al., 2011a). For example, perceptions of defeat have been found to statistically significantly predict suicidality twelve months later when controlling for depressive symptoms (Taylor et al., 2011ab), perceptions of entrapment have been found to statistically significantly predict social anxiety problems when controlling for depressive and psychotic symptoms (Birchwood et al., 2007; Gumley et al., 2004), and perceptions of defeat have been found to statistically significantly predict PTSD when controlling for depression (Jobson & O’Kearney, 2009). The similar magnitude correlations between defeat and entrapment and the four psychological problems may be noteworthy for suicidality researchers because several theories of suicidality posit a prominent role for perceptions of defeat and entrapment (e.g., Baumeister, 1990; O’Connor, 2011; Williams, 2001). Whilst the present results corroborate these theories, they also suggest that additional variables to defeat and entrapment are needed to explain the specific phenomenology of suicidality. It is noteworthy that our within study analyses revealed a slightly stronger relationship between entrapment and suicidality, relative to the relationship between defeat and suicidality. Although the within study analyses probably have higher validity than the between study analyses, additional research is required to arrive at a firm conclusion regarding whether perceptions of entrapment constitute a particular risk for suicidality, independent of perceptions of defeat. This meta-analysis assumed that different triggers are interchangeable and homogeneous in bringing about perceptions of defeat or entrapment across different psychiatric disorders. For example, perceptions of entrapment by traumatic experiences were treated as being equivalent to perceptions of entrapment as a result of a caregiving role. The absence of significant between-study heterogeneity across all analyses supports this assumption and suggests that the literature should adopt broad (Taylor et al., 2011a) rather than disorder-specific (Birchwood et al., 1993; 2012; Dunmore et al., 2001) definitions and conceptualisations of defeat and entrapment.
Table 1 Characteristics of studies included in the meta-analysis Article Sample details N Defeat and/or entrapment data analysed Measure of defeat and/or entrapment Psychiatric disorder Measure(s) of psychiatric disorder Mean age (SD) Percentage of sample female Allan & Gilbert (2002) University undergraduates 197 External entrapment Defeat and Entrapment Scales Depression CES-D 23.40 (8.0) 62.9 Birchwood et al (1993) Medicated; psychosis sample 84 Internal entrapment PBIQ Depression BDI 48.05 (13.2) 35.7 Birchwood et al (2007) First-episode schizophrenia spectrum disorder 79 Internal entrapment PBIQ Anxiety problems Social Interaction Anxiety Scale Not reported 22.8 Birchwood et al (2012) First-episode schizophrenia spectrum disorder 150 Internal entrapment PBIQ-R Depression Calgary Depression Scale for Schizophrenia 23.37 (4.98) Not reported Carvalho et al (2013) Sample 1 Depressed outpatients 106 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI 37.9 (10.6) 74.0 Carvalho et al (2013) Sample 2 School and private institution community convenience sample 116 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI 35.9 (10.3) 75.0 Clare & Singh (1994) Medicated; Mixed psychosis and other affective disorders 11 Internal entrapment PBIQ Depression BDI 35.00 (Not reported) 27.3
Dunmore et al (1997) Mixed physical and sexual assault victims 20 Defeat MDTS PTSD PTSD Symptom Scale Self-Report 38.10 (11.4) 75.0 Dunmore et al (1999) Mixed physical and sexual assault victims 92 Defeat MDTS PTSD PTSD Symptom Scale Self-Report 38.60 (16.2) 47.8 Dunmore et al (2001) Assault survivors 57 Defeat MDTS PTSD PTSD Symptom Scale Self-Report Not reported 54.4 et al (2010) Chronic pain (Fibromyalgia) outpatients 250 Defeat PSPS Depression; Anxiety problems HADS 44.90 (7.2) 91.6 Gilbert & (1998) Sample 1 University undergraduates 302 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI 22.90 (8.0) 77.2 Gilbert & Allan (1998) Sample 2 Depressed patients 90 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI 22.90 (8.0) 77.2 Gilbert et al (2002) Sample 1 University undergraduates 193 Defeat; External entrapment Defeat and Entrapment Scales Depression; Anxiety problems MASQ 22.90 (7.7) 76.7 Gilbert et al (2002) Sample 2 Mixed psychiatric inpatients 81 Defeat; External entrapment Defeat and Entrapment Scales Depression; Anxiety problems MASQ 36.80 (13.0) 60.5 Gilbert et al (2004) Depressed inpatients and outpatients 50 External entrapment Custom interview concerning entrapment Depression BDI-II 43.45 (Not reported) 46.0
