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Death Studies Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/udst20
Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents a
a
Abbas Abdollahi & Mansor Abu Talib a
Faculty of Human Ecology, Universiti Putra Malaysia, Selangor, Malaysia Accepted author version posted online: 29 Apr 2015.
Click for updates To cite this article: Abbas Abdollahi & Mansor Abu Talib (2015): Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents, Death Studies, DOI: 10.1080/07481187.2015.1013163 To link to this article: http://dx.doi.org/10.1080/07481187.2015.1013163
Disclaimer: This is a version of an unedited manuscript that has been accepted for publication. As a service to authors and researchers we are providing this version of the accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proof will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to this version also.
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents Abbas Abdollahi1, Mansor Abu Talib1 1
Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Corresponding author: Abbas Abdollahi: Email: [email protected]
Abstract To examine the moderating role of spirituality between hopelessness, spirituality, and suicidal ideation, 202 Iranian depressed adolescent inpatients completed measures of patient health, suicidal ideation, hopelessness, and core spiritual experience. Structural equation modelling indicated that depressed inpatients high in hopelessness, but also high in spirituality, had less suicidal ideation than others. These findings reinforce the importance of spirituality as a protective factor against hopelessness and suicidal ideation.
KEYWORDS: Hopelessness, Spirituality, Suicidal ideation, Depressed patients.
Suicide is a serious public health problem in many countries, and is a leading cause of death among adolescents around the world (WHO; World Health Organization, 2012). According to the World Health Organization, one million people have died from suicide, and every 40 seconds one is committing suicide. Further, WHO predicts that by 2020, one person would die every 20 seconds if urgent action is not taken (2012).
1
The rates of suicide in Iran were around 6 per 100,000 for men and 3 for women (Malakouti et al., 2009). In Iran, 33% of depressed patients attempt to commit suicide at least once in their lifetime (Shabani & Teimurinejad et al., 2013). Much of the study on suicidal behavior in Iran has been simple descriptive studies of completed suicides
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
(Malakouti et al., 2009; Mofidi, Ghazinour, Salander-Renberg, & Richter, 2008; Shooshtary et al., 2008), and limited studies have been conducted on suicide ideation as an important predictor of suicide. Attempted suicide may be related to cultural obstacles, religious prohibition, the existence of a strong stigma on mental disorders (particularly on suicide), and the absence of registration systems. Thus, understanding about suicidal ideation as a preceding phase in the suicidal process is necessary in preventing suicide in depressed individuals.
Spirituality is a factor in suicidal ideation. Spirituality is an individual phenomenon related to the relationship of a person with a Higher Power (Vaughan, 1991); the awareness of the Higher Power brings meaning, a goal and hope to a person's life (Hinterkopf, 1994). Meaning in life, a tenet of spiritual belief, creates a goal, and hope in one's life (Westgate, 1996). Spirituality can alleviate physical, psychological, and even social problems (Cotton et al., 2009; Tuncay, 2007). Spirituality can provide a sense of hope in extremely hopeless situations, increased intimacy, comfort and relief from stress, meaning and a useful goal in life, help in finding effective solutions to problems (Cotton et al., 2009), and a positive coping style against stressful life events (Folkman & Moskowitz, 2000). In addition, in Islam, high spirituality helps individuals to reinterpret the crisis to give them purpose and meaning (Koenig, Zaben, & Khalifa, 2012).
2
Previous studies revealed that spirituality was associated with decreased suicidal ideation in different populations (Abdollahi & Talib, 2015; Garroutte, Goldberg, Beals, Herrell, & Manson, 2003; McClain-Jacobson et al., 2004). Additionally, a review revealed that 84% of studies reported a lower prevalence of suicidal behavior/ideation among people who
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
were more spiritual (Koenig, King, & Carson, 2012).
Given the influence of depression in the context of suicide, it is important to understand the relationship between spirituality and suicidal ideation in depressed individuals. One study of the lifetime suicide attempts in depressed inpatients found that spiritual people had significantly decreased suicidal ideation compared to those with low spirituality (Rasic, Robinson, Bolton, Bienvenu, & Sareen, 2011). However, it remains unclear whether these findings in depressed inpatients in Western countries generalize to depressed inpatients in Iran as a representative of Islamic country.
Hopelessness is the most powerful predictor of suicide and suicidal ideation (Britton et al., 2008; Chioqueta & Stiles, 2005), explaining more than depression in patients with at least one mood disorder (Beck, Steer, Beck, & Newman, 1993). Suicidal individuals are more likely to experience hopelessness than non-suicidal individuals (Jager-Hyman et al., 2014; Weishaar & Beck, 1992). However, spirituality may provide a sense of goal in life, and offers fruitful meaning in life (Litwinczuk & Groh, 2007). Previous studies found that an inverse association existed between spirituality and hopelessness in patients with advanced cancer (Mystakidou et al., 2007). The feeling of hopelessness in adolescents has also been implicated as a contributing factor to suicide and suicidal ideation
3
(Johnson, Gooding, Wood, & Tarrier, 2010; Polanco-Roman & Miranda, 2013). In particular, during the adolescence, depressive symptoms and hopelessness increase (Hovey & King, 2002).
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Although the spirituality literature and hopelessness literature have related to suicidal ideation, these literatures have remained independent from each other. In addition, the majority of studies on suicide have conducted in Western European countries and American samples, and need to be replicated in other cultures to explore the generalizability of the findings. Theories of suicidal ideation and research findings about suicidal ideation will be more fruitful if they can apply to different cultures. Therefore, the current study attempts to provide a greater understanding of the relationship between spirituality, hopelessness, and suicidal ideation among Iranian depressed inpatients. Clarifying these relationships can provide competent treatment and prevention programs about the reduction of suicidal ideation.
Iran, one of the biggest Islamic countries, is 99% Muslim (Rezaei, Adib-Hajbaghery, Seyedfatemi, & Hoseini, 2008). Suicide is a horrible crime under Islamic law in Iran, and suicide attempts may lead to criminal prosecution. The lower suicide rate in Islamic countries compared to Western countries may be explained by the fact that Islam severely prohibits suicide (Zeyrek, Gençöz, Bergman, & Lester, 2009). Additional explanation for the low reporting rate of suicidal behavior in Islamic populations is that individuals who plan to commit suicide know that they will almost certainly be blamed by other people and that if they survive, they will suffer greatly from stigma. These reasons might
4
discourage individuals for reporting suicidal experiences in Iran.
Therefore, the current study sought to explore the generality of the predicted relationships to Iranian depressed population. We hypothesized that depressed adolescent in-patients
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
who were hopeless, but had high levels of spirituality, would experience less suicidal ideation than depressed in-patients who were low in spirituality.
METHOD Participants Participants were 202 adolescent inpatients (105 girls, 97 boys) who had been psychiatrically hospitalized due to depression, recruited from psychiatric inpatient units from five public hospitals in Tehran (103 from two mental hospitals and 99 from three regular hospitals). They were aged from 13-18 years (M = 16.28, SD = 2.58). Data were collected by researchers from 18 September 2012 to 10 November 2012. Based on the total score on Patient Health Questionnaire (Spitzer, Kroenke, Williams, & Group, 1999), participants were categorized as minimal depression (PHQ = 1-4, n = 10), mild depression (PHQ = 5-9, n = 12), moderate depression (PHQ = 10-14, n = 78), moderately severe depression (PHQ = 15-19, n = 124), and severe depression (PHQ = 20- 27, n = 18). The average length of hospitalization was 198 days (range= 2-14 months). Most (n = 182, 90%) were single. In education, 71 (35%) were college students, 87 (43%) were high-school students, 24 (12%) were guidance-school students, and 22 (10%) were an elementary degree, this means that they were not in school. Most lived with both their parents (n =145, 72%). In terms of religion, 184 (91%) considered themselves Muslim.
5
Almost half (47%, n= 95) reported a suicide attempt history and 107 reported no suicide attempt history.
Measures
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Patient Health Questionnaire (PHQ; Spitzer et al., 1999) is nine symptoms of depression answered on a 4-point scale from 0 (Not at all) to 3 (Nearly every day). In the current study, the average score was 16.0 (SD: 6), with a range of 4 to 27. The PHQ had a good reliability (α: 0.81) when used with adolescent psychiatric inpatients (Surrence, Miranda, Marroquín, & Chan, 2009).
Suicidal Ideation Questionnaire (SIQ; Reynolds, 1991) is 30 items that measure the frequency of suicidal ideation. All the questions are based on a 7-point Likert scale from 0 (Never had the thought) to 6 (Had the thought almost every day). The total score is from 0 to 180, with a higher score indicating higher levels of suicidal ideation. The SIQ had an excellent internal consistency and good test-retest stability when used with adolescent psychiatric inpatients (Pinto, Whisman, & McCoy, 1997; Reynolds, 1986). In the present study, the average score was 87.14 (SD: 15.12), with a range of 23–152.
