FACTORS RELATED TO HOPELESSNESS IN COLLEGE STUDENTS

ABSTRACT

Objective:

To identify factors related to hopelessness in college students.

Method:

cross-sectional study conducted in a Higher Education Institution in the state of Piauí - Brazil, in 2017, with 142 students from the health courses. The Beck Hopelessness Scale, Beck Suicidal Intent Scale, and socioeconomic and academic questionnaire were used. The data were analyzed using Fisher’s exact test, Mann-Whitney test, and Kruskall-Wallis test.

Results:

Of the students with suicidal ideation, 24 (77.4%) presented a severe level of hopelessness. Higher mean scores on the Hopelessness Scale were observed in male students, who did not attend the desired course, with reports of insecurity about their professional future, users of alcohol and other drugs, with a history of suicide attempts, bullying and depressed mood.

Conclusion:

Hopelessness correlates with the presence of suicidal ideation and low academic performance, highlighting the importance of physical, mental, and academic health support actions.

DESCRITORES
Suicidal Ideation; Hope; Students, Health Occupations; Mental Health; Risk Factors

RESUMO

Objetivo:

identificar fatores relacionados à desesperança em universitários.

Método:

estudo transversal, realizado em uma Instituição de Ensino Superior no estado do Piauí - Brasil, em 2017, com 142 estudantes dos cursos de saúde. Utilizou-se a Escala de Desesperança de Beck, Escala de Ideação Suicida de Beck e questionário socioeconômico e acadêmico. Os dados foram analisados utilizando os testes exato de Fisher, Mann-Whitney e Kruskall-Wallis.

Resultados:

dos estudantes com ideação suicida, 24 (77,4%) apresentaram nível de desesperança severa. Maiores médias na Escala de Desesperança foram observadas em estudantes do sexo masculino, que não frequentavam o curso desejado, com relato de insegurança quanto ao futuro profissional, usuários de álcool e outras drogas, com histórico de tentativa de suicídio, bullying e de humor deprimido.

Conclusão:

A desesperança correlaciona-se com a presença de ideação suicida e baixo rendimento acadêmico, destacando a importância de ações de apoio físico, mental e de saúde acadêmica.

DESCRITORES
Ideação Suicida; Esperança; Estudantes de Ciências da Saúde; Saúde Mental; Fatores de Risco

RESUMEN

Objetivo:

identificar los factores relacionados con la desesperanza en los estudiantes universitarios.

Método:

estudio transversal, realizado en una Institución de Educación Superior del estado de Piauí, Brasil, en 2017, con 142 estudiantes de los cursos de salud. Se utilizó la escala de desesperanza de Beck, la escala de ideación suicida de Beck y un cuestionario socioeconómico y académico. Los datos se analizaron mediante las pruebas exactas de Fisher, Mann-Whitney y Kruskall-Wallis.

Resultados:

De los estudiantes con ideación suicida, 24 (77,4%) presentaban un nivel severo de desesperanza. Se observaron puntuaciones medias más altas en la escala de desesperanza en los estudiantes varones, que no asistieron al curso deseado, con informes de inseguridad sobre su futuro profesional, consumidores de alcohol y otras drogas, con antecedentes de intento de suicidio, acoso escolar y estado de ánimo deprimido.

Conclusión:

La desesperanza se correlaciona con la presencia de ideación suicida y el bajo rendimiento académico, destacando la importancia de las acciones de apoyo a la salud física, mental y académica.

DESCRIPTORES
Ideación Suicida; Esperanza; Estudiantes del Área de la Salud; Salud Mental; Factores de Riesgo

INTRODUCTION

The entry of young people into higher education causes changes in social life and daily activities, in addition to exposure to stressors related to academic life. For students in health courses, the proximity to the illness/death of others can potentiate these stressors and generate psychic suffering in the student ⁽1⁾.

It is noteworthy that these changes directly affect academic performance, positively or not. Thus, in the positive repercussion, the student manages to overcome the crisis and ensure an increase in his biopsychosocial maturity. On the other hand, in a negative way, the student cannot deal with the changes, showing his/her state of unbalance and feeling of inability to solve the crisis, which can result in hopelessness ⁽2⁾.

Hopelessness consists of the grouping of cognitive schemas in which negative expectations about the future are evident, prevailing feelings of disbelief, despair and loss of hope. The person who has no hope for the future believes that nothing will result in success, that they will never succeed in anything they do, that they will not be able to conquer their goals, and that their most significant problem will never be solved ⁽3⁾.

The occurrence of thoughts typical of hopelessness compromises the subject’s mental health and the way he/she interacts with his/her social environment, since it makes it difficult for him/her to engage in productive and healthy activities and to face life’s problems. Studies indicate that the association of hopelessness with symptoms of anxiety and depression influence risk behaviors, such as substance abuse and suicidal behaviors⁽4^-5⁾.

