November 15, 2015
3
Tarsafi et al. Table 1. Mean scores of the Iranian and American students. Iran
United States
Mean (SD)
Mean (SD)
Age (years) Depression Hopelessness Defeat Entrapment Internal External
21.0 (1.7) 11.0 (9.4) 3.8 (4.0) 20.8 (9.2) 17.7 (13.4) 6.6 (5.7) 11.0 (8.4)
21.6 (5.2) 8.1 (7.2) 2.7 (3.1) 14.7 (9.3) 11.6 (12.2) 4.5 (5.1) 7.1 (7.7)
Percentages
Sex Suicidal ideation Suicidal threat Suicide attempt
28% male 21% 16% 5%
23% male 35% 15% 5%
t(338)
Two-tailed p
1.44 3.32 2.98 6.00 4.35 3.65 4.47
ns .001 .003
ISP0010.1177/0020764015583921International Journal of Social PsychiatryTarsafi et al.
E CAMDEN SCHIZOPH
Article
The defeat-entrapment theory versus Beck’s hopelessness theory of depression and suicidality: A cross-national analysis in Iran and the United States
International Journal of Social Psychiatry 1–4 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764015583921 isp.sagepub.com
Mahdieh Tarsafi1, Seyed Mohammad Kalantarkousheh1 and David Lester2
Abstract Background: The defeat-entrapment theory has been proposed to explain both depression and suicidal behavior. Methods: Measures of defeat, entrapment, hopelessness and depression were administered to Iranian and American students. Results: Scores on measures of hopelessness, defeat, entrapment and depression were strongly associated. In both nations, scores for defeat and entrapment were stronger predictors of past suicidal ideation and attempted suicide. Overall, the Iranian respondents had higher scores on the measures of defeat, entrapment, hopelessness and depression, but less often reported prior suicidal ideation. Conclusion: The defeat-entrapment theory of depression and suicidal behavior appears to have validity in both Iran and America. Keywords Depression, defeat, entrapment, hopelessness
There are many competing psychological theories of suicidal behavior but, typically, research studies test predictions from only one theory. Rarely does research test competing theories to examine which is more successful in explaining suicidal behavior. The present article compares two major theories of suicidal behavior (defeat-entrapment theory and hopelessness theory) for their ability to predict suicidal behavior. Based on a theory of evolutionary psychology, Gilbert and Allan (1998) proposed that feelings of being defeated and trapped in circumstances from which one cannot escape results in depression. Defeat refers to subjective feelings of being brought down in status or fortune. Entrapment refers to the belief that there is no escape, either because of one’s own limitations or because the environment does not permit an escape. In a sample of 302 undergraduate students, Gilbert and Allan found that scores on measures of defeat and entrapment were associated with scores on a measure or depression (Pearson correlations ranging from .64 to .73). A similar model has been proposed by Williams (1997) to explain suicidal behavior. Lester (2012) found that scores on the defeat and entrapment scales were associated with scores on a measure of depression and with a lifetime history of suicidal ideation or attempted suicide. Taylor et al. (2010) examined the
relationship between defeat and entrapment in a sample of patients with schizophrenia. They found that defeat and entrapment accounted for a large amount of the variance in suicidal ideation and behavior (31%). Taylor, Gooding, Wood, and Tarrier (2011) have recently reviewed research on this theory and found good support for an association between defeat/entrapment and depression, while Taylor, Gooding, Wood, Johnson, and Tarrier (2011) found that defeat, but not entrapment, predicted suicidal ideation in British college students. The cognitive process most central to Aaron Beck’s theory of suicide is hopelessness (Wenzel & Beck, 2008). Hopelessness was defined by Beck, Weissman, Lester, and Trexler (1974) as negative expectations for the future, and Beck, Brown, Berchick, Stewart, and Steer (1990) found that a score of 9 or higher on the scale predicted 16 of 17 psychiatric patients who later died by suicide. Wenzel and 1Department
of Counseling Faculty of Psychology and Education Sciences, Allameh Tabataba’i University, Tehran, Iran 2The Richard Stockton College of New Jersey, Galloway, NJ, USA Corresponding author: David Lester, Psychology Program, The Richard Stockton College of New Jersey, 101 Vera King Farris Drive, Galloway, NJ 08205, USA. Email: [email protected]
Downloaded from isp.sagepub.com at Duke University Libraries on November 15, 2015
2
International Journal of Social Psychiatry
Beck (2008) noted that trait hopelessness may not be relevant to all suicides but only for those who engage in premeditated suicidal actions. The majority of research is conducted on ‘weird’ samples, that is, students from Western, Educated, Industrialized, Rich and Democratic nations (Henrich, Heine, & Norenzayan, 2010). Researchers assume that results from these samples are generalizable to individuals in all nations, but this is not necessarily a valid assumption. In the case of suicide, Lester (2005) found that the predictors of suicide rates in WEIRD nations do not predict suicide rates in non-WEIRD nations. The present study sought to compare these two approaches to predicting and understanding suicidal behavior (hopelessness versus defeat-entrapment) in non-clinical populations in two very different nations, Iran and the United States.
