Cognitive Therapy and Research

, Volume 37, Issue 4, pp 796–804 | Cite as

An Examination of Optimism/Pessimism and Suicide Risk in Primary Care Patients: Does Belief in a Changeable Future Make a Difference?

  • Edward C. Chang
  • Elizabeth A. Yu
  • Jenny Y. Lee
  • Jameson K. Hirsch
  • Yvonne Kupfermann
  • Emma R. Kahle
Original Article


An integrative model involving optimism/pessimism and future orientation as predictors of suicide risk (viz., depressive symptoms and suicidal behavior) was tested in a sample of adult, primary care patients. Beyond the additive influence of the two predictors of suicide risk, optimism/pessimism and future orientation were also hypothesized to interact together to exacerbate suicide risk. Results indicated that optimism/pessimism was a robust predictor of suicide risk in adults. Future orientation was found to add significant incremental validity to the prediction of depressive symptoms, but not of suicidal behavior. Noteworthy, the optimism/pessimism × future orientation interaction was found to significantly augment the prediction of both depressive symptoms and suicidal behavior. Implications for therapeutic enhancement of future-oriented constructs in the treatment of suicidal individuals are discussed.


Optimism/pessimism Future orientation Adults Primary care Suicide risk 



The first author would like to acknowledge Chang Suk-Choon and Tae Myung-Sook for their encouragement and support throughout this project.


  1. Bailey, T. C., Eng, W., Frisch, M. B., & Snyder, C. R. (2007). Hope and optimism as related to life satisfaction. Journal of Positive Psychology, 2, 168–175. doi: 10.1080/17439760701409546.CrossRefGoogle Scholar
  2. Carver, C. S., & Scheier, M. F. (2002). Optimism. In C. R. Snyder & S. Lopez (Eds.), Handbook of positive psychology (pp. 231–243). New York: Oxford University Press.Google Scholar
  3. Carver, C. S., Scheier, M. F., & Segerstrom, S. C. (2010). Optimism. Clinical Psychology Review, 30, 879–889. doi: 10.1016/j.cpr.2010.01.006.PubMedCrossRefGoogle Scholar
  4. Chang, E. C. (1996). Cultural differences in optimism, pessimism, and coping: Predictors of subsequent adjustment in Asian American and Caucasian American college students. Journal of Counseling Psychology, 43, 113–123. doi: 10.1037/0022-0167.43.1.113.CrossRefGoogle Scholar
  5. Chang, E. C. (1998). Dispositional optimism and primary and secondary appraisal of a stressor: Controlling for confounding influences and relations to coping and psychological and physical adjustment. Journal of Personality and Social Psychology, 74, 1109–1120. doi: 10.1037/0022-3514.74.4.1109.CrossRefGoogle Scholar
  6. Chang, E. C. (2001). Cultural influences on optimism and pessimism: Differences in Western and Eastern construals of the self. In E. C. Chang (Ed.), Optimism and pessimism: Implications for theory, research, and practice (pp. 257–280). Washington, DC: American Psychological Association. doi: 10.1037/10385-012.CrossRefGoogle Scholar
  7. Chang, E. C. (2002a). Cultural differences in psychological distress in Asian and Caucasian American college students: Examining the role of cognitive and affective concomitants. Journal of Counseling Psychology, 49, 47–59. doi: 10.1037/0022-0167.49.1.47.CrossRefGoogle Scholar
  8. Chang, E. C. (2002b). Optimism-pessimism and stress appraisal: Testing a cognitive interactive model of psychological adjustment in adults. Cognitive Therapy and Research, 26, 675–690. doi: 10.1023/A:1020313427884.CrossRefGoogle Scholar
  9. Chang, E. C. (Ed.). (2008). Self-criticism and self-enhancement: Theory, research, and clinical implications. Washington, DC: American Psychological Association. doi: 10.1037/11624-000.Google Scholar
  10. Chang, E. C. (2009). An examination of optimism, pessimism, and performance perfectionism as predictors of positive psychological functioning in middle-aged adults: Does holding high standards of performance matter beyond generalized outcome expectancies? Cognitive Therapy and Research, 33, 334–344. doi: 10.1007/s10608-008-9215-9.CrossRefGoogle Scholar
  11. Chang, E. C., & Asakawa, K. (2003). Cultural variations on optimistic and pessimistic bias for self versus a sibling: Is there evidence for self-enhancement in the West and for self-criticism in the East when the referent group is specified? Journal of Personality and Social Psychology, 84, 569–581. doi: 10.1037/0022-3514.84.3.569.PubMedCrossRefGoogle Scholar
  12. Chang, E. C., & Banks, K. H. (2007). The color and texture of hope: Some preliminary findings and implications for hope theory and counseling among diverse racial/ethnic groups. Cultural Diversity and Ethnic Minority Psychology, 13, 94–103. doi: 10.1037/1099-9809.13.2.94.PubMedCrossRefGoogle Scholar
  13. Chang, E. C., & Bridewell, W. B. (1998). Irrational beliefs, optimism, pessimism, and psychological distress: A preliminary examination of differential effects in a college population. Journal of Clinical Psychology, 54, 137–142. doi: 10.1002/(SICI)1097-4679(199802)54:2<137:AID-JCLP2>3.0.CO;2-P.PubMedCrossRefGoogle Scholar
  14. Cheung, Y., Liu, K., & Yip, P. F. (2007). Performance of the CES-D and its short forms in screening suicidality and hopelessness in the community. Suicide and Life-Threatening Behavior, 37, 79–88. doi: 10.1521/suli.2007.37.1.79.PubMedCrossRefGoogle Scholar
  15. Cohen, J. (1977). Statistical power analysis for the behavioral sciences (rev. ed.). New York: Academic Press.Google Scholar
  16. Cohen, J. (1988). Set correlation and contingency tables. Applied Psychological Measurement, 12, 425–434. doi: 10.1177/014662168801200410.CrossRefGoogle Scholar
  17. Cukrowicz, K. C., Schlegel, E. F., Smith, P. N., Jacobs, M. P., Van Orden, K. A., Paukert, A. L., et al. (2011). Suicide ideation among college students evidencing subclinical depression. Journal of American College Health, 59, 575–581. doi: 10.1080/07448481.2010.483710.PubMedCrossRefGoogle Scholar
