STDtesting

14.06.2011 um 19:51 Uhr

STDtesting

von: test522


Introduction:


The vast majority of research on suicide risk focuses on negative factors that increase the chances of an individual engaging in intentional self-harm (e.g., Beck, Kovacs, & Weismann, 1979; Joiner & Rudd, 1996).

The different approach to assessment suicide risk arose with the product and development of the Reasons for Living Inventory (RFL; Linehan, Goodstein, Nielsen,& Chiles, 1983). Linehan and colleagues chose to examine the cognitive factors that allow individuals desire to living in the face of hardship and adversity. They say that suicidal individuals lack coping characteristics possessed by normal individuals and have important role in understanding suicide risk. Their new scale allowed to therapist differentiated suicidal and normal individuals to be based on the content of their belief systems. This scale has a 48-item and six valid and reliable subscales: Survival and Coping Beliefs (SCB), Responsibility to Family (RF), Child Related Concerns (CRC), Fear of Suicide (FS), Fear of Social Disapproval (FSD), and Moral Objections (MO).

 

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The RFL and its psychometric properties have been examined and supported in several studies (Kralik & Danforth, 1992; Osman et al., 1993; Osman, Gregg, Osman, & Jones, 1992; Osman, Jones, & Osman, 1991). Findings on sex differences with the RFL have varied. One study found no differences in scores across subscales (Osman et al., 1991), whereas women scored higher than men on some subscales, such as FS, RF, and MO, in others (Hirsch & Ellis, 1996; Osman et al., 1993; Osman et al., 1992; Osman et al., 1991).

The RFL has been used in a variety of studies with college students in the countries like United States and Australia as a means of examining protective factors (Hirsch & Ellis, 1996).  Results of Dyck et al (1991) showed weak but significant negative correlations between total RFL score and hopelessness, and they belief that the RFL have a distinct construct have supported. In addition, Hirsch and Ellis (1996) found that suicide Ideators could be distinguished from normal based on their scores on the RFL. Connell and Meyer (1991) grouped college students into categories based on reported history of suicidality and found that the SCB, RF, and MO subscales adequately discriminated between groups. The clinical utility of the RFL has been demonstrated with both adult outpatient (Dyck, 1991) and psychiatric inpatient samples (Strosahl, Chiles, &Linehan, 1992). Dyck concluded that the RFL is less influenced by depression than a commonly used measure of hopelessness and may therefore be a better measure of suicide risk with depressed patients.

Strosahl and colleagues found that the SCB subscale of the RFL was the best at discriminating across of desire to suicide in a group of patients with a history of suicide. Range, Hall, and Meyers (1993) examined the factor structure, reliability, and validity of the RFL when used with adolescents. Their sample included 128 high school students between the ages of 14 and 17, plus a comparison sample of 153 college students under the age of 20. Their confirmatory factor analysis (CFA) failed to fit the data from either sample to the original RFL six-factor structure or to a five-factor solution (deleting CRC items).

However, Range et al. (1993) were able to derive two unique six-factor solutions accounting for 53.6% of the variance in high school student data and 49.8% of variance in college student data. The authors determined internal consistency reliability of all original RFL subscales except MO to be adequate in both samples (range of Cronbach? ?= .77 to .91).

Westfield, Cardin, and Deaton (1992) based on original RFL scale produced an RFL-type measure specifically for the college student population. Similar original RFL scale they derived a six-factor solution. But they put college-related concerns factor in new scale and remove child-related concerns factor for a specific, increased importance placed on friends in addition to family. College Student Reasons for Living inventory included: SCB, College and Future-Related Concerns, MO, Responsibility to Friends and Family, FS, and FSD (Westfield et al., 1992). The psychometric properties of the College Student Reasons for Living inventory examined and accepted in the several studies (Rogers & Hanlon, 1996; Westfield, Bandura, Kiel, & Scheel, 1996).



