Perceived COVID-19 Stress and Suicidal Ideation Among College Students: Meditation Roles of Family Cohesion and Unmet Interpersonal Needs

Purpose: Few studies examined variables that might explain the link between perceived COVID-19 stress and suicidal ideation. The present study tested a multiple-sequence mediation model with family cohesion, thwarted belongingness, and perceived burdensomeness as mediators. Methods: The current study surveyed 1098 college students in China using questionnaires concerning perceived COVID-19 stress, family cohesion, unmet interpersonal needs, and suicide ideation. Results: Perceived COVID-19 stress was significantly associated with family cohesion, thwarted belongingness, perceived burdensomeness, and suicidal ideation. Family cohesion, thwarted belongingness, and perceived burdensomeness mediated the relationship between perceived COVID-19 stress and suicidal ideation separately. These factors also had multiple sequence-mediated effects between perceived COVID-19 stress and suicidal ideation. Conclusion: The study revealed pathways from perceived COVID-19 stress to suicidal ideation and suggested that interventions to increase family cohesion and reduce one's unmet interpersonal needs were beneficial in decreasing individuals' suicidal ideation.

Interpersonal Needs, Mental Pain, and Hopelessness in Psychiatric Inpatients with Suicidal Ideation

INTRODUCTION

Suicide is a leading cause of death worldwide and models may help the understanding of the phenomenon and ultimately reduce its burden through effective suicide prevention strategies. The Interpersonal Theory of Suicide and Shneidman's Model have tried to describe different unmet needs related to suicidal ideation. The study aims to assess the association between thwarted belongingness, perceived burdensomeness, and suicidal ideation in a sample of psychiatric inpatients and the mediating role of hopelessness and mental pain in this association.

METHODS

112 consecutive adult psychiatric inpatients were administered the Columbia Suicide Severity Rating Scale (C-SSRS), the Italian version of the Interpersonal Needs Questionnaire-15-I (INQ-15-I), the Physical and Psychological Pain Scale, and the Beck Hopelessness Scale (BHS).

RESULTS

Mediation models indicated a significant indirect effect of perceived burdensomeness (with thwarted belongingness as covariates) on suicidal ideation intensity with hopelessness as a mediator. When thwarted belongingness (controlling for perceived burdensomeness as a covariate) was included in a model as an independent variable, direct and indirect effects on suicidal ideation intensity were not significant.

CONCLUSIONS

Psychosocial interventions focusing on identifying and decreasing the perception of being a burden for others and the feeling hopeless could represent a powerful pathway for reducing suicidal ideation. Moreover, the attention toward unmet interpersonal needs may help increase and focus clinical discussions on risk factors, which may help engagement toward psychiatric care and downsize the stigma related to suicide. Raising awareness toward mental health topics is a goal of healthcare services globally.

Self-burdensomeness, other-burdensomeness, and suicidal ideation

Perceiving oneself as a burden to others (other-burdensomeness), as well as perceiving one's selfhood as a burden (self-burdensomeness), have been proposed as risk factors for suicidal ideation. Yet, it is unclear whether the altruistic motive of being a burden to others or the self-oriented motive of being a burden on oneself is more relevant to suicidal ideation. Given this background, two rival mediation models were tested. Data from N = 228 outpatients (64% female; age: M(SD) = 38.69 (12.27), range:17-65) undergoing psychotherapy were collected at two measurement time points over a three-month period (first measurement = T1, second measurement = T2). The significant positive association between other-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by self-burdensomeness (T1). Furthermore, the significant positive association between self-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by other-burdensomeness (T1). Results suggest that suicidal ideation can develop from both an altruistic, self-sacrificial perception of being a burden to others, as well as from a more self-oriented perception of being a burden to oneself. There is no indication that either self-burdensomeness or other-burdensomeness is a stronger indicator in the development of suicidal ideation.

Depression, anxiety, stress, and satisfaction with life: Moderating role of interpersonal needs among university students

Depression, anxiety, and stress are ranked among the top mental health concerns faced by university students in recent times perpetuated by the proliferation of digitalization. Thus, this study was performed to assess the relationship between depression, anxiety, stress, and satisfaction with life, with interpersonal needs (perceived burdensomeness and thwarted belongingness) as moderators. A cross-sectional study using a convenient sampling method was conducted among 430 Malaysian private university students (Mean aged= 20.73 years; SD = 1.26 years). A self-administered questionnaire comprising the Depression, Anxiety and Stress Scale (DASS-21), Satisfaction with Life Scale, and Interpersonal Needs Questionnaire were used. Students who experienced lower depression and anxiety reported higher satisfaction with life under the influence of low perceived burdensomeness. Perceived burdensomeness, when coupled with depression (β = 0.76, p < 0.01) and anxiety (β = 0.79, p < 0.01), contributed 15.8% of variance in satisfaction with life. Students who experienced stress reported higher satisfaction with life under the influence of high thwarted belongingness (β = 0.73, p < 0.01), contributing 17.3% of the variance in satisfaction with life. For university students who experienced depression and anxiety symptoms, mental health practitioners may need to be cognizant of how to support students' education and management of their perceived burdensomeness perceptions.