  18. Daukantaité, D., & Zukauskiene, R. (2012). Optimism and subjective well-being: Affectivity plays a secondary role in the relationship between optimism and global life satisfaction in the middle-aged women. Longitudinal and cross-cultural findings. Journal of Happiness Studies, 13, 1–16. doi: 10.1007/s10902-010-9246-2.CrossRefGoogle Scholar
  19. Davidson, K., & Prkachin, K. (1997). Optimism and unrealistic optimism have an interacting impact on health-promoting behavior and knowledge changes. Personality and Social Psychology Bulletin, 23, 617–625. doi: 10.1177/0146167297236005.CrossRefGoogle Scholar
  20. De Leo, D. (Ed.). (2001). Suicide and euthanasia in older adults: A transcultural journey. Ashland, OH: Hogrefe & Huber Publishers.Google Scholar
  21. Endrighi, R., Hamer, M., & Steptoe, A. (2011). Associations of trait optimism with diurnal neuroendocrine activity, cortisol responses to mental stress, and subjective stress measures in healthy men and women. Psychosomatic Medicine, 73, 672–678. doi: 10.1097/PSY.0b013e31822f9cd7.PubMedCrossRefGoogle Scholar
  22. Harris, P. R., Griffin, D. W., & Murray, S. (2008). Testing the limits of optimistic bias: Event and person moderators in a multilevel framework. Journal of Personality and Social Psychology, 95, 1225–1237. doi: 10.1037/a0013315.PubMedCrossRefGoogle Scholar
  23. Hart, S. L., Vella, L., & Mohr, D. C. (2008). Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression. Health Psychology, 27, 230–238. doi: 10.1037/0278-6133.27.2.230.PubMedCrossRefGoogle Scholar
  24. Hirsch, J. K., Conner, K. R., & Duberstein, P. R. (2007a). Optimism and suicide ideation among young adult college students. Archives of Suicide Research, 11, 177–185. doi: 10.1080/13811110701249988.PubMedCrossRefGoogle Scholar
  25. Hirsch, J. K., Duberstein, P. R., Conner, K. R., Heisel, M. J., Beckman, A., Franus, N., et al. (2006). Future orientation and suicide ideation and attempts in depressed adults ages 50 and over. American Journal of Geriatric Psychiatry, 14, 752–757. doi: 10.1097/01.JGP.0000209219.06017.62.PubMedCrossRefGoogle Scholar
  26. Hirsch, J. K., Duberstein, P. R., Conner, K. R., Heisel, M. J., Beckman, A., Franus, N., et al. (2007b). Future orientation moderates the relationship between functional status and suicide ideation in depressed adults. Depression and Anxiety, 24, 196–201. doi: 10.1002/da.20224.PubMedCrossRefGoogle Scholar
  27. Hirsch, J. K., Visser, P. L., Chang, E. C., & Jeglic, E. L. (2012). Race and ethnic differences in hope and hopelessness as moderators of the association between depressive symptoms and suicidal behavior. Journal of American College Health, 60, 115–125. doi: 10.1080/07448481.2011.567402.PubMedCrossRefGoogle Scholar
  28. Hirsch, J. K., Wolford, K., LaLonde, S. M., Brunk, L., & Morris, A. (2007c). Dispositional optimism as a moderator of the relationship between negative life events and suicide ideation and attempts. Cognitive Therapy and Research, 31, 533–546. doi: 10.1007/s10608-007-9151-0.CrossRefGoogle Scholar
  29. Hooper, L. M., Epstein, S. A., Weinfurt, K. P., DeCoster, J., Qu, L., & Hannah, N. J. (2012). Predictors of primary care physicians’ self-reported intention to conduct suicide risk assessments. Journal of Behavioral Health Services & Research, 39, 103–115. doi: 10.1007/s11414-011-9268-5.CrossRefGoogle Scholar
  30. Keng, S., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31, 1041–1056. doi: 10.1016/j.cpr.2011.04.006.PubMedCrossRefGoogle Scholar
  31. Lancastle, D., & Boivin, J. (2005). Dispositional optimism, trait anxiety, and coping: Unique or shared effects on biological response to fertility treatment? Health Psychology, 24, 171–178. doi: 10.1037/0278-6133.24.2.171.PubMedCrossRefGoogle Scholar
  32. Lopes, M. P., & Cunha, M. P. (2008). Who is more proactive, the optimist or the pessimist? Exploring the role of hope as a moderator. Journal of Positive Psychology, 3, 100–109. doi: 10.1080/17439760701760575.CrossRefGoogle Scholar
  33. Mäkikangas, A., Kinnunen, U., & Feldt, T. (2004). Self-esteem, dispositional optimism, and health: Evidence from cross-lagged data on employees. Journal of Research in Personality, 38, 556–575. doi: 10.1016/j.jrp.2004.02.001.CrossRefGoogle Scholar
  34. Marshall, G. N., Wortman, C. B., Kusulas, J. W., Hervig, L. K., & Vickers, R. R., Jr. (1992). Distinguishing optimism from pessimism: Relations to fundamental dimensions of mood and personality. Journal of Personality and Social Psychology, 62, 1067–1074. doi: 10.1037/0022-3514.62.6.1067.CrossRefGoogle Scholar
