Associations between emotional intelligence, depression and suicide risk in nursing students
Introduction
Suicide is a public health problem of considerable importance, and over the last 45 years suicide rates have increased worldwide (World Health Organization, 2012). Notably, young people constitute the highest-risk group in one third of the world's countries, and between the ages of 10 and 24, suicide is the second most frequent cause of death. In one US study the lifetime prevalence of suicidal ideation and suicide attempts in adolescents aged between 13 and 18 years was 12.1% and 4.1%, respectively, and one-third (33.9%) of adolescents with suicidal ideation had made at least one attempt (Nock et al., 2013). Eisenberg et al. (2007), in a study involving 2483 university students, reported that 2.5% of undergraduates and 1.6% of graduate students had reported suicidal thoughts in the four weeks prior to the study.
Several studies have indicated an elevated risk of suicide for health-related professions, especially nurses and physicians (Hawton et al., 2011, Meltzer et al., 2008), although the reasons for this are unknown. One proposed explanation for the increased risk of suicide in medical occupational groups is the higher rate of psychiatric disorders compared with other occupations (Hawton et al., 2002, Hawton et al., 2011). In the specific case of nurses, their working conditions and the nature of the job make them especially vulnerable to problems such as burnout, anxiety, depression and low self-esteem. These aspects play a decisive role in making nursing one of the professions with the highest prevalence of suicidal behaviour (Hawton et al., 2002). In relation to nursing students, Goetz (1998) suggests that they may be at higher risk for suicide than are other college students because they are subjected to a stressful academic curriculum. Specifically, nurse training includes both clinical placements and theory-based classes, and among other stressful situations, nurses must also learn to cope with suffering and death (Pryjmachuk and Richards, 2007, Pulido-Martos et al., 2012). In a recent study of 142 Greek nursing students, 10% reported suicidal thoughts and 1.4% stated that they might attempt suicide if they had the chance (Melissa-Halikiopoulou et al., 2011). At present, however, few data are available with which to estimate the prevalence of suicidal behaviour among nursing students.
Previous studies have clearly shown that mental disorders, particularly depression (Cavanagh et al., 2003, Wang et al., 2011) and anxiety (Choi et al., 2011), are among the strongest risk factors for both attempted and completed suicide. A study of US university students estimated that the prevalence of depressive or anxiety disorders was 15.6% for undergraduates and 13.0% for graduate students (Eisenberg et al., 2007). Most theoretical models of suicidal behaviour propose a diathesis-stress model in which certain psychiatric, psychological and biological factors would make a person more predisposed to such behaviour, while stressful life events would interact with these factors to increase the risk (Nock et al., 2012). The experience of persistent stress might therefore explain, at least in part, why some professionals such as physicians, nurses and students on health-related courses present higher rates of suicidal behaviour.
Whatever the case, there is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. Severity of self-harm history has been shown to be associated with higher levels of depression, anxiety and impulsivity, with lower levels of self-esteem, and with stressful life events in multiple areas of young people's lives (Madge et al., 2011). In this context, self-esteem, emotional adaptation, positive social support and experiential well-being are powerful factors that may reduce the risk of suicidal behaviour among at-risk adolescents (Sharaf et al., 2009, Wang et al., 2011).
In the nursing context several authors have ascribed a key role to emotional intelligence, and it has been suggested that the nursing curriculum should include the teaching of specific strategies for managing emotions, as well as social and communication skills training. The purpose of these skills would be to help nursing students and professionals cope with emotionally stressful situations (Görgens-Ekermans and Brand, 2012, Montes-Berges and Augusto-Landa, 2007).
According to the model of Mayer and Salovey (1997, p.10) emotional intelligence is “the ability to perceive accurately, appraise, and express emotion: the ability to access and/or generate feelings when they facilitate thought; the ability to understand emotion and emotional knowledge; and the ability to regulate emotions to promote emotional and intellectual growth”. The first instrument developed to assess perceived emotional intelligence was the Trait Meta-Mood Scale (TMMS; Salovey et al., 1995). The TMMS has three subscales that measure attention to emotions, emotional clarity, and emotional repair. Attention to emotions refers to a person's tendency to notice and think about his/her feelings and emotions. Emotional clarity refers to the ability to understand and discriminate one's emotions and feelings. Finally, emotional repair refers to a person's ability to moderate his/her emotional responses and to fix negative mood states.
Although there is limited evidence about the relationship between emotional intelligence and suicidal behaviour, research conducted with young students has concluded that emotional intelligence is a protective factor against suicidal ideation and behaviour (Cha and Nock, 2009, Ciarrochi et al., 2002). With regard to emotional regulation, there is a sequential process whereby a certain level of attention to feelings is necessary in order to understand emotional states and a certain level of clarity of feelings is required in order to moderate or regulate those (Palmer et al., 2003). Interestingly, however, Ciarrochi et al. (2002) showed that emotionally perceptive people appear to be more strongly impacted by stress than are their less perceptive counterparts. In line with this, generic research in the field of emotional intelligence has suggested that people who score high on emotional attention are more likely to experience depressive and anxiety disorders and to report more physical symptoms (Salovey et al., 2002, Thompson et al., 2007). In this regard, a recent study of 243 nursing students found that those who scored high on emotional attention found it harder to cope with the idea of death (Aradilla-Herrero et al., 2012–2013).