The Beck Hopelessness Scale (BHS; Beck, Weissman, Lester, & Trexler, 1974) is 20 true-false items with higher scores indicating higher hopelessness. In clinical adolescents, the BHS had strong internal consistency (α: 0.83 to 0.93; Beck et al., 1974). Several studies have good concurrent validity with clinicians’ ratings of hopelessness (α: 0.74;
6
Beck, Steer, Kovacs, & Garrison, 1985). In the present study, the average score was 11.21 (SD: 3.51), with a range of 6 to 16.
Index of Core Spiritual Experience (ICSE; Kass, Friedman, Leserman, Zuttermeister, &
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Benson, 1991) is seven items on spiritual valiance, spiritual practice, and frequency of religious experience. All items are on a 4-point scale so total scores can range from 7 to 28, higher scores indicating higher spirituality. Among clinical adolescents, the ICSE had good consistency (α: 0.93), and good concurrent validity (α: 0.69) with the intrinsic subscale of a religious orientation Inventory (Jafari et al., 2010). In the current study, the average score was 19.98 (SD: 4.45), with a range of 9 to 26.
Procedure A psychiatrist or a psychologist informed each adolescent of the research, that participation was voluntary and anonymous, and that they could withdraw at any time asked each inpatient to complete all questionnaires. An exclusion criterion was inability to read or comprehend the questionnaires. The researcher obtained written permission from each depressed inpatient, and parental consent as well. The packages of questionnaires were distributed among depressed inpatients, and collected in a nontreatment session. Depressed inpatients were received medical and psychological treatment within 14 days prior to the study assessment.
RESULTS
7
The questionnaires were translated into the Persian language. In order to ensure that the Persian translation correctly reflect the meaning of the English version, back-translation (Brislin, 1980) was conducted with the assistance of three experts in English language, and needed changes were performed accordingly. A pilot study on 40 depressed
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
inpatients determined the reliability: Cronbach alpha were: PHQ = 0.81; SIQ = 0.73; BHS = 0.78; and ICSE = 0.79.
For model fit, Kline (2005) suggested using indexes of model fit, including the chi square/degree of freedom ratio (CMIN/DF), the comparative-fit index (CFI), the goodness-of-fit index (GFI), and the Tucker-Lewis Index (TLI). This model includes spirituality, hopelessness, and suicidal ideation as latent variables. According to Kline (2005), this model provides an adequate fit for the model: CMIN/DF (Chi-square) = 2.39, p
Death Studies Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/udst20
Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents a
a
Abbas Abdollahi & Mansor Abu Talib a
Faculty of Human Ecology, Universiti Putra Malaysia, Selangor, Malaysia Accepted author version posted online: 29 Apr 2015.
Click for updates To cite this article: Abbas Abdollahi & Mansor Abu Talib (2015): Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents, Death Studies, DOI: 10.1080/07481187.2015.1013163 To link to this article: http://dx.doi.org/10.1080/07481187.2015.1013163
Disclaimer: This is a version of an unedited manuscript that has been accepted for publication. As a service to authors and researchers we are providing this version of the accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proof will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to this version also.
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents Abbas Abdollahi1, Mansor Abu Talib1 1
Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Corresponding author: Abbas Abdollahi: Email: [email protected]
Abstract To examine the moderating role of spirituality between hopelessness, spirituality, and suicidal ideation, 202 Iranian depressed adolescent inpatients completed measures of patient health, suicidal ideation, hopelessness, and core spiritual experience. Structural equation modelling indicated that depressed inpatients high in hopelessness, but also high in spirituality, had less suicidal ideation than others. These findings reinforce the importance of spirituality as a protective factor against hopelessness and suicidal ideation.
KEYWORDS: Hopelessness, Spirituality, Suicidal ideation, Depressed patients.
Suicide is a serious public health problem in many countries, and is a leading cause of death among adolescents around the world (WHO; World Health Organization, 2012). According to the World Health Organization, one million people have died from suicide, and every 40 seconds one is committing suicide. Further, WHO predicts that by 2020, one person would die every 20 seconds if urgent action is not taken (2012).
1
The rates of suicide in Iran were around 6 per 100,000 for men and 3 for women (Malakouti et al., 2009). In Iran, 33% of depressed patients attempt to commit suicide at least once in their lifetime (Shabani & Teimurinejad et al., 2013). Much of the study on suicidal behavior in Iran has been simple descriptive studies of completed suicides
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
(Malakouti et al., 2009; Mofidi, Ghazinour, Salander-Renberg, & Richter, 2008; Shooshtary et al., 2008), and limited studies have been conducted on suicide ideation as an important predictor of suicide. Attempted suicide may be related to cultural obstacles, religious prohibition, the existence of a strong stigma on mental disorders (particularly on suicide), and the absence of registration systems. Thus, understanding about suicidal ideation as a preceding phase in the suicidal process is necessary in preventing suicide in depressed individuals.