Method
The Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) consists of 21 items each answered on a scale of intensity ranging from 0 to 3, so that the range of possible scores is 0–63. The scale has been used in many research studies with a record of excellent reliability and validity (Reinecke & Franklin-Scott, 2005). In addition, all participants were asked their age, sex and two questions: (1) I have had thoughts of killing myself in the past and (2) In the past, I have attempted suicide, each answered yes versus no.
Results The mean scores (with SDs), along with Cronbach’s alpha reliabilities for both the American and Iranian samples are shown in Tables 1 and 2.
Participants
Iranian versus American students
The participants were convenience samples of undergraduate student in Iran and the United States. In the United States, 194 students (149 women and 45 men; mean age 21.6 years, standard deviation (SD) = 5.2 years) enrolled in psychology courses were administered a questionnaire anonymously while in class. In Iran, 146 undergraduates students (105 women and 41 men; mean age 21.0 years, SD = 1.7 years) enrolled in counseling courses were administered the questionnaire while in class. For the Iranian students, the scales were translated into Farsi, and back-translation was used in order to check the accuracy of the translation. The questionnaires had not previously been administered to Iranian students. The study was approved by the Institutional Review Boards at the two institutions. There were no missing data.
The scores of the Iranian and American students are shown in Table 1, where it can be seen that the Iranian respondents obtained significantly higher scores on all of the scales – depression, hopelessness, defeat and entrapment. However, the two groups of respondents did not differ in a history of suicide attempts, while the American students more often reported a history of suicidal ideation.
Questionnaire The defeat and entrapment scales (Gilbert & Allan, 1998) have three subscales: internal entrapment (e.g. ‘I want to get away from myself’), external entrapment (‘I feel trapped by other people’) and defeat (‘I feel defeated by life’), with 6, 10 and 16 items, respectively, answered with anchors 1 (never) and 4 (almost all the time). The ranges of possible scores are 6–24 for internal entrapment, 10–40 for external entrapment and 16–64 for defeat. Gilbert and Allan (1998) reported high Cronbach’s alpha reliabilities for the scales (0.93, 0.88 and 0.94) and single factor structures for each of the scales. The scores from the scales also had good construct validity, for example, significant correlations with measures of submissive behavior. The Beck Hopelessness Scale (Beck et al., 1974) contains 20 items answered with a true–false format. A typical item is ‘My future seems dark to me’. The scale has been used in many studies with demonstrated reliability and validity (Reinecke & Franklin-Scott, 2005). The range of possible scores is 0–20.
Predicting suicidal behavior The Pearson correlations between the variables are reported in Table 3. For the dichotomous variables, point-biserial correlations and phi coefficients were used. A factor analysis (with a principal components extraction – see Table 4) indicated that all the scores (for depression, hopelessness, defeat and entrapment) were highly inter-correlated and loaded on one factor. Multiple regressions were carried out separately for the Iranian and United States samples using logistic regression for the dichotomous variables (suicidal ideation and attempt) and linear regression for depression. For predicting depression, hopelessness, defeat and entrapment, all contributed significantly to the prediction in both countries (see Table 5). For predicting suicidal ideation, for both countries, only entrapment was statistically significant in the regression analyses (see Table 5). For a history of attempting suicide, defeat was the significant predictor for Iranian students and entrapment for American students.
Discussion The present study found that measures of hopelessness and of defeat and entrapment were significantly inter-related. Furthermore, all three variables were associated with measures of depression and suicidal ideation. Interestingly, this
Downloaded from isp.sagepub.com at Duke University Libraries on November 15, 2015
3
Tarsafi et al. Table 1. Mean scores of the Iranian and American students. Iran
United States
Mean (SD)
Mean (SD)
Age (years) Depression Hopelessness Defeat Entrapment Internal External
21.0 (1.7) 11.0 (9.4) 3.8 (4.0) 20.8 (9.2) 17.7 (13.4) 6.6 (5.7) 11.0 (8.4)
21.6 (5.2) 8.1 (7.2) 2.7 (3.1) 14.7 (9.3) 11.6 (12.2) 4.5 (5.1) 7.1 (7.7)
Percentages
Sex Suicidal ideation Suicidal threat Suicide attempt
28% male 21% 16% 5%
23% male 35% 15% 5%
t(338)
Two-tailed p
1.44 3.32 2.98 6.00 4.35 3.65 4.47
ns .001 .003
