Analysis of the psychometric properties of the Interpersonal Needs Questionnaire (INQ) among community-dwelling older adults

Predictors of attitudes towards aging in elderly living in community care

BACKGROUND

Due to the aging of the population, the promotion of healthy aging is an important part of public health. Healthy aging of the population can be influenced by the attitudes of the elderly themselves towards old age and aging. The aim of this cross-sectional study was to find out the attitudes of older people living in a community environment toward old age and the predictors that influence these attitudes.

METHODS

The evaluation of attitudes towards old age using the WHO AAQ (Attitudes to Aging Questionnaire) questionnaire involved 1,174 elderly people living in the community. Age, sex, marital status, education, subjective health assessment, social support, depression (GDS-15), anxiety (GAI), sense of coherence (SOC-13) and self-esteem (RSES) were used to evaluate related factors.

RESULTS

As part of the exploratory factor analysis, a three-factor model (Psychosocial Loss, Physical Change, and Psychological Growth) was confirmed. The Cronbach alpha was found to be acceptable (α = 0.835). The predictors of better AAQ in the Psychological Loss domain were: subjective health, age, quality of life, self-esteem, sense of coherence, life satisfaction, anxiety, and social support; in the Physical Change domain: subjective health, quality of life, self-esteem, life satisfaction, cohabitation, and depression; and in the Psychological Growth domain: age, self-esteem, sense of coherence, life satisfaction, and social support.

CONCLUSION

Preventive and policy measures should aim to increase the satisfaction and self-assessment of the elderly, which can help them evaluate the period of old age more positively. It is also important to create a positive perspective of ageing and elderly in society.

Understanding suicidal ideation-a network analysis of the Interpersonal Needs Questionnaire

INTRODUCTION

Identifying various interacting risk factors for suicidality is important to develop preventive measures. The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) postulates suicidal ideation resulting from the occurrence of Perceived Burdensomeness (PB) and Thwarted Belongingness (TB). Suicidal behavior ultimately occurs if people have a Capability for Suicide. In past studies, the validity of TB was often not empirically confirmed, questioning which of the aspects of TB are central and related to suicidal ideation and whether applied measurement methods adequately capture the construct.

METHOD

Using a sample of 3,404 individuals from different clinical and nonclinical settings, 30% (1,023) of whom reported suicidal ideation, two network analyses were conducted on the Interpersonal Needs Questionnaire (INQ) and a variable mapping suicidal ideation.

RESULTS

Analyses revealed that some items of the INQ were not related to suicidal ideation and the most central items did not have the strongest associations to suicidal ideation.

CONCLUSION

Based on these results, a shortened version of the INQ with the four items that showed the strongest associations with suicidal ideation in the network analyses was suggested.

The prospective relation between borderline personality disorder symptoms and suicide risk: The mediating roles of emotion regulation difficulties and perceived burdensomeness

BACKGROUND

Despite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing suicide risk among individuals with heightened BPD symptoms. This study examined the prospective relations among BPD symptoms, emotion regulation (ER) difficulties, perceived burdensomeness, thwarted belongingness, and suicide risk across five assessments over a 7-month period. Consistent with the interpersonal theory of suicide, we hypothesized that greater BPD symptoms would predict greater suicide risk over time via greater ER difficulties and, subsequently, greater perceived burdensomeness.

METHODS

A U.S. nationwide sample of 500 adults (47 % women; mean age = 40.0 ± 11.64) completed a prospective online study, including an initial assessment and four follow-up assessments over the next seven months.

RESULTS

Results revealed a significant indirect relation between BPD symptoms and greater suicide risk over time through greater ER difficulties and later perceived burdensomeness. Results also provided evidence for transactional relations between BPD symptoms and ER difficulties and suicide risk over time.

LIMITATIONS

All constructs were assessed via self-report questionnaire data. Our measure of suicide risk focuses on only suicidal ideation, plans, and impulses, and not suicide attempts or preparatory behaviors.

CONCLUSIONS

Results highlight both ER- and interpersonal-related factors as key mechanisms underlying suicide risk among community adults with BPD symptoms.

Substance Use Frequency Relates to Suicidal Ideation Through Perceived Burdensomeness and to Suicide Attempts Through Capability for Suicide

BACKGROUND

Although substance use has been linked to both suicidal ideation and suicide attempts, the factors underlying these relations remain unclear. The Interpersonal-Psychological Theory of Suicide (ITS) provides a framework for understanding how substance use may increase suicide risk. The purpose of the current study was to examine if frequency of substance use is indirectly related to suicidal ideation and suicide attempts through core ITS variables (i.e., burdensomeness, thwarted belongingness, and suicide capability).

