In this study, the link between hopelessness and suicidal intent was investigated for two categories of suicidal thoughts, and the associations of these two categories of thoughts with a range of symptoms were also examined. A total of 97 patients with suicidal thoughts were assessed at the crisis unit of a psychiatric hospital. In interviews, suicidal intent was assessed using the Beck Scale for Suicide Ideation, while psychological distress was assessed using both the Beck Hopelessness Scale and the Derogatis Symptom Checklist. Ideation items describing the frequency, duration and acceptance of a wish to die were significantly correlated with feelings of hopelessness. However, items reflecting preoccupation with a method of self-harm showed only a weak correlation with hopelessness, although the relationship varied according to diagnosis. That is, this preoccupation was significantly associated with hopelessness for depressed patients, but this was not the case for the personality disorder, anxiety disorder and substance-abuse subgroups. Finally, analyses indicated that the primary predictor of suicidal intent was the patient's cognitive distortion, not hopelessness.