  35. Norem, J. K. (2008). Defensive pessimism, anxiety, and the complexity of evaluating self-regulation. Social and Personality Psychology Compass, 2, 121–134. doi: 10.1111/j.1751-9004.2007.00053.x.CrossRefGoogle Scholar
  36. Norem, J. K., & Cantor, N. (1986). Defensive pessimism: Harnessing anxiety as motivation. Journal of Personality and Social Psychology, 51, 1208–1217. doi: 10.1037/0022-3514.51.6.1208.PubMedCrossRefGoogle Scholar
  37. Norem, J. K., & Chang, E. C. (2002). The positive psychology of negative thinking. Journal of Clinical Psychology, 58, 993–1001. doi: 10.1002/jclp.10094.PubMedCrossRefGoogle Scholar
  38. O’Connor, R. C., & Cassidy, C. (2007). Predicting hopelessness: The interaction between optimism/pessimism and specific future expectancies. Cognition and Emotion, 21, 596–613. doi: 10.1080/02699930600813422.CrossRefGoogle Scholar
  39. Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443–454. doi: 10.1177/107319110100800409.PubMedCrossRefGoogle Scholar
  40. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. doi: 10.1177/014662167700100306.CrossRefGoogle Scholar
  41. Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247. doi: 10.1037/0278-6133.4.3.219.PubMedCrossRefGoogle Scholar
  42. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078. doi: 10.1037/0022-3514.67.6.1063.PubMedCrossRefGoogle Scholar
  43. Scheier, M. F., Carver, C. S., & Bridges, M. W. (2001). Optimism, pessimism, and psychological well-being. In E. C. Chang (Ed.), Optimism and pessimism: Implications for theory, research, and practice (pp. 189–216). Washington, DC: American Psychological Association. doi: 10.1037/10385-009.CrossRefGoogle Scholar
  44. Showers, C., & Ruben, C. (1990). Distinguishing defensive pessimism from depression: Negative expectations and positive coping mechanisms. Cognitive Therapy and Research, 14, 385–399. doi: 10.1007/BF01172934.CrossRefGoogle Scholar
  45. Siddique, H. I., LaSalle-Ricci, V. H., Glass, C. R., Arnkoff, D. B., & Díaz, R. J. (2006). Worry, optimism, and expectations as predictors of anxiety and performance in the first year of law school. Cognitive Therapy and Research, 30, 667–676. doi: 10.1007/s10608-006-9080-3.CrossRefGoogle Scholar
  46. Snyder, C. R., Sympson, S. C., Michael, S. T., & Cheavens, J. (2001). The optimism and hope constructs: Variants on a positive expectancy theme. In E. C. Chang (Ed.), Optimism and pessimism: Implications for theory, research, and practice (pp. 101–125). Washington, DC: American Psychological Association. doi: 10.1037/10385-005.CrossRefGoogle Scholar
  47. Tennen, H., & Affleck, G. (1987). The costs and benefits of optimistic explanations and dispositional optimism. Journal of Personality, 55, 377–393. doi: 10.1111/j.1467-6494.1987.tb00443.x.CrossRefGoogle Scholar
  48. Terrill, A. L., Ruiz, J. M., & Garofalo, J. P. (2010). Look in the bright side: Do benefits of optimism depend on the social nature of the stressor? Journal of Behavioral Medicine, 33, 399–414. doi: 10.1007/s10865-010-9268-6.PubMedCrossRefGoogle Scholar
  49. Thomson, W. (2012). Long term follow up of suicide in a clinically depressed community sample. Journal of Affective Disorders, 139, 52–55. doi: 10.1016/j.jad.2012.02.012.PubMedCrossRefGoogle Scholar
  50. Unützer, J. (2002). Diagnosis and treatment of older adults with depression in primary care. Biological Psychiatry, 52, 285–292.PubMedCrossRefGoogle Scholar
  51. Vacek, K. R., Coyle, L. D., & Vera, E. M. (2010). Stress, self-esteem, hope, optimism, and well-being in urban ethnic minority adolescents. Journal of Multicultural Counseling and Development, 38, 99–111. doi: 10.1002/j/2161-1912.2010.tb00118.x.CrossRefGoogle Scholar
  52. Wingate, L. R., Burns, A. B., Gordon, K. H., Perez, M., Walker, R. L., Williams, F. M., et al. (2006). Suicide and positive cognitions: Positive psychology applied to the understanding and treatment of suicidal behavior. In T. E. Ellis (Ed.), Cognition and suicide: Theory, research, and therapy (pp. 261–283). Washington, DC: American Psychological Association. doi: 10.1037/11377-012.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Edward C. Chang
    • 1
  • Elizabeth A. Yu
    • 1
  • Jenny Y. Lee
    • 1
  • Jameson K. Hirsch
    • 2
  • Yvonne Kupfermann
    • 1
  • Emma R. Kahle
    • 1
  1. 1.Department of PsychologyUniversity of MichiganAnn ArborUSA
  2. 2.Department of PsychologyEast Tennessee State UniversityJohnson CityUSA

Personalised recommendations