The presence of hopelessness among college students is far from being an uncommon phenomenon. A study conducted in Brazilian federal institutions of higher education showed that 79.8% of students said they had experienced some emotional difficulty in the twelve months prior to the survey, among which 32.5% reported helplessness and hopelessness ⁽6⁾.

In this sense, the attention to the mental health of college students has been raising discussions inside and outside the academic environment, especially in situations in which mental suffering assumes more critical nuances, compromising academic performance and leaving the student more vulnerable to the development of mental disorders and suicidal behavior. The search for factors associated with hopelessness can contribute to the planning of actions that are more in line with the students’ needs. Thus, this study aims to identify factors related to hopelessness in college students.

METHOD

This is an analytical cross-sectional study carried out in a Health Sciences Center of a public Higher Education Institution in the State of Piauí, which includes the courses of medicine, nursing, psychology, and physiotherapy.

The source population was composed of 849 university health students. Those older than 18 years of age were included, and those who were away from the institution and those who did not answer the questionnaires in full were excluded. A confidence level of 95%, maximum error of 5%, and presumed prevalence ⁽2⁾ of 12.6% were used to calculate the sample, obtaining a sample of 142 students. The sample was simple random probability sampling.

Data collection was performed in January 2017, with the help of two validated scales: Beck Hopelessness Scale (BSH) and the Beck Suicidal Intent Scale (BSI), to identify the presence of hopelessness and suicidal ideation. A questionnaire designed by the authors was also applied, addressing socioeconomic aspects and academic variables.

The Beck Hopelessness Scale is a self-completion instrument consisting of 20 items that measure negative actions about the future. Of these 20 items, nine are classified as factual and 11 as counterfactual, and the results obtained can range from zero to 20. If the value found is between zero and three it is considered minimal, if it is between four and nine it is considered medium, if it is between nine and 14 moderate, and if it is greater than 14 it is considered severe ⁽7⁾.

The Beck Suicidal Intent Scale (BSI) is a self-assessment instrument for estimating the severity of suicidal ideation, composed of 21 items scored on a scale of zero to three points, with a score variation of zero-38, calculated by the sum of the first 19 items. There is no dichotomous cut-off for high-risk definition, but high scores indicate a higher risk of suicidal ideation ⁽8⁾.

The data were submitted to the process of double entry, using Excel spreadsheets, which were exported and analyzed in the Statistical Package for the Social Science (SPSS) software version 20.0. Fisher’s exact test was used to verify the association between the dependent variable (hopelessness) and the independent variable (suicidal ideation), and the Mann Whitney and Kruskall Wallis tests were used to compare the means of the BHS score (dependent variable) and gender, academic aspects, and life conditions (independent variables), adopting a significance level of p<0.05.

This study was approved by the Research Ethics Committee of the State University of Piauí, under opinion no. 1.861.528.

RESULTS

When associating the level of hopelessness among students who presented suicidal ideation, it is observed that 24 (77.4%) college students presented a severe level of hopelessness, with a significant association in the bivariate analysis (Table 1).

Table 1
Level of hopelessness in college students according to the presence of suicidal ideation. Teresina, PI, Brazil, 2020

		Suicidal Ideation			p *
		Yes n (%)	No n (%)	Total n (%)
Hopelessness Level					0,000
	Normal Hope	1 (3,2)	74 (66,7)	75 (52,8)
	Slight hopelessness	2 (6,5)	29 (26,1)	31 (21,8)
	Moderate Hopelessness	4 (12,9)	7 (6,3)	11 (7,7)
	Severe Hopelessness	24 (77,4)	1 (0,9)	25 (17,6)

• Source: Authors (2020)
• ^*
  Fisher’s Exact Test

The mean BHS score obtained by the sample was 6.42 (6.26), while when only the group of college students with suicidal ideation was considered, the mean rose to 16.52 (4.71). A significant positive correlation was observed between the BHS score and BSI score (r=0.685; p=0.000) and a significant negative correlation with academic performance (r= -0.275); p=0.001).

Table 2 shows the comparison of means of the BHS score according to gender, school variables and living conditions. Higher means were observed in male students, who studied Psychology, did not attend the desired course, and reported insecurity about their professional future. As for living conditions, we observed higher means in students who reported habits of alcohol consumption, smoking and other drugs, history of suicide attempt, history of bullying and presence of depressed mood. Except for the variables gender and insecurity about their professional future, all other variables showed statistically significant differences in the means of the groups.