METHODS

An online sample of Mechanical Turk workers (N = 365) completed measures assessing substance use frequency, burdensomeness, thwarted belongingness, suicide capability, suicidal ideation, and suicide attempts.

RESULTS

After controlling for relevant clinical and demographic covariates, substance use frequency was indirectly related to suicidal ideation through burdensomeness but not thwarted belongingness. Substance use frequency was indirectly related to suicide attempts through suicide capability only.

LIMITATIONS

The cross-sectional design precludes conclusions about the precise nature and direction of the relations examined. The use of a community sample limits generalizability to more severe substance using samples.

CONCLUSIONS

Results highlight the relevance of distinct ITS factors in the relation between substance use frequency and both suicidal ideation and suicide attempts. Results may inform specific targets for novel interventions aimed at reducing suicide risk among substance-using individuals.HighlightsSubstance use frequency was indirectly related to SI through burdensomeness.Substance use frequency was not indirectly related to SI through thwarted belongingness.Substance use frequency was indirectly related to SA only through suicide capability.

The Geriatric Feelings of Burdensomeness Scale (GFBS)

OBJECTIVES

The present article describes the development and psychometric evaluation of the Geriatric Feelings of Burdensomeness Scale using two samples of older adults collected through Amazon Mechanical Turk. The scale is a 25-item measure of general subjective feeling of being a burden on or problem for others. The goal of the measure is to capture a broad conceptualization of burdensomeness that is relevant to a variety of important psychological variables.

METHOD

Two studies are described, including item development and selection, and the examination of reliability and validity evidence in a sample of 192 older adults.

RESULTS

The estimates of reliability (coefficient alpha and average interitem correlations) were strong. Preliminary examination of convergent validity evidence found significant moderate correlations between the Geriatric Feelings of Burdensomeness Scale and measures of conceptually related constructs (hopelessness, suicidality, perceived burdensomeness, thwarted belongingness). Small, non-significant correlations were found between three indices of religiosity, providing preliminary discriminant validity evidence.

CONCLUSIONS

Our results provide initial psychometric support for a more general and inclusive assessment tool for measuring older adults' feelings of burdensomeness.

CLINICAL IMPLICATIONS

With further research on clinical significance of feelings of burdensomeness and predictive validity, this measure may be used to identify concerns and beliefs about burdensomeness among distressed older adults.

Psychometric Properties of the Interpersonal Needs Questionnaire-15 in Spanish Adolescents

BACKGROUND

Thwarted Belongingness (TB) and Perceived Burdensomeness (PB) are considered risk factors of suicide behavior in the Interpersonal Theory of Suicide and constitute the main factors of the Interpersonal Needs Questionnaire-INQ.

AIMS

The present study analyzes the internal consistency, construct validity, and invariance across sex and age of the INQ-15, which comprises two subscales, in a sample of Spanish community adolescents.

METHODS

Participants were 1,536 adolescents from 12 to 19 years old. The INQ-15, the total number of non-suicidal self-injuries (NSSI), the Hopelessness Scale, and the Purpose in Life Test-Adolescents (PIL-A) were used.

RESULTS

The INQ-15 showed good internal consistency for TB ( ω ¯ = 0.88) and PB ( ω ¯ = 0.78) subscales and construct and concurrent/discriminant validity in the whole sample. Both the PB and TB subscales showed a good fit { S B χ 2 ( 9 ) = 6.448, p = 0.694, CFI = 1.000, RMSEA = 0.000 [90% CI (0.000, 0.022)] and S B χ 2 ( 27 ) = 248.973, p = 0.000, CFI = 0.922, RMSEA = 0.073 [90% CI (0.065, 0.082)]}, respectively. Regarding the invariance analyses, we found (1) non-invariance in the PB subscale across sex groups and metric, scalar, and stric invariance across age groups, and (2) that it was not possible to perform the invariance analysis for the TB subscale across both sex and age because the fit was not adequate for both boys and 12-15 years old groups. Positive and significant relationships were found between the INQ-15 subscales and hopelessness and NSSI frequency, and negative and significant correlations with meaning in life.

CONCLUSIONS

The INQ-15 is a valid instrument for assessing TB and PB in Spanish adolescents. Future studies should analyze the invariance of this instrument in adolescents across sex and age.

Toward Understanding of Suicidality in a Spanish Clinical Population: Validation of the European Spanish Version of the Interpersonal Needs Questionnaire

INTRODUCTION

Suicidal ideation (SI) represents one of the most prominent predictors of suicidal behavior (SB). The Interpersonal Needs Questionnaire (INQ) was developed from the Interpersonal Theory of Suicide (ITS) to assess the 2 core drivers of SI proposed by the theory. Despite the relevance of suicide-related ideations and ITS, there is a lack of psychometric measures validated in clinical Spanish population that adequately evaluate SI components of ITS. Thus, the main aim of the study was to validate INQ-10 in a Spanish clinical sample including the genuine cultural and linguistic characteristics of European Spanish.