Some researchers have found differences between men and women in relation to the TMMS dimensions. Specifically, women tend to score higher than men on emotional attention (Salguero et al., 2010). There is also evidence that women are more emotionally responsive and expressive than men, and that they process emotional information more efficiently (Thayer et al., 2003). Paradoxically, however, women show a greater tendency to engage in rumination than do men, and they present higher levels of depression and anxiety (Nolen-Hoeksema, 2012). The women in this latter study used a wider range of strategies than did men, including rumination, reappraisal, active coping, acceptance and social support. Nolen-Hoeksema and Aldao (2011) suggest that although women may use adaptive strategies more than men do, this does not help in terms of preventing distress and depressive symptoms; furthermore, women's increased use of maladaptive strategies makes them more vulnerable than men to distress and depression.
In an attempt to provide a detailed description of the factors that influence suicide risk in nursing students, the present study sought to determine the prevalence of suicide risk in a sample of these students, to examine the relationship between suicide risk and perceived emotional intelligence, depression, trait anxiety and self-esteem, and to identify any gender differences in relation to these variables. The specific hypothesis tested was that perceived emotional intelligence and self-esteem protect against the risk of suicide, whereas depression and anxiety are predisposing factors.
Section snippets
Participants
First-year nursing undergraduates from a university nursing school in Catalonia (Spain) were invited to participate in the study. Of the 140 students enrolled, a total of 105 were present in class on the day of test administration, and of these, 93 completed the questionnaire and 12 returned it blank. Therefore, the study sample corresponded to 66.43% of the total number of first-year nursing students enrolled at that time.
Ethical Considerations and Data Collection
A descriptive, cross-sectional study was carried out. Ethical approval
Results
The 93 participants had a mean age of 20.49 years (SD = 3.75; range 18–42), with 75 (80.6%) being female and 18 (19.4%) male. Total scores on the 15-item Plutchik Suicide Risk Scale (SRS) ranged from 0 to 10, with a mean of 3.03 (SD = 2.29). The analysis showed that 86% of the 93 nursing students obtained a total score of 5 or less (Fig. 1). Thus, applying the cut-off score of 6 that has been established for the Spanish version of the SRS (Rubio et al., 1998) would mean that 14% of these students
Discussion
The main finding of this study is that depression and emotional attention are shown to be significant predictors of suicidal ideation. The results partially support the initial hypothesis, since depression but not anxiety emerged as a predictor of suicide risk. A possible explanation for this could be the high levels of anxiety that have been detected among nursing students during their clinical placements (Melo et al., 2010). However, our students were all in their first year of training and
Conclusions
The present study supports the hypothesis that depression and emotional attention impact upon the risk of suicide among nursing students. In addition, the results suggest that interventions to reduce suicidal ideation among these students should include, as part of the nursing curriculum, strategies to enhance self-esteem and improve emotional intelligence.
The findings should, however, be treated with caution, not least because suicidal behaviour is a highly complex phenomenon that is
References (50)
- et al.
Predictive validity of Perceived Emotional Intelligence on nursing students' self-concept
Nurse Education Today
(2009) - et al.
Emotional intelligence is a protective factor for suicidal behavior
Journal of the American Academy of Child and Adolescent Psychiatry
(2009) - et al.
Emotional intelligence moderates the relationship between stress and mental health
Personality and Individual Differences
(2002) - et al.
Mental health behaviours among undergraduate nursing students: Issues for consideration
Nurse Education Today
(2012) - et al.
Improving emotional intelligence and emotional self-efficacy through a teaching intervention for university students
Learning and Individual Differences
(2012) - et al.
Gender differences in the developmental course of depression
Journal of Affective Disorders
(2010) - et al.
The moderating effect of trait meta-mood and perceived stress on life satisfaction
Personality and Individual Differences
(2009) - et al.
Risk of suicide in medical and related occupational groups: A national study based on Danish case population-based registers
Journal of Affective Disorders
(2011) - et al.
The impact of nursing curricula on clinical practice anxiety
Nurse Education Today
(2010) - et al.
Gender and age differences in emotion regulation strategies and their relationship to depressive symptoms
Personality and Individual Differences
(2011)
An attempt to employ the Zung Self-Rating Depression Scale as a “lab test” to trigger follow-up in ambulatory oncology clinics: criterion validity and detection
Journal of Pain and Symptom Management
Correlates of suicide and violence risk, I: The suicide risk measure
Comprehensive Psychiatry
Trait meta-mood and affect as predictors of somatic symptoms and life satisfaction
Personality and Individual Differences
Gender and depression in men
Clinical Psychology: Science and Practice
Death attitudes and emotional intelligence in nursing students
Omega: Journal of Death and Dying
Emotional intelligence: implications for personal, social, academic, and workplace success
Social and Personality Psychology Compass
Psychological autopsy studies of suicide: a systematic review
Psychological Medicine
A study on correlation between anxiety symptoms and suicidal ideation
Psychiatry Investigation
Prevalence and correlates of depression, anxiety, and suicidality among university students
The American Journal of Orthopsychiatry
Suicidal ideation in medical students: who is at risk?
Annals of the Academy of Medicine, Singapore
Validity and reliability of the Spanish modified version of the Trait Meta-Mood Scale
Psychological Reports
Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention college screening project at Emory University
Depression and Anxiety
Are you prepared to S.A.V.E. your nursing student from suicide?
Journal of Nursing Education
Emotional intelligence as a moderator in the stress–burnout relationship: a questionnaire study on nurses
Journal of Clinical Nursing
Suicide in female nurses in England and Wales
Psychological Medicine
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