Table 2
Comparison of means of the BHS score according to sex, school variables and living conditions. Teresina, PI, Brazil, 2020

		BHS score Mean (SD)	P
Gender			0,180 1
	Male	6,97 (6,26)
	Female	5,86 (6,24)
Course			0,002 2
	Nursing	4,26 (4,14)
	Physiotherapy	5,33 (5,39)
	Medicine	6,35 (6,12)
	Psychology	11,03 (7,7)
Desired Course			0,000 1
	Yes	3,83 (4,11)
	No	8,61 (6,91)
Insecurity about the professional future			0,472 1
	Yes	6,46 (6,15)
	No	6,27 (6,81)
Alcohol Use			0,001 1
	Yes	7,77 (6,81)
	No	4,02 (4,19)
Cigarette use			0,000 1
	Yes	11,23 (7,53)
	No	5,13 (5,19)
Use of another drug			0,000 1
	Yes	11,68 (7,28)
	No	5,13 (5,25)
Previous suicide attempt			0,000 1
	Yes	15,67 (5,71)
	No	3,95 (3,45)
Presence of depressed mood			0,000 1
	Yes	8,62 (6,84)
	No	4,10 (4,57)
History of bullying			0,000 1
	Yes	10,98 (7,55)
	No	4,57 (4,52)

• ¹
  Test the Mann Whitney;
• ²
  Test the Kruskall Wallis
• Source: Authors (2020)

DISCUSSION

The high percentage of severe hopelessness associated with suicidal ideation found in this study corroborates other studies that demonstrate the same. A study conducted with 142 depressed patients followed for more than 10 years pointed out that hopelessness was higher among those who reported any suicidal behavior (ideation or attempts) compared to non-suicidal individuals, hopelessness being better conceptualized as a risk factor for suicidal ideation, but not for the progression from ideation to attempts ⁽9⁾.

An integrative review corroborated this study by evidencing that medical students presented thoughts of hopelessness more frequently. Furthermore, it identified the existence of a positive correlation between suicide risk and the presence of depressive symptoms and hopelessness ⁽10⁾. A study carried out with undergraduate nursing students indicated that the feeling of sadness, depression and hopelessness was presented by 33.7% of these students. These are important data for a more careful evaluation of cases of depression and hopelessness among students who have already attempted suicide since they are risk factors for new attempts at self-extermination ⁽11⁾.

When comparing the mean scores obtained in the application of the BHS scale with other studies with a similar sample, it was observed that this study presented a higher mean. It is noteworthy that the BHS scores range from zero to 20, thus increasing the severity of hopelessness, according to the score ⁽12⁾.

It was evidenced that academic performance showed a negative correlation with hopelessness, i.e., the higher the level of hopelessness, the worse the student’s performance. This can be justified because psychological suffering, whether by hopelessness, depression or other aggravations, compromises the student’s ability to acquire new knowledge effectively, which impairs the academic performance index ⁽13⁾.

The fact that hopelessness scores are higher in men can be explained by the fact that this public seeks help less frequently, besides postponing as much as possible the search for treatments related to mental health, situations influenced by deep-rooted social and cultural taboos. On the other hand, women are more open to dialogue, showing ease in expressing pain, sadness, anguish and in seeking health care and social support for the stressful moments of life ⁽14⁾.

In the present study, students in the Psychology course presented higher scores of hopelessness when compared to the other courses. In a similar study but covering the major areas of the National Council for Scientific and Technological Development (CNPq), students from the Linguistics, Literature and Arts areas, followed by the Social Sciences and Humanities areas, presented higher risks for depressive episodes. In the same study, students of social sciences and humanities courses presented a risk of approximately 25% for depressive episodes when compared to the other courses ⁽15⁾.

Studies have observed that contact with the psychological suffering of other people or the academic contents more related to human subjectivity correlate with a certain vulnerability and may increase the probability of developing some mental disorder, which may explain the greater psychological suffering in students of Psychology courses. In the same study, the existence of psychological suffering was evidenced, reporting unfavorable facts and experiences, such as difficulties of initial adaptation to the university context, excessive workload and activities of the course and theoretical and practical contents of the profession that mobilize the students’ feelings ⁽16⁾. This occurs because these students, during graduation, go through intense emotional stimuli, mainly related to the duality of life and death, besides the numerous requirements necessary for professional qualification⁽13⁾.

In the significant association of the variable hopelessness and desired course, it was noticed that students who did not attend the desired course had higher scores of hopelessness, which can be justified by the need of these students to meet family and social expectations at the expense of their own, which leads to frustration, hopelessness and insecurity about the professional future. In a qualitative study conducted in college students, it was evident in the reports of respondents who entered higher education, uncertainties about their academic career, emphasizing that the Higher Education Institution of origin is omissive in not making this transition easier, especially regarding the transmission of information and support to students and responsible people ⁽17⁾.