METHODS

315 participants were included in the analyses; 149 of them consulted mental health services for the presence of suicide-related behaviors. A series of exploratory and confirmatory factor analyses were carried out to identify the factor solution. Bivariate and multivariate analyses were used to analyze psychometric properties. Finally, sensitivity and specificity properties were explored through receiver-operating characteristic analyses which also provided the cut-off values of the questionnaire.

RESULTS

An 8-item version demonstrated a good fit to the 2-factor solution. Likewise, this 8-item version showed good psychometric properties. Sensitivity and specificity indices of the version validated as well as the calculated cut-off points were excellent.

CONCLUSIONS

The current results demonstrate the utility of an 8-item INQ European Spanish version as a valid measure of the current SI in Spanish clinical population. In addition, the validated form reflects the theoretical framework on which it was built.

Examining the relations between hopelessness, thwarted interpersonal needs, and passive suicide ideation among older adults: does meaning in life matter?

Older adults are at an elevated risk for passive suicide ideation. The interpersonal theory of suicide and the 3-step theory may provide a framework to better understand factors that contribute to passive suicide ideation among older adults. Specifically, this study aimed to test components of prominent suicide theories and examine the role of meaning in life in the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Participants were 243 adults aged 60 and older recruited from primary care settings in the southwest United States. We hypothesized that high meaning in life would weaken the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation. Results from moderation analyses indicate that meaning in life was a significant moderator of the associations between hopelessness and passive suicide ideation, thwarted belongingness and passive suicide ideation, and perceived burdensomeness and passive suicide ideation. These findings suggest that when meaning in life is low there are significant negative associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Implications, limitations, and future directions are discussed.

Aggressive Worriers: How Aggression Moderates the Association between Intolerance of Uncertainty and Suicidal Desire Constructs

Suicide is a public health concern and has been the tenth leading cause of death in the United States since 2008. The Interpersonal-Psychological Theory of Suicidal Behavior is an empirically supported model of suicide. The theory posits that thwarted belongingness and perceived burdensomeness examine the individual's perceived connectedness to others around them and together create suicidal desire. Anxiety is another widespread public health concern, associated with suicidal ideation and suicide attempts above and beyond the effects of socio-demographic factors and other mental disorders. A key factor in anxiety disorders is intolerance of uncertainty, or the individual's tendency to perceive ambiguous situations and events as being aversive to emotional and behavioral well-being. Additionally, different facets of aggression have been associated with both intolerance of uncertainty and suicidal desire. The current study sought to examine how facets of aggression moderated the associations between intolerance of uncertainty (both prospective and inhibitory) and thwarted belongingness/perceived burdensomeness. Participants were 440 adults recruited online. The hypotheses of aggression facets moderating the association between intolerance of uncertainty and perceived burdensomeness were largely supported with statistical significance for six out of eight models. Similarly, the hypotheses of aggression facets moderating thwarted belongingness were largely supported with significant moderations for seven out of eight models. The results were upheld when using Benjamini-Hochberg test of significance to account for Type I error. Overall, results indicate that aggressive facets can amplify the associations between intolerance of uncertainty and thwarted belongingness/perceived burdensomeness; however, results differed based on the intolerance of uncertainty dimensions.

The mediating role of interpersonal needs on attitude towards ageing and its relationship with community sense and depression among community-dwelling older adults

This study aimed to determine the impact of community sense, depression and interpersonal needs on attitude towards ageing among older adults. This is a cross-sectional and correlational study. From December 2018 to June 2019, 211 community-dwelling older adults from a mid-sized city in Korea participated in the study. The results showed a significant interpersonal needs path from depression and community sense to attitude towards ageing. When interpersonal needs were mediated, the indirect effect of both depression and community sense on attitude towards ageing was significant. Interpersonal needs had a significant mediating effect on the relationships between attitude towards ageing and community sense and depression. The results of this study showed the effects of socio-psychological factors on attitude towards ageing, which is a known indicator of successful ageing and quality of life improvement in older adults. Based on this study, we suggest that the development of programs to promote successful ageing should include strategies to improve community sense, interpersonal needs fulfilment and interventions to reduce depression.