Dynamic associations between interpersonal needs and suicidal ideation in a sample of individuals with eating disorders

BACKGROUND

Over half of individuals with eating disorders experience suicidal ideation at some point in their lives, yet few longitudinal studies have examined predictors of ideation in this at-risk group. Moreover, prospective research has focused on relatively distal or trait-level factors that are informative for distinguishing who is most at risk but not when. Little is known about more proximal or state-level risk factors that fluctuate within an individual, which is critical for determining when a person is most likely to engage in suicidal behaviors.

METHODS

Women (N = 97) receiving treatment for their eating disorder completed questionnaires weekly to assess suicidal ideation and interpersonal constructs (i.e. perceived burdensomeness, thwarted belongingness) theorized to be proximal predictors of suicidal desire. Longitudinal multilevel models were conducted to examine both within- and between-person predictors of suicidal ideation across 12 weeks of treatment.

RESULTS

Statistically significant within-person effects for burdensomeness (β = 0.06; p < 0.001) indicate that when individuals have greater feelings of burdensomeness compared to their own average, they also experience higher suicidal ideation. We did not find any significant influence of thwarted belongingness or the interaction between burdensomeness and belongingness on suicidal ideation.

CONCLUSIONS

This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results are only partially consistent with the Interpersonal Theory of Suicide and suggest that short-term changes in burdensomeness may impact suicidal behavior in individuals with eating disorders.

Predicting suicidal ideation in a longitudinal high-risk sample: Multilevel analyses and 12-month trajectories

BACKGROUND

The Interpersonal Theory of Suicide states that suicidal ideation (SI) results from perceived burdensomeness (PB) and thwarted belongingness (TB). Cross-sectional studies found associations with SI. This study examined the prospective prediction of SI.

METHODS

Three hundred and eight inpatients reporting severe SI or a recent suicide attempt were assessed four times within 12 months. The prediction of SI was examined using multilevel analyses, group comparisons, and logistic regression analyses.

RESULTS

Cross-sectionally, PB and TB were associated with SI. Prospectively, neither PB nor TB predicted SI. We found no autocorrelation of SI over time. Patients with persistent and fluctuating SI reported higher PB at T0. PB predicted the persistence of SI over 12 months.

CONCLUSION

Results emphasize cross-sectional associations between PB, TB, and SI. PB and TB could not predict the intensity of SI over time. SI did not predict itself over time. PB was associated with a persistent trajectory of SI over 12 months.

Perceived burdensomeness is a curvilinear, short-term predictor of suicide ideation in a community sample of adults

OBJECTIVE

Our primary aim was to test the Interpersonal Theory of Suicide's synergy hypothesis (i.e., the interaction between perceived burdensomeness and thwarted belongingness) in the proximal prediction of suicide ideation, while accounting for quadratic effects.

METHOD

We used MTurk to recruit participants (N = 478) with a lifetime history of suicidal thoughts and behaviors; they completed two batteries of self-report questionnaires three days apart.

RESULTS

Contrary to the synergy hypothesis, only suicide ideation and the quadratic effect of perceived burdensomeness at Time 1 were significant predictors of suicide ideation at Time 2. The quadratic effect of perceived burdensomeness indicated a u-shaped function, whereby scores at or above the 80^th percentile on perceived burdensomeness at Time 1 had increasingly strong, positive associations with suicide ideation at Time 2, while scores under the 80^th percentile were not predictive of suicide ideation at Time 2. Also, thwarted belongingness and suicide ideation at Time 1 were significant predictors of perceived burdensomeness at Time 2.

CONCLUSIONS

These findings add to a growing literature that does not support the synergy hypothesis and suggests the importance of including nonlinear terms when examining the Interpersonal Theory of Suicide's constructs.

Interpersonal theory of suicide: prospective examination

BACKGROUND

The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies.

AIMS

To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design.

METHOD

Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18-81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted.

RESULTS

The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59-3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01).

CONCLUSIONS

The results challenge the theoretical validity of the IPTS and its clinical utility - at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.

Internalized stigma, sense of belonging, and suicidal ideation among veterans with serious mental illness

OBJECTIVE

There is emerging evidence that internalized stigma increases risk for suicide among individuals with serious mental illness. The purpose of the current study was to evaluate whether sense of belonging moderates the relationship between internalized stigma and suicidal ideation.