Utility of the RFL with the adolescent population in the several studies examined. Cole (1989) based on five subscale (CRC was dropped) of six subscale RFL compared high school students and adolescences delinquents. They results were consistent with Linehan et al. (1983) but MO failed to significantly correlate with depression, hopelessness, or suicidality in the delinquent adolescences (Cole, 1989).  In the other hand, the high school sample Ideators were distinguished from attempters based on their MO scores.

Results study of Pinto, Weismann, and Conwell (1998) Instead, exploratory components analysis yielded a five-factor solution accounting for 66.5% of the variance failed to replicate the original RFL factor structure with adolescent psychiatric inpatients.

Based on the available data, it appears that the theoretical base of RFL is adequate to adolescents. However, the results of past studies when the RFL is used with adolescents and college students suggested the need for a unique measure for adolescents (Osman et al., 1996).Therefore decided to develop a new measure, based on the underlying theory of the RFL, specifically for adolescents.

Improved ways of assessing the level suicide risk in the Iranian adolescents is necessary. Based on annual data for 2006 collected from Social Welfare organization, from 5 attempt for suicide three of them are adolescents between age 12 to 24 (Social Welfare organization 2006).  In the all cities and state of Iran, Kermanshah have upper rate of suicide. The rate of completed suicides in the 15- to 24-year-old age group has deviated from a mean of 6.1 (per100, 000 population) for the 1387(2008) year in the Kermanshah city (Emam Khomeini hospital of treatment suicide). These data suggest that intentional self-harmful behavior and the potential for engaging in such behaviors are a serious concern for young people, parents, teachers and counselors and overall society in the Kermanshah city.

The RFL–A is a 32-item self-report measure designed specifically to assess adolescents' adaptive reasons for not committing suicide. It is comprised of five factors: Future Optimism (FO), Suicide-Related Concerns (SRC), Family Alliance (FA), Peer Acceptance and Support (PAS), and Self-Acceptance (SA). Less relevant items (e.g., relating to concerns about the effects of suicide on one's children) are not included in the RFL–A. The factor structure of the RFL–A is consistent with the multifaceted nature of adolescent suicidality (Osman et al., 1998). The authors also found support for convergent and construct validity. Important group differences on the RFL–A were identified. Specifically, boys had significantly higher SA scores, adolescents   in the normal group scored higher on all subscales than an suicidal group, and a psychiatric no suicidal group scored higher than a psychiatric attempter group. The main purpose of this study was to confirm the factor structure of the RFL–A derived by Osman et al. (1998) in the Iranian adolescents (Kermanshah city).and we tested the hypothesis that: 1) the RFL–A can distinguish adolescent on suicide group from normal. 2) Finally, we hypothesized that the RFL–A would discriminate between suicide attempters and no attempters better than the Beck Hopelessness Scale (BHS; Beck, Weismann, Lester, & Trexler, 1974).



Method



Participants



Participants (189 boys and 211 girls) were recruited from all Kermanshah high schools and patients between age 15 to 24 that because attempt to suicide be care in Farabi hospital. Boys (M age = 15.42, SD = .88) and girls (M age = 15.86, SD = 1.04) did not differ significantly in age, t (221) = .21, p = .83. Most of the participants were Kurd (94.4%), 3.1% were Lack, and 2.5% were Fars. Data collected from the total sample of participants were used to assess the factor structure of the RFL–A. To explore additional psychometric properties of the RFL–A, we collected complete data on the measures used in this study on a subsample (n = 96; 54boys and 42 girls) of participants (see Measures and Procedure section). We assigned these participants to two groups based on information obtained by author and a review of the medical records. In addition to the semi structured (i.e., clinical interviews).

Participants in the group suicide (13 boys and 25 girls) with a history of multiple suicide attempts who were admitted because of a recent (within 1–2 weeks prior to admission) suicide attempt (self-harm or injury with established intent to die) were assigned to the attempter group (n = 14). The method of attempts identified included drug or medication overdoses (n = 5), self-inflicted lacerations (n = 3), hanging (n = 8), attempts to use a gun (n = 3), car accidents (n= 2), and jumping from heights (n =3). Participants in the normal group (176 boys and 186 girls) who had no previous history of suicide attempts.



Measures and Procedure



Each participant completed a brief demographic questionnaire, the RFL–A, the Beck Suicide Scale Ideation (BSSI), and Oxford Happiness Inventory (Argyle et al, 1987).

Reasons for living inventory for adolescents (RFL-A; Osman et al., 1998). The RFL–A is a 32-item self-report measure designed specifically to assess adolescents' adaptive reasons for not committing suicide. It is comprised of five factors: Future Optimism (FO), Suicide-Related Concerns (SRC), Family Alliance (FA), Peer Acceptance and Support (PAS), and Self-Acceptance (SA). less relevant items (e.g., relating to concerns about the effects of suicide on one's children) are not included in the RFL–A. The factor structure of the RFL–A is consistent with the multifaceted nature of adolescent suicidality (Osman et al., 1998). The authors also found support for convergent and construct validity.



Beck Suicide Scale Ideation (BSSI; Beck et al., 1974). This 19-item scale is designed to assess prior suicide ideation and behavior, frequency of suicide ideation, threats of suicide, and likelihood of attempting

Suicide someday. The BSSI has been used in several investigations with adolescents and young adults. The BSSI was used as a measure of self-reported suicide likelihood in validating the RFL–A scales. In this study we use from BSSI to assess divergent validation.



Oxford Happiness Inventory (OHI; Argyle et al, 1987). The OHI contains 29 items designed to assess the happens. It also assesses four dimensions of suicidality: happens, hope and positive expectations about future events. Each OHI item is rated on a 4-point scale ranging from 1 (none or a little of the time) to 4 (most or all of the time). The SPS has good reliability and concurrent validity (Tatman, Greene, & Karr, 1993). We used this scale as a measure to assess convergent validation

Beck Hopelessness Scale (BHS; Beck et al., 1974).The BHS is a 20-item self-report instrument with a true–false response format. As in previous investigations, this scale has been used in several investigations to assess the extent of negative expectations about future events (see Joiner & Rudd, 1996; Marano, Cisler,& Lemuroid, 1993).

We collected data from each participant within 4 weeks of admission. Participation in the study was voluntary. During data collection, the second author or a practicum student in psychology (all trained in the administration of the research package) approached and asked each potential participant to volunteer to participate in the study. Next, the study was briefly explained, informed consent was obtained, and the questionnaire package was administered individually. Approval for conducting the study was obtained from the hospital administrator and the Medical Sciences University of Kermanshah. The protocol also included obtaining adolescent assent and significant other (legal guardians and parents) written informed consent before administering the questionnaire packet and reviewing the medical records.

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Data analyses:

Based goals of study used from below data analyses:

1. For analyses material of scales used from classic test model
2. Statically features of material of scales assess by descriptive statistics
3. Reliability of items each scale assess by kornbakh coefficient and retest
4. For assess factor validation and determine number factors of scale used from pc style
5. For calculation divergent validation correlation between RFL-A and BSSI assessed.
6. For calculation convergent validation correlation between RFL-A and OHI assessed.
7.  For calculation relationship between RFL-A and other variables like age, gender and education used from T-test and correlation.   
8.   For calculation discriminate validation and comparison mean of two group (suicide and normal) used from T-test.

Results



Reliability Analysis

We examined the internal consistency reliability of the RFL–A total and scales for the combined sample before evaluating the validity of this new instrument. The alpha coefficients for the RFL–A scales were as

Follows: FA = .88, SRC = .92, SA = .91, PAS = .89, and FO = .90. The corrected item-total correlation for each scale was greater than .40. The alpha index for the RFL–A total scale was .93. These findings are consistent with those reported by Osman et al. (1998). And result of retest after 2 weeks on subsample (n=50) was .87. in the table 1 we can see mean, std. deviation, Corrected Item-Total Correlation and Cronbach's Alpha if Item Deleted  all question of  RFL-A.