It was observed that the use of alcohol, tobacco and other drugs by college students is associated with hopelessness. The need these students must feel accepted in the university circle, as well as the desire to dissipate feelings, symptoms, and anguish, caused or not by the academic environment, can lead to substance abuse. Research revealed a prevalence of 32% of depression, 24% of anxiety and 12% of hopelessness in moderate or severe levels among young drug addicts ⁽5⁾.

Suicidal behavior is complex and has gradients of severity ranging from suicidal ideation to suicide attempt, and there is a strong relationship between these two variables. Ideation may characterize the first step towards the consolidation of suicidal acts, which highlights the importance of early detection of this behavior in college students. Feelings of hopelessness and inability to manage the crisis cause intense psychological suffering that can lead to suicide attempt, which explains the statistical significance between the variable’s hopelessness score and previous suicide attempt in the present study. Lack of perspective and hopelessness should be seen as predictors of suicide, as should attitudes of affective disturbance, severe suicidal ideation, history of suicide attempt, previous family history of suicide, alcohol and drug overuse, in addition to age, gender, and ethnicity ⁽2⁾.

A study carried out in a population of the same age group and predominantly university students found that the variable hopelessness is also significantly associated with suicidal ideation. This result reinforces the importance of this research, since the identification of the precursors of hopelessness can contribute to the implementation of public policies aimed at promoting mental health in college students ⁽18⁾.

The relationship between depressive symptoms and hopelessness, already widely discussed, is related to the fact that, in the face of these symptoms, the person has a pessimistic view of himself and interprets his experiences in a negative way, that is, the psychic suffering anticipates the future in its worst outcome; it anticipates and intensifies obstacles, frustrations, and deprivations, looking at them with hopelessness ⁽19⁾.

The presence of depressed mood was strongly related to hopelessness. It is known that depressed mood and hopelessness are part of the range of symptoms of depressive disorders, which have a complex etiology that involves various symptoms, such as those related to mood swings, like depressed mood, and, in the sphere of volition, the loss of energy ⁽7⁾. In similar studies performed in college students, it was observed that 28% of students presented depressive symptoms, being 51.3% with signs of mild to moderate depression, 35.9% with signs of moderate depression, and 12.8% with signs of severe depression, factors that increase the vulnerability of these students ⁽20^-21⁾.

College students who had a history of bullying were associated with hopelessness, in the sense that students who had been bullied often reported feelings of helplessness and helplessness - risk factors that probably make them more vulnerable to mental illness. It is noteworthy that bullying, which happens most commonly in adolescence, generates pressure, isolation, and mental exhaustion in the victim, which contributes to mental illness. It is noteworthy, in this sense, that the effects of bullying on the adolescent may reverberate into mental suffering in adulthood, favoring feelings of hopelessness ⁽22⁾.

The factors associated with hopelessness among university students, investigated in this study, point to emotional and academic losses, while highlighting the need for improvement in student mental health care actions, including suicide prevention actions in the academic environment.

Like any research, the study presents advantages and limitations. The advantages refer to the fact that this theme is still little explored in the national literature, especially in the young population, and specifically in the university population, considering the increase in suicide rates in this population segment. As for the limitations, it was carried out with a non-clinical sample, used self-report measures, and the very design of the study (transversal), which makes it impossible to evaluate causal relations.

CONCLUSION

This study evidenced a correlation between hopelessness and suicidal ideation. Not being in the desired course, having insecurities about the professional future, use of alcohol, cigarettes and other drugs, having a history of suicide, depressed mood and being a victim of bullying were factors associated with hopelessness. In addition, the level of hopelessness had a significant association with low academic performance in college students.

Such evidence highlights the need for interventions involving the university public, in order to prevent these risk factors that corroborate to the feeling of hopelessness and, concomitantly, to the risk of suicide. It is recognized that there is unpreparedness on the part of educational institutions to deal with individuals who present symptoms of hopelessness, causing many students not to be understood and to give up seeking help. Although the participants of the study are health students, who during their academic activities value the maintenance of their patients’ lives, their education does not always adequately prepare them to deal with their own mental illness.

It is hoped that this study can contribute to the creation of integrated health care systems in the context of universities, contemplating physical, mental, and academic health support actions, such as qualified listening by nurses and professors, with a view to offering solutions to university students, reducing their psychological suffering.

HOW TO REFERENCE THIS ARTICLE:

• Lima CLS, Veloso LUP, Lira JAC, Silva AGN, Rocha ARC, Conceição BB. Factors related to hopelessness in college students. Cogitare enferm. [Internet]. 2021 [accessed “insert day, monh and year”]; 26. Available from: http://dx.doi.org/10.5380/ce.v26i0.76442.

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Edited by

Associate editor: Luciana Alcântara Nogueira

Publication Dates

• Publication in this collection
  29 Oct 2021
• Date of issue
  2021

History

• Received
  18 Sept 2020
• Accepted
  20 Nov 2020