Analysis of the Escape Theory of Suicide in an outpatient clinical population
A model of the Escape Theory of Suicide was constructed and tested in an outpatient clinical population. The hypothesis of the model was that: (a) level of depression will be related to negative life events and dimensions of perfectionism (i.e., self-oriented and socially prescribed perfectionism) and their interaction; (b) depression was expected to be related to a high degree of hopelessness; (c) hopelessness would be related to lowered reasons for living; (d) lowered reasons for living would be associated with increased suicide ideation; and (e) level of suicide ideation would be affected by negative life events, socially prescribed perfectionism, and their interaction, and also by degree of hopelessness. The participants in the study were 132 clinical outpatients who were obtained at a community mental health center and at a large medical center. The participants completed the Life Events Questionnaire, the Multidimensional Perfectionism Scale, the Self-Rating Depression Scale, the Hopelessness Scale, the Brief Reasons for Living Inventory, and the Scale for Suicide Ideation. LISREL structural equation modeling and multiple regression analysis showed that the model had a good overall fit. The portion of the model that hypothesizes the initiation of the suicidal process prior to depression occurring was not validated, i.e., negative life events, self-oriented perfectionism and the interaction of negative life events and dimensions of perfectionism were not related to depression. However, the portion of the model of the ETS that begins when depression is present was validated and showed some utility. As expected higher levels of socially prescribed perfectionism was related to increased levels of depression, increased levels of depression was related to an increased degree of hopelessness, which in turn was related to lowered reasons for living. Increased levels of suicide ideation was predicted by levels of hopelessness and reasons for living, but not by negative life events, socially prescribed perfectionism, and their interaction. These findings further validate the need to assess for suicidality in those patients who are depressed, hopeless, and have fewer reasons for living. The findings also suggest that research should focus on what initiates the suicidal process before depression occurs.