Semester

Summer

Date of Graduation

2014

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Amy Fiske

Committee Co-Chair

Barry Edelstein

Committee Member

William Fremouw

Committee Member

Julie H. Patrick

Committee Member

Ian Rockett

Abstract

Hopelessness has garnered a wealth of empirical support as an important construct in psychological assessment and treatment. It is more than a symptom of major depression; rather, hopelessness has been shown to be a strong risk factor for physical illness, suicidal behavior, and mortality. In fact, hopelessness has been found to be an independent risk factor for these negative outcomes controlling for overall depressive symptoms. Hopelessness is an especially important construct for assessment in later life, as older adults are at an elevated risk of suicide worldwide. Studies have generally supported the use of the Beck Hopelessness Scale (BHS; Beck et al, 1974) with older adults; though, it was not designed with this population in mind. On the other hand, the Geriatric Hopelessness Scale (GHS; Fry, 1984) was constructed specifically for use with older adults, but has demonstrated unstable psychometric properties. In addition, many items on the GHS lack face validity or may be too culturally specific. Both the BHS and the GHS contain items that may be conflated with realistic appraisals of remaining time or physical illness. Based on these characteristics, the creation of a new measure for geriatric hopelessness is warranted. The current study sought to construct and validate a self-report scale for late-life hopelessness that contains future-oriented thematic content relevant to older adults (e.g., legacy, social support, pain) and excludes items that may be inherently biased against older adults or individuals with life-limiting illnesses. Items were drafted based on a literature review and sent to experts in the field of geriatric depression/suicide for revision and to establish content validity. After review, the preliminary version of the Hopelessness Inventory for Later Life (HILL) contained 30 items and utilized a 4-point Likert-type response format. A sample of 265 older adults completed a survey battery containing the preliminary HILL, as well as other relevant measures in order to further revise the item content and examine its psychometric properties. The sample included older adults recruited in-person (i.e., from senior centers, a family medicine clinic, churches), through a mailing list, and online via Amazon mTurk (M age=71.1 SD=6.7). An examination of item-response characteristics (e.g., skewness) revealed one item as a candidate for deletion. An unrotated principal components analysis was then used to examine unidimensionality and to identify additional items for deletion. Based on these analyses, two viable versions of the scale, the HILL and the HILL-Shortened (HILL-S) were proposed. Both exhibited strong item-response characteristics, as well as preliminary evidence of unidimensionality, internal consistency (alpha=.96 and alpha=.89, respectively), and construct validity. Regarding construct validity, the HILL and the HILL-S were strongly associated with measures of hopelessness (BHS), geriatric depression, perceived burdensomeness, and social support. Moderate correlations were found with suicide risk, anxiety, self-rated health, physical health, and pain interference. The HILL and the HILL-S demonstrated small associations with social desirability and pain frequency. Finally, there was no relation observed between age and either the HILL or the HILL-S. Exploratory analyses provided evidence that both measures functioned as mediators and moderators in the relation between geriatric depression and suicidality, consistent with relevant theories of suicide, whereas the BHS did not. Overall, results from the current study provide preliminary evidence of good psychometric properties for both the HILL and HILL-S. Moreover, in light of findings from mediational and moderational analyses, the current study lends greater support to the HILL and HILL-S in the assessment of late-life hopelessness compared to the BHS.

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