Gilbert et al (2005) University undergraduates 166 Internal and external entrapment Defeat and Entrapment Scales Depression CES-D 22.07 (7.2) 83.1 Goldstein & Willner (2002) University undergraduates 32 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI Not reported 100.0 Griffiths et al (2014) Community sample from low SES backgrounds 195 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression; Anxiety problems CES-D; STAI: State subscale 36.90 (8.3) 64.0 Gumley et al (2004) Schizophrenia spectrum disorder 38 Internal entrapment PBIQ Anxiety problems Brief Symptoms Interview: Social Anxiety 34.35 (8.4) 26.3 Iqbal et al (2000) Schizophrenia spectrum disorder 105 Internal entrapment PBIQ Depression BDI Not reported Not reported Jobson & O'Kearny (2009) Community sample: traumatic experiences 106 Defeat Mental defeat rated from narrative PTSD Post-Traumatic Stress Diagnostic Scale 37.21 (13.4) 69.1 Karatzias et al (2007) Schizophrenia spectrum disorder 138 Internal entrapment PBIQ Depression; Anxiety problems SCID: Comorbid Anxiety or Affective Disorder 36.60 (9.8) 28.3 Martin et al (2006) Caregivers of Alzheimer disease patients 70 External entrapment CES Depression CES-D Not reported Not reported O’Connor et al (2013) Individuals who had attempted 70 Defeat; Defeat and Entrapment Scales Depression; Suicidality HADS; Suicide Ideation subscale of the 35.6 (13.24) 58.57
suicide attending A&E Internal and external entrapment Suicide Probability Panagioti et al (2012) Community sample: experienced a traumatic event 56 Defeat; Internal and external entrapment Defeat and Entrapment Scales PTSD; Suicidality Suicidal Behaviors Post-Traumatic Diagnostic Scale 29.10 (11.5) 82.1 Rasmussen et al (2010) Individuals who had attempted suicide 103 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression; Anxiety problems; Suicidality Suicide Probability Scale; HADS 34.92 (13.4) 59.0 Stommel et al (1990) Caregivers of elderly relatives 307 External entrapment CBS-E Depression CES-D Not reported Not reported Sturman (2011) University undergraduates 119 Internal and external entrapment ISQ Depression; Anxiety problems CES-D; Social Anxiety Interaction and Social Phobia Scale 19.00 (Not reported) 79.8 Sturman & Mongrain (2008) Formerly depressed students 146 Internal and external entrapment Defeat and Entrapment Scales Depression SCID: Depression Not reported 71.9 Tang et al (2007) Chronic pain patients 302 Defeat PSPS Depression; Anxiety problems HADS 46.10 (12.3) 72.7 Tang et al (2010) Chronic pain patients 133 Defeat PSPS Depression; Anxiety problems HADS 46.10 (Not reported) Not reported
Taylor et al (2010) Schizophrenia spectrum disorder 78 Defeat; Internal and external entrapment Defeat and Entrapment Scales Suicidality Beck of Suicidal Ideation 42.50 (11.8) 25.6 Taylor et al (2010) University undergraduates with past or current suicidal ideation 93 Defeat; Internal and external entrapment Defeat and Entrapment Scales Suicidality Suicidal Behaviors 23.45 (7.1) 81.7 Taylor et al (2011) University undergraduates Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression; Suicidality BDI-II; Suicidal Behaviors 19.61 (4.5) 83.5 Trachsel et al (2010) Community sample (general population) 540 Internal and external entrapment Defeat and Entrapment Scales Depression CES-D Not reported 63.2 Troop & Baker (2008) Female office workers 74 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI-II 24.60 (7.6) 100.0 Troop & Hiskey (2013) Community sample recruited from stress and websites 275 Defeat; Internal and external entrapment Defeat and Entrapment Scales PTSD Post-Traumatic Diagnostic 31.60 (11.4) 75.0 Troop et al (2014) Eating disorder history 189 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI-II 35.50 (9.9) 96.0
Troop (2014) Eating disorder inpatient and outpatients 114 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression; PTSD Post-Traumatic Diagnostic 33.70 (10.3) 96.5 White et al (2007) Schizophrenia spectrum disorder 100 Internal and external entrapment PBIQ Depression Calgary Depression Scale for Schizophrenia 39.40 (11.2) 22.0 Willner & Goldstein (2001) Mothers of children with special educational 76 Defeat; Internal and external entrapment Defeat and Entrapment Scales Depression BDI 40.20 (7.2) Not reported & Gilbert (1998) University undergraduates 113 Defeat Defeat and Entrapment Scales Depression CES-D 24.88 (8.3) 77.9 Yoon (2003) Caregivers of family member with functional and/or cognitive impairment 311 External entrapment CBS-E Depression Self-Rating Depression Scale 56.10 (15.6) 81.0 Note: BDI = Beck Depression Inventory, BDI-II = Beck Depression Inventory – II, CBS-E = Caregiver Burden Scale – Entrapment subscale, CES = Caregiver’s Entrapment Scale, CES-D = Center for Epidemiological Studies Depression Scale, HADS = Hospital Anxiety and Depression Scale, MASQ = Mood and Anxiety Symptoms Questionnaire, MDTS = Mental Defeat during Trauma Scale, PBIQ = Personal Beliefs about Illness Questionnaire, PBIQ-R = Personal Beliefs about Illness Questionnaire-Revised, PSPS = Pain Self Perception Scale, SCID = Structured Clinical Interview for DSM-IV Disorders, STAI-State = State Trait Anxiety Scale – State subscale.
Table 2 Meta-analyses of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder and suicidality 95% Confidence Interval for r Analysis I2 (95% Confidence Interval)a z Defeat .10 (.00, .39) .66 .69 Depression .02 (.00, .50) .73 .77 Anxiety problems 7 .00 (.00, .71) .58 .63 PTSD 7 .06 (.00, .73) .58 .66 6 6 * 8 9