Spirituality is a factor in suicidal ideation. Spirituality is an individual phenomenon related to the relationship of a person with a Higher Power (Vaughan, 1991); the awareness of the Higher Power brings meaning, a goal and hope to a person's life (Hinterkopf, 1994). Meaning in life, a tenet of spiritual belief, creates a goal, and hope in one's life (Westgate, 1996). Spirituality can alleviate physical, psychological, and even social problems (Cotton et al., 2009; Tuncay, 2007). Spirituality can provide a sense of hope in extremely hopeless situations, increased intimacy, comfort and relief from stress, meaning and a useful goal in life, help in finding effective solutions to problems (Cotton et al., 2009), and a positive coping style against stressful life events (Folkman & Moskowitz, 2000). In addition, in Islam, high spirituality helps individuals to reinterpret the crisis to give them purpose and meaning (Koenig, Zaben, & Khalifa, 2012).
2
Previous studies revealed that spirituality was associated with decreased suicidal ideation in different populations (Abdollahi & Talib, 2015; Garroutte, Goldberg, Beals, Herrell, & Manson, 2003; McClain-Jacobson et al., 2004). Additionally, a review revealed that 84% of studies reported a lower prevalence of suicidal behavior/ideation among people who
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
were more spiritual (Koenig, King, & Carson, 2012).
Given the influence of depression in the context of suicide, it is important to understand the relationship between spirituality and suicidal ideation in depressed individuals. One study of the lifetime suicide attempts in depressed inpatients found that spiritual people had significantly decreased suicidal ideation compared to those with low spirituality (Rasic, Robinson, Bolton, Bienvenu, & Sareen, 2011). However, it remains unclear whether these findings in depressed inpatients in Western countries generalize to depressed inpatients in Iran as a representative of Islamic country.
Hopelessness is the most powerful predictor of suicide and suicidal ideation (Britton et al., 2008; Chioqueta & Stiles, 2005), explaining more than depression in patients with at least one mood disorder (Beck, Steer, Beck, & Newman, 1993). Suicidal individuals are more likely to experience hopelessness than non-suicidal individuals (Jager-Hyman et al., 2014; Weishaar & Beck, 1992). However, spirituality may provide a sense of goal in life, and offers fruitful meaning in life (Litwinczuk & Groh, 2007). Previous studies found that an inverse association existed between spirituality and hopelessness in patients with advanced cancer (Mystakidou et al., 2007). The feeling of hopelessness in adolescents has also been implicated as a contributing factor to suicide and suicidal ideation
3
(Johnson, Gooding, Wood, & Tarrier, 2010; Polanco-Roman & Miranda, 2013). In particular, during the adolescence, depressive symptoms and hopelessness increase (Hovey & King, 2002).
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Although the spirituality literature and hopelessness literature have related to suicidal ideation, these literatures have remained independent from each other. In addition, the majority of studies on suicide have conducted in Western European countries and American samples, and need to be replicated in other cultures to explore the generalizability of the findings. Theories of suicidal ideation and research findings about suicidal ideation will be more fruitful if they can apply to different cultures. Therefore, the current study attempts to provide a greater understanding of the relationship between spirituality, hopelessness, and suicidal ideation among Iranian depressed inpatients. Clarifying these relationships can provide competent treatment and prevention programs about the reduction of suicidal ideation.
Iran, one of the biggest Islamic countries, is 99% Muslim (Rezaei, Adib-Hajbaghery, Seyedfatemi, & Hoseini, 2008). Suicide is a horrible crime under Islamic law in Iran, and suicide attempts may lead to criminal prosecution. The lower suicide rate in Islamic countries compared to Western countries may be explained by the fact that Islam severely prohibits suicide (Zeyrek, Gençöz, Bergman, & Lester, 2009). Additional explanation for the low reporting rate of suicidal behavior in Islamic populations is that individuals who plan to commit suicide know that they will almost certainly be blamed by other people and that if they survive, they will suffer greatly from stigma. These reasons might
4
discourage individuals for reporting suicidal experiences in Iran.
Therefore, the current study sought to explore the generality of the predicted relationships to Iranian depressed population. We hypothesized that depressed adolescent in-patients
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
who were hopeless, but had high levels of spirituality, would experience less suicidal ideation than depressed in-patients who were low in spirituality.
