Testing the Interpersonal Theory of Suicide in Chronic Pain

Prevalence of suicidal behavior in patients with chronic pain: a systematic review and meta-analysis of observational studies

Objective

Chronic pain is a leading cause of disability, severely impairing an individual's daily activity and quality of life. In addition, this condition may contribute to suicidal thoughts by leading to neuropsychological impairments, a perceived lack of meaning in life, and pain-related catastrophizing. This systematic review aimed to comprehensively investigate the prevalence and associated factors of suicidal behaviors (SBs) including suicidal ideation (SI) and suicide attempt (SA) or its complete, in individuals with chronic pain.

Methods

Five electronic databases were searched up to October 4, 2022. Only observational studies investigating the prevalence of SB in individuals with chronic pain were included. The methodological quality of the included studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. A meta-analysis was conducted to quantify the prevalence of SB in the population, and the command "Metaprop" was used in STATA/MP 16. In addition, factors explaining the association between chronic pain and SB identified through regression analysis were investigated.

Results

A total of 19 studies were included in this review (N = 3,312,343). The pooled lifetime prevalence of SI and SA was 28.90% (95% confidence interval, 17.95 to 41.26%) and 10.83% (5.72 to 17.30%), respectively, in a mixed sample comprising various chronic pain conditions. Importantly, the pooled prevalence of past 2-week SI was as high as 25.87% (18.09 to 34.50%). The methodological quality of the included studies was not optimal, and studies using validated SB assessment tools were lacking. Potential protective factors against SB in this population included pain coping and self-efficacy, older age, certain race/ethnicity groups, and marriage.

Conclusion

This systematic review and meta-analysis demonstrated the high prevalence of SB in individuals with chronic pain. Specifically, around 1 in 4 individuals with chronic pain had SI within the last 2 weeks. However, there was considerable heterogeneity in the pooled prevalence of SB in this population.

The Relationship Between Chronic Pain, Depression, Psychosocial Factors, and Suicidality in Adolescents

BACKGROUND

Chronic pain in youth is often associated with social conflict, depression, and suicidality. The interpersonal theory of suicide posits that there are psychosocial factors, such as peer victimization and lack of fear of pain, that may also influence suicidality.

OBJECTIVES

The objective of this study was to determine whether depressive symptoms, peer victimization, and lack of fear of pain predict suicidality in adolescents with chronic pain. It was hypothesized that higher levels of depressive symptoms and peer victimization, and lower levels of fