Natural History of Hopelessness, Suicidality, and Optimism in Psychiatric Inpatients Following Discharge

Contact information. On the day of enrollment, contact information (address, phone number)
will be obtained from the subject. Subjects will also be asked to provide the contact
information for a family member or friend who the study team may contact in case of
emergency or if unable to get in touch with subject at follow up. Subjects unable to provide
contact information for at least one family member will not be enrolled.

Baseline evaluation.

On the date of enrollment, study staff will obtain two types of information:

1. Baseline clinical characteristics. Study staff will obtain specific clinical variables
from the patient to gather information about variables that could impact levels of
hopelessness/optimism after discharge. These variables include: age, gender, # of
prior admissions [zero, 1-5, more than 5], presence of substance use disorder (assessed
via inpatient chart review), admission for suicide attempt or suicidal ideation only,
and involvement in exercises that can increase feelings of well-being like gratitude,
forgiveness, using one's personal strengths, and acts of kindness.

2. Baseline outcome measures: Study staff will also administer six instruments:

- Beck Hopelessness Scale (BHS):14 This is a 21-item scale used to assess feelings
of hopelessness.

- Concise Health Risk Tracking Scale (CHRT):15 This is a 12 item scale used to
assess the presence and intensity of suicidal thoughts.

- Life Orientation Test-Revised (LOT-R):16 This is a 10-item scale that measures
optimism (and pessimism).

- Positive Affect Negative Affect Schedule (PANAS):17 This is a well-validated
20-item self-report measure of more general positive and negative affect.

- Sheehan Disability Scale:18 This is a 5 item scale used to assess the degree to
which the subject's condition or disease (psychological, social, physical) has
impacted his or her functioning in daily life.

- Quick Inventory of Depressive Symptomatology, Self Report (QIDS-SR):19 This is a
16-item questionnaire that assesses the subject's depressive symptoms. It will
serve as an additional reliable, valid way to gather information on the subject's
mood.

This evaluation should take approximately 20-30 minutes.

Follow-up assessments.

Follow-up assessments will occur by phone or mail at 2 weeks, 4 weeks and 8 weeks. Similar
to initial assessments, the follow-up assessments will have two components:

1. Assessment of characteristics: Study staff will inquire about subjects' living
situation at discharge (homelessness, living alone), employment/academic status,
treatment postdischarge (follow-up with therapist, psychiatrist, PCP, groups, AA/NA,
partial hospital programs, and other treatment and forms of peer support), and
involvement in exercises that can increase feelings of well-being like gratitude,
forgiveness, using one's personal strengths, and acts of kindness.

2. Assessment of study outcomes: Staff will readminister the five measures above, and
will also inquire about psychiatric readmissions, suicide attempts, and episodes of
self-harm (cutting, burning, banging/hitting body parts, ingesting toxic
materials/objects, and other intentional non-suicidal self-harm behaviors). This
evaluation should take 20-30 minutes.

Inclusion criteria:

- Admission to MGH inpatient psychiatric unit, age 18 and older

- Suicidal ideation reported on admission (suicidal thoughts or active suicidal
ideation documented in the admission note) OR admission occurring in context of a
suicide attempt

- Mood disorder (assessed and determined by patient's clinical treatment team and
consulting inpatient chart review)

- Patient able to read and write in English

Exclusion criteria:

- Psychotic symptoms, as assessed using the MINI12 and inpatient chart review

- Cognitive disorder, as assessed using a six-item cognitive screen developed for
research

- Participation in other studies that are focused on improving hopelessness/optimism.