Psychometric properties of the Italian version of the Interpersonal Needs Questionnaire-15 (INQ-15-I)

OBJECTIVE

The Interpersonal Needs Questionnaire (INQ-15) is a self-report measure of thwarted belongingness and perceived burdensomeness, two constructs associated with suicidal ideation. The objective of the current study was to translate the INQ-15 from English to Italian (INQ-15-I) and to test its factor structure, reliability, and validity in Italian samples.

METHOD

We examined (a) whether the components of the hypothesized two-factor measurement model are invariant across a community sample (N = 510) and a clinical sample (N = 259); (b) the relations between the INQ-15-I factors and measures of depression (Beck Depression Inventory-II), hopelessness (Beck Hopelessness Scale), and suicidal ideation (Beck Scale for Suicide Ideation); (c) the reliability and psychometric properties of the INQ-15-I.

RESULTS

Results from multigroup confirmatory factor analyses supported the adequacy of the two-factor model to represent thwarted belongingness and perceived burdensomeness. The model is invariant across community and clinical groups, showing excellent fit. The two INQ-15-I scales measure highly intercorrelated constructs. Both significantly correlate with depression, hopelessness, and suicidal ideation, and correlations are high in the clinical sample.

CONCLUSION

The INQ-15-I is a valid and reliable measure of thwarted belongingness and perceived burdensomeness. Implications for research, assessment, and intervention in suicidal ideation are discussed.

Thwarted belongingness and perceived burdensomeness explain the associations of COVID-19 social and economic consequences to suicide risk

OBJECTIVE

The social and economic consequences of COVID-19 and related public health interventions aimed at slowing the spread of the virus have been proposed to increase suicide risk. However, no research has examined these relations. This study examined the relations of two COVID-19 consequences (i.e., stay-at-home orders and job loss) to suicide risk through thwarted belongingness, perceived burdensomeness, and loneliness.

METHOD

Online data from a nationwide community sample of 500 adults (mean age = 40) from 45 states were collected between March 27 and April 5, 2020. Participants completed measures assessing thwarted belongingness, perceived burdensomeness, loneliness, and suicide risk, as well as whether they (a) were currently under a stay-at-home order and (b) had experienced a recent job loss due to the pandemic.

RESULTS

Results revealed a significant indirect relation of stay-at-home order status to suicide risk through thwarted belongingness. Further, whereas recent job loss was significantly correlated with suicide risk, neither the direct relation of job loss to suicide risk (when accounting for their shared relations to perceived burdensomeness) nor the indirect relation through perceived burdensomeness was significant.

CONCLUSIONS

Results highlight the potential benefits of interventions targeting thwarted belongingness and perceived burdensomeness to offset suicide risk during this pandemic.

Performance of the interpersonal needs questionnaire in adolescent clinical samples: Confirmatory factor analyses and evaluation of measurement invariance

OBJECTIVE

This study evaluated the factor structure, internal consistency reliability, construct and criterion validity, and measurement invariance of the Interpersonal Needs Questionnaire (INQ) among adolescents.

METHOD

Participants (N = 539) included three distinct samples of youth drawn from two outpatient psychology clinics and an inpatient psychiatric unit. The combined sample was 63.3% female and had a mean age of 14.95 years (SD = 1.31 years). All participants completed the INQ as well as measures of depressive symptoms and suicide ideation.

RESULTS

Confirmatory factor analyses indicated that the removal of three items from the thwarted belongingness subscale of the INQ was needed to achieve acceptable model fit. The resulting combined 12-item scale demonstrated good factor structure, internal consistency reliability, construct validity, and criterion validity. The modified 12-item INQ also demonstrated scalar invariance across subgroups defined by sex, race, and age.

CONCLUSIONS

Findings support the use of this reduced 12-item version of the INQ among adolescents. Youth may have difficulty accurately responding to changes in item valence; thus, future research with youth should consider using a 12-item version of the INQ that avoids valence changes within subscales.

A Measurement Invariance Analysis of the Interpersonal Needs Questionnaire and Acquired Capability for Suicide Scale in Autistic and Non-Autistic Adults