METHOD Participants Participants were 202 adolescent inpatients (105 girls, 97 boys) who had been psychiatrically hospitalized due to depression, recruited from psychiatric inpatient units from five public hospitals in Tehran (103 from two mental hospitals and 99 from three regular hospitals). They were aged from 13-18 years (M = 16.28, SD = 2.58). Data were collected by researchers from 18 September 2012 to 10 November 2012. Based on the total score on Patient Health Questionnaire (Spitzer, Kroenke, Williams, & Group, 1999), participants were categorized as minimal depression (PHQ = 1-4, n = 10), mild depression (PHQ = 5-9, n = 12), moderate depression (PHQ = 10-14, n = 78), moderately severe depression (PHQ = 15-19, n = 124), and severe depression (PHQ = 20- 27, n = 18). The average length of hospitalization was 198 days (range= 2-14 months). Most (n = 182, 90%) were single. In education, 71 (35%) were college students, 87 (43%) were high-school students, 24 (12%) were guidance-school students, and 22 (10%) were an elementary degree, this means that they were not in school. Most lived with both their parents (n =145, 72%). In terms of religion, 184 (91%) considered themselves Muslim.
5
Almost half (47%, n= 95) reported a suicide attempt history and 107 reported no suicide attempt history.
Measures
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Patient Health Questionnaire (PHQ; Spitzer et al., 1999) is nine symptoms of depression answered on a 4-point scale from 0 (Not at all) to 3 (Nearly every day). In the current study, the average score was 16.0 (SD: 6), with a range of 4 to 27. The PHQ had a good reliability (α: 0.81) when used with adolescent psychiatric inpatients (Surrence, Miranda, Marroquín, & Chan, 2009).
Suicidal Ideation Questionnaire (SIQ; Reynolds, 1991) is 30 items that measure the frequency of suicidal ideation. All the questions are based on a 7-point Likert scale from 0 (Never had the thought) to 6 (Had the thought almost every day). The total score is from 0 to 180, with a higher score indicating higher levels of suicidal ideation. The SIQ had an excellent internal consistency and good test-retest stability when used with adolescent psychiatric inpatients (Pinto, Whisman, & McCoy, 1997; Reynolds, 1986). In the present study, the average score was 87.14 (SD: 15.12), with a range of 23–152.
The Beck Hopelessness Scale (BHS; Beck, Weissman, Lester, & Trexler, 1974) is 20 true-false items with higher scores indicating higher hopelessness. In clinical adolescents, the BHS had strong internal consistency (α: 0.83 to 0.93; Beck et al., 1974). Several studies have good concurrent validity with clinicians’ ratings of hopelessness (α: 0.74;
6
Beck, Steer, Kovacs, & Garrison, 1985). In the present study, the average score was 11.21 (SD: 3.51), with a range of 6 to 16.
Index of Core Spiritual Experience (ICSE; Kass, Friedman, Leserman, Zuttermeister, &
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
Benson, 1991) is seven items on spiritual valiance, spiritual practice, and frequency of religious experience. All items are on a 4-point scale so total scores can range from 7 to 28, higher scores indicating higher spirituality. Among clinical adolescents, the ICSE had good consistency (α: 0.93), and good concurrent validity (α: 0.69) with the intrinsic subscale of a religious orientation Inventory (Jafari et al., 2010). In the current study, the average score was 19.98 (SD: 4.45), with a range of 9 to 26.
Procedure A psychiatrist or a psychologist informed each adolescent of the research, that participation was voluntary and anonymous, and that they could withdraw at any time asked each inpatient to complete all questionnaires. An exclusion criterion was inability to read or comprehend the questionnaires. The researcher obtained written permission from each depressed inpatient, and parental consent as well. The packages of questionnaires were distributed among depressed inpatients, and collected in a nontreatment session. Depressed inpatients were received medical and psychological treatment within 14 days prior to the study assessment.
RESULTS
7
The questionnaires were translated into the Persian language. In order to ensure that the Persian translation correctly reflect the meaning of the English version, back-translation (Brislin, 1980) was conducted with the assistance of three experts in English language, and needed changes were performed accordingly. A pilot study on 40 depressed
Downloaded by [UZH Hauptbibliothek / Zentralbibliothek Zürich] at 09:41 05 May 2015
inpatients determined the reliability: Cronbach alpha were: PHQ = 0.81; SIQ = 0.73; BHS = 0.78; and ICSE = 0.79.
For model fit, Kline (2005) suggested using indexes of model fit, including the chi square/degree of freedom ratio (CMIN/DF), the comparative-fit index (CFI), the goodness-of-fit index (GFI), and the Tucker-Lewis Index (TLI). This model includes spirituality, hopelessness, and suicidal ideation as latent variables. According to Kline (2005), this model provides an adequate fit for the model: CMIN/DF (Chi-square) = 2.39, p