METHOD

Two hundred forty-two veterans with serious mental illness completed measures of internalized stigma, belongingness, and depression. Moderation analysis was used to determine whether sense of belonging interacts with internalized stigma to predict suicidal ideation when accounting for individual differences in depression and relevant demographic variables.

RESULTS

Consistent with our hypothesis, sense of belonging significantly moderated the relationship between internalized stigma and suicidal ideation. Specifically, the relationship between internalized stigma and suicidal ideation was strongest when sense of belonging was low.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Internalized stigma and belongingness interact to increase risk for suicide. Both constructs should be assessed and included in interventions to reduce suicide risk among veterans with serious mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Role of Interpersonal Problems and Family Environment in the Association Between Impulsivity and Suicidal Ideation: A Moderate Mediation Model

Impulsivity, interpersonal problems, and family environment are important factors in the development of suicidal ideation, but the pathway of these factors on suicidal ideation is not clear. This study constructed a moderated mediation model to examine whether interpersonal problems mediated the relationship between impulsivity and suicidal ideation and whether this mediating process was moderated by family environment. For this purpose, 902 college students from Tianjin Normal University located in the north of China were recruited to participate in this study with Barratt Impulsiveness Scale, Adolescent Self-Rating Life Events Check List, Family Environment Scale, and Beck Scale for Suicidal Ideation. Impulsivity could significantly predict suicidal ideation, and the relationship between impulsivity and suicidal ideation was significantly mediated by interpersonal problems; furthermore, the mediating effect and the directing effect were significantly moderated by family environment. These findings contribute to our understanding of a comprehensive interpretation of both environmental and individual factors' impacts on suicidal ideation.

Relations Between Thwarted Belongingness, Perceived Burdensomeness, and History of Suicide Attempts and Readiness for Mental Health Treatment in High-Risk Veterans, Reserves, and Active Duty Service Members

Suicide rates for service members and veterans are growing rapidly in the United States. Despite availability of evidence-based approaches, a large number of high-risk individuals are reluctant to seek out treatment. The present study used the interpersonal theory of suicide, involving 3 primary predictors of death by suicide to investigate treatment readiness in high-risk U. S. veterans, reserves, and active duty service members. Four hundred and two service members were recruited. Inclusion criteria involved (a) reporting active suicidal ideation and (b) denying active behavioral health treatment. All participants completed a self-report battery that assessed burdensomeness, thwarted belongingness, lifetime suicide attempts, and perceptions about treatment. Regression analyses revealed that thwarted belongingness was significantly predictive of treatment perceptions and readiness, in that higher or more severe scores on the thwarted belongingness scale were significantly related to lower or less likely treatment perceptions and readiness scores. The findings suggested that, in high-risk service members, thwarted belongingness is predictive of lower treatment readiness, and contributes to the growing literature on perceived stigmas, treatment barriers and readiness, and suicidal behaviors and risk factors.

High frequency heart rate variability: Evidence for a transdiagnostic association with suicide ideation

Low levels of high frequency heart rate variability (HF-HRV) have been shown to be associated with suicidal ideation and behavior in students and depressed patients. The goal of the present study was to examine associations between suicide ideation and resting HF-HRV as well as HF-HRV reactivity in a diagnostically heterogeneous sample of adult outpatients with or without concurrent suicide ideation. Participants were N = 85 outpatients (67.1% female; age: M = 38.8, SD = 13.72). HF-HRV reactivity was assessed using a sad film induction method. Associations between resting HF-HRV, HF-HRV reactivity and suicide ideation were analyzed using linear regression modeling - controlling for depression, anxiety and stress. HF-HRV reactivity towards the sad film, but not low resting HF-HRV baseline, was predictive of higher scores on suicidal ideation within the whole sample. In women, lower resting as well as perturbed HF-HRV reactivity was associated with higher scores on suicidal ideation. Results suggest that suicide ideators have a reduced capacity to regulate their response to stress.

Military personnel compared to multiple suicide attempters: Interpersonal theory of suicide constructs

The current study aimed to address the discrepancy between suicide rates in the military and general population by comparing facets of the interpersonal theory of suicide between civilians with multiple suicide attempts and U.S. military personnel. Military personnel exhibited higher levels of capability for suicide but lower levels of perceived burdensomeness and thwarted belongingness than civilian multiple attempters. When comparing only personnel endorsing ideation and civilian multiple attempters, the significant difference for capability remained, but the differences for perceived burdensomeness and thwarted belongingness became nonsignificant. Results suggest the emergence of ideation places personnel at a greater risk for suicide than many civilian multiple attempters.