Background: Autistic adults are more likely to engage in suicidal thoughts and behaviors, but there is little research to explore the underlying reasons. It is unclear whether self-report suicide scales that have been designed for non-autistic people accurately measure suicide risk constructs in autistic people. Therefore, this study explored, for the first time, whether the measurement properties of the self-report scales of the Interpersonal Theory of Suicide are equivalent in autistic and non-autistic adults. Methods: In this study, responses from 342 autistic and 353 non-autistic people on the Interpersonal Needs Questionnaire-10 (INQ-10) and Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD) were compared by using measurement invariance analysis. Data were gathered through an online cross-sectional survey of the self-report measures. Results: Results suggest that measurement properties of the INQ-10 were different in autistic people. Autistic characteristics, such as different theory of mind and preference for concrete language, may have led the scale items to load differently on the factors in the autistic group than in the non-autistic group. The measurement properties of the ACSS-FAD were invariant between autistic and non-autistic people. Conclusions: Scores on the INQ-10 cannot be meaningfully compared between autistic and non-autistic people due to different measurement properties. Future research could explore how autistic people experience the concepts of burdensomeness and belonging, to consider how measures could accurately capture this. This would allow researchers to explore the role of these constructs in the development of suicidal thoughts and behaviors in autistic people. Clinicians should be aware that suicide risk factors may present differently in autistic people. Scores on the ACSS-FAD can be meaningfully compared, but the negatively worded scale items may pose similar response difficulties to autistic and non-autistic people.

Aging with Honor: Examining Ambivalent Ageism and Interpersonal Risk-Factors for Suicide as Explanations for the Honor-Suicide Link

Introduction: Prior research has demonstrated that rates of suicide are greater in more honor-oriented regions of the U.S. (particularly among White men), and that this difference in suicide rates becomes greater as men enter older adulthood. Research into the honor-suicide link has suggested explanatory factors that coincide with the interpersonal theory of suicide, such as untreated depression, heightened risk-taking, and the use of firearms in suicide.

Method: The present study exam-ined ambivalent ageism, permissive attitudes toward suicide, and interpersonal risk factors for suicide as explanations for the honor-suicide link among a sample of 201 American men in midlife and above.

Results: After controlling for participant age and religiosity, participants with greater endorsement of honor ideology but lower levels of honor fulfillment expressed heightened levels of thwarted belongingness—an established interpersonal risk factor for suicide. Additionally, lower levels of honor fulfillment predicted greater anxiety about aging, greater perceived burdensomeness, and more positive implicit attitudes toward youth. Conversely, greater levels of honor fulfillment also predicted more positive attitudes toward older adults.

Discussion: Our results extend previous research on the honor-suicide relationship by demonstrating the utility of integrating the inter-personal theory of suicide with research on cultures of honor.

Thwarted belongingness and perceived burdensomeness in Korean college students: Psychometric properties and cultural considerations for the interpersonal needs Questionnaire-10

The present study aimed to validate a Korean version of the Interpersonal Needs Questionnaire in a college student sample. Three hundred and one students completed the scale and other measures of suicidal ideation, loneliness, interpersonal support, responsibility to family, meaning in life, fearlessness about death, anxiety and depression. Results revealed that the scale has two-factor structure (thwarted belongingness and perceived burdensomeness) and it also has good internal consistency, convergent validity and discriminant validity. Cultural comparisons showed that the levels of thwarted belongingness in Korean college students were higher than those in the U.S. college students.

Thwarted Belongingness in Relation to Face-to-Face and Online Interactions

Suicide is ranked as the tenth leading cause of death for all ages in the United States (Centers for Disease Control and Prevention, 2012). Joiner's (2005) interpersonal theory of suicide stated thwarted belongingness-the feeling of being alienated from others-and perceived burdensomeness-the feeling of being a liability to others-are the primary proximal factors leading to suicidal desire. The current study focused on thwarted belongingness and examined its relationship to face-to-face interactions and online interactions in both an undergraduate and community sample. We hypothesized that negative face-to-face and online interactions would be independently associated with higher levels of thwarted belongingness. Furthermore, we hypothesized that face-to-face interactions would moderate the relationship between online interactions and thwarted belongingness and that online interactions would moderate the relationship between face-to-face interactions and thwarted belongingness. Three hundred eighty-seven participants (79.6% female) at a southern university and 209 (62.7% male) participants recruited from Amazon's Mechanical Turk website completed an online survey. Results only partially supported hypotheses, with only face-to-face interactions shown to be independently related to higher levels of thwarted belongingness. These findings indicated that negative face-to-face interactions may contribute to higher levels of risk factors for suicide ideation and highlighted the importance of assessing for negative interactions across all contexts.

Self-perceptions of aging mediate the longitudinal relationship of hopelessness and depressive symptoms

OBJECTIVES

The purpose of the current study was to examine the hypothesis that the prospective relationship between hopelessness and depressive symptoms is mediated by self-perceptions of aging.

METHODS

Data from 3 waves of the US Health and Retirement Study (2008, 2012, and 2014) were used (N = 4606; age M = 65.3, 55.5% female). In mediation analyses, hopelessness in 2008 was the independent variable, self-perceptions of aging in 2012 were the mediator, and depressive symptoms in 2014 were the outcome variable.

RESULTS

After controlling for covariates, hopelessness in 2008 was an independent predictor of self-perceptions of aging in 2012 (β = -.10, P < .001), and self-perceptions of aging in 2012 was an independent predictor of depressive symptoms in 2014 (β = -.41, P < .001). Hopelessness in 2008 showed both direct (β = .09, P < .001) and indirect (β = .03, P < .001) effects on depressive symptoms in 2014, indicating partial mediation by change in self-perceptions of aging.

CONCLUSIONS

As hypothesized, change in self-perceptions of aging partially mediated the relationship of hopelessness with depressive symptoms 6 years later. Findings are consistent with a conceptualization of hopelessness as broad negative expectations about the future that may contribute to negative self-perceptions of aging and subsequent changes in depressive symptoms. Reducing hopelessness, increasing hope, and improving self-perceptions of aging have potential to reduce and prevent depressive symptoms for older adults. Future research should examine the mechanisms of these interrelationships and other aging outcomes.

Suicide Risk Factors Among Older Adults: Exploring Thwarted Belongingness and Perceived Burdensomeness in Relation to Personality and Self-Esteem

The objective of this study was to explore the role of personality and self-esteem in later life within two established risk factors for suicidal ideation (SI)—Thwarted Belongingness (TB) and Perceived Burdensomeness (PB). The data about personality (i.e., Five Factor Model [FFM] and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Personality Disorders [PD]), self-esteem, TB, PB, and SI were collected from 102 community-dwelling older adults and analyzed using bivariate and multivariate techniques. All FFM domains and most PD traits were significantly correlated with SI, TB, and PB. Furthermore, FFM and PD traits explained a significant and meaningful amount of variance of SI, TB, and PB. Self-esteem demonstrated strong negative relationships with SI, TB, and PB. Personality features and self-esteem are important associated features for SI, TB, and PB. Clinicians should consider this information when assessing and evaluating for suicidal risk among older adults. The findings also highlight the need to consider personality traits in developing prevention strategies.

The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research

Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum. (PsycINFO Database Record

Longitudinal associations of hopelessness and loneliness in older adults: results from the US health and retirement study

BACKGROUND

Hopelessness and loneliness are potent risk factors for poor mental and physical health in later life, although the nature of their relationships with each other over time is not clear. The aim of the current study was to examine relationships between hopelessness and loneliness over an eight-year study period.

METHODS

Three waves of data from the US Health and Retirement Study (2006, 2010, 2014) were used to test a cross-lagged model of hopelessness and loneliness (N = 7,831), which allows for the simultaneous evaluation of the reciprocal associations of loneliness and hopelessness. Age in 2006, gender, years of education, number of medical conditions, and depressive symptoms were included as covariates.

RESULTS

The autoregressive effects of loneliness (B (SE) = 0.63 (0.02), p < 0.001) and hopelessness (B (SE) = 0.63 (0.02), p < 0.001) were substantive and significant across the three waves, pointing to the stability of both constructs over the eight-year study period. The lagged effect of loneliness on hopelessness was non-significant (B (SE) = 0.05 (0.03), p = 0.16), whereas the lagged effect of hopelessness on loneliness was significant (B (SE) = 0.01 (0.01), p = 0.03). These lagged effects were not significantly different from each other, however, χ2 (1) = 2.016, p = 0.156.

CONCLUSIONS

Participants who were more hopeless tended to become lonelier four years later, but lonelier participants did not become more hopeless four years later. Findings are tentative given the small magnitude and lack of difference between the cross-lagged effects. Future directions include replicating these findings in different samples and time frames, examining potential mechanisms of relationships between hopelessness and loneliness, and potential intervention strategies that might improve both conditions.

Belongingness and Burdensomeness in Adolescents: Slovene Translation and Validation of the Interpersonal Needs Questionnaire

The Interpersonal Needs Questionnaire (INQ) for assessing thwarted belongingness (TB) and perceived burdensomeness (PB) has not been validated with community adolescents. We translated and administered the INQ to 307 Slovenian adolescents twice over 2-3 months and found that the 15-item version (INQ-15) did not fit without modification. TB and PB scales correlated with concurrent and later suicide ideation and lifetime suicide attempt history. The latent PB factor was associated with concurrent and later ideation controlling for TB, age, gender, depressive symptoms, binge drinking, and peer victimization. Suicide ideation and binge drinking were independently related to attempt history. Assessing and intervening on PB and binge drinking may be promising approaches to suicide prevention with community adolescents.

Perceived Burdensomeness in Older and Younger Adults: Evaluation of the Psychometric Properties of the Interpersonal Needs Questionnaire

OBJECTIVES

We evaluated measurement invariance of the Interpersonal Needs Questionnaire (INQ-15) Perceived Burdensomeness subscale across younger and older adult age groups as well as the construct validity of the Perceived Burdensomeness subscale by comparing nomological networks across age groups.

METHOD

We used nested multigroup confirmatory factor analyses to address measurement invariance and Fisher's r-to-z transformations to compare correlations between perceived burdensomeness and other constructs in younger and older samples.

RESULTS

Results generally supported measurement invariance, but signals of differences in fit in older adults were present. The INQ-15 Perceived Burdensomeness subscale exhibited a significantly lower correlation with depressive symptoms in older adults compared to younger adults. Correlations between perceived burdensomeness and all other constructs were similar across age groups.

CONCLUSION

This study provides marginal support for measurement invariance of the INQ-15 Perceived Burdensomeness subscale across younger and older adults, but results also suggest age differences in the perceived burdensomeness construct.

Investigating the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults

OBJECTIVES

To investigate the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults.

METHOD

We recruited 173 voluntary participants, 65 years and older, into a 2+ year longitudinal study of the onset or exacerbation of depressive symptoms and suicide ideation. We assessed the internal consistency of the GSIS and its four component subscales, and its shorter and longer duration test-retest reliability, convergent (depression, social hopelessness, and loneliness), divergent (psychological well-being, life satisfaction, perceived social support, and self-rated health), discriminant (basic and instrumental activities of daily living and social desirability), criterion (history of suicide behavior), and predictive validity (future suicide ideation).

RESULTS

The GSIS demonstrated strong test-retest reliability and internal consistency. Baseline GSIS scores were significantly positively associated with suicide risk factors, negatively associated with potential resiliency factors, and not associated with functional impairment or social desirability. GSIS scores significantly differentiated between participants with as compared to those without a history of suicide behavior. Baseline GSIS scores significantly predicted suicide ideation at a 2+ year follow-up assessment.

CONCLUSION

Findings suggest strong measurement characteristics for the GSIS with community-residing older adults, including impressive consistency over time. These results are consistent with research attesting to the empirical and pragmatic strengths of this measure. These findings have implications for the monitoring of suicide risk when aiming to enhance mental health and well-being and prevent suicide in later life.

Burdensomeness, Belongingness, and Capability: Assessing the Interpersonal–Psychological Theory of Suicide With MMPI-2-RF Scales

Given the emerging body of literature demonstrating the validity of the interpersonal–psychological theory of suicide (IPTS), and the importance of increasing our understanding of the development of risk factors associated with suicidal behavior, it seems worthwhile both to expand IPTS research via Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) correlates and to expand the availability of methods by which to assess the constructs of the IPTS. The present study attempted to do so in a large adult outpatient mental health sample by (a) inspecting associations between the IPTS constructs and the substantive scales of the MMPI-2-RF and (b) exploring the utility of MMPI-2-RF scale–based algorithms of the IPTS constructs. Correlates between the IPTS constructs and the MMPI-2-RF scales scores largely followed a pattern consistent with theory-based predictions, and we provide preliminary evidence that the IPTS constructs can be reasonably approximated using theoretically based MMPI-2-RF substantive scales. Implications of these findings are discussed.

The German version of the Interpersonal Needs Questionnaire (INQ)--Dimensionality, psychometric properties and population-based norms

PURPOSE

The Interpersonal Needs Questionnaire (INQ) assesses the two interpersonal constructs perceived burdensomeness (PB) and thwarted belongingness (TB) that lead to suicidal ideation, according to the interpersonal theory of suicide (IPTS). The present study investigates dimensionality and psychometric properties of the German version of the INQ in a population-based representative sample and delivers norm values.

METHODS

The German INQ as well as measures of depression and past suicidality were administered to a population-based representative sample of the German general population (n=2513) to analyze its dimensionality and construct validity by confirmatory factor analysis and correlational analysis.

RESULTS

Results of the confirmatory factor analysis were in line with the assumption of two-dimensionality of the INQ. The two subscales showed very good internal consistencies (α ≥ 0.89) as well as correlations with depression and suicidality that indicate convergent validity. There were no gender effects but slight age effects in the scores of both subscales. Population-based norms are provided.

LIMITATIONS

Convergent validity was solely examined with measures of depression and suicidal thoughts instead of further suitable constructs like loneliness and social support. Divergent validity was not investigated in the study.

CONCLUSION

The German version of the INQ shows good psychometric properties making it a promising tool for assessing PB and TB. The provided norms enable researchers to compare INQ scores of their samples with reference values of a population-based representative sample.

The interpersonal needs questionnaire with a shortened response scale for oral administration with older adults

OBJECTIVES

The purpose of this paper is to examine the psychometric properties and construct validity of the interpersonal needs questionnaire (INQ) using a modified three-point response scale for oral administration with older adults.

METHODS

In-home interviews were conducted with 269 participants aged 60 and older who were completing an eligibility interview for a randomized control trial. The INQ was administered orally, as were measures of social support, death and suicide ideation, and meaning in life.

RESULTS

A confirmatory factor analysis demonstrated acceptable fit, with all of the items loading significantly onto the associated latent variable of thwarted belongingness or perceived burdensomeness. Construct validity of the measure was supported through an examination of discriminant validity using constructs hypothesized by the interpersonal theory of suicide to be related to the measured constructs, including social support and social integration for thwarted belongingness, social worth and death ideation for perceived burdensomeness, and meaning in life and suicide ideation for both.

CONCLUSION

The INQ yields reliable and valid scores of thwarted belongingness and burdensomeness when administered orally using a shortened response scale with older adults. These results help establish the measure as a valuable and practical tool for use in the field of late-life suicide prevention.

Incorporating Resilience Factors Into the Interpersonal Theory of Suicide: The Role of Hope and Self-Forgiveness in an Older Adult Sample

OBJECTIVES

The interpersonal theory of suicide posits that perceived burdensomeness and thwarted belongingness are risk factors for suicide ideation. To more comprehensively characterize this model, it is important to identify resilience factors. Forgiveness of oneself may attenuate the relation between perceived burdensomeness and suicide ideation. Similarly, hope might weaken the association between thwarted belongingness and suicide ideation.

METHOD

We examined these relations cross-sectionally in a sample (N = 91) of older adults after including symptoms of depression and demographic variables in the models.

RESULTS

Self-forgiveness moderated the relation between perceived burdensomeness and suicide ideation. Hope did not moderate the relation between thwarted belongingness and suicide ideation.

CONCLUSIONS

These findings suggest that including resilience factors (i.e., self-forgiveness) in models of suicide ideation may result in better identification of those most at risk for suicide and may allow for more precise intervention targets.

Evaluating the Interpersonal Needs Questionnaire: Comparison of the Reliability, Factor Structure, and Predictive Validity across Five Versions

Five versions of the Interpersonal Needs Questionnaire (INQ), a self-report measure of perceived burdensomeness and thwarted belongingness, have been used in recent studies (including 10-, 12-, 15-, 18-, and 25-items). Findings regarding the associations between perceived burdensomeness, thwarted belongingness, and suicidal ideation using different versions have been mixed, potentially due to differences in measurement scales. This study evaluated factor structure, internal consistency, and concurrent predictive validity of these five versions in three samples. Samples 1 and 2 were comprised of 449 and 218 undergraduates, respectively; Sample 3 included 114 adolescent psychiatric inpatients. All versions demonstrated acceptable internal consistency. The 10-item version and 15-item version demonstrated the best, most consistent model fit in confirmatory factor analyses. Both perceived burdensomeness and thwarted belongingness consistently predicted concurrent suicidal ideation on the 10-item INQ only. Future research should consider using the 15-item or 10-item versions.

Depressive symptoms and interpersonal needs as mediators of forgiveness and suicidal behavior among rural primary care patients

BACKGROUND

Suicide is the 10th leading cause of death in the US, and rates of suicide are higher in rural than urban areas. As proposed by the Interpersonal-Psychological Theory of Suicide, thwarted belongingness and perceived burdensomeness are risk factors for suicidal behavior, although protective individual-level characteristics such as forgiveness, may indirectly affect suicidal behavior by decreasing the deleterious effect of thwarted interpersonal needs.

METHOD

A sample of uninsured adults recruited from a rural primary clinic (N=101) completed the Brief Multidimensional Measure of Religiousness and Spirituality; Suicidal Behaviors Questionnaire-Revised; Interpersonal Needs Questionnaire; and Center for Epidemiologic Studies Depression Scale. Parallel and serial multivariable mediation analyses were conducted to test for direct and indirect effects of forgiveness on suicidal behavior.

RESULTS

In parallel mediation, covarying depressive symptoms, forgiveness of self had an indirect effect on suicidal behavior, through perceived burdensomeness. Inclusion of depressive symptoms as a mediator revealed an indirect effect of forgiveness of self and others on suicidal behavior via depression, thwarted belongingness, and perceived burdensomeness in a serial mediation model.

LIMITATION

A longitudinal study, with an equal representation of males and diverse populations is needed to replicate our findings.

DISCUSSION

Our findings have implications for the role health providers can play in addressing suicide with rural patients. Promoting forgiveness, may, in turn affect interpersonal functioning and decrease risk for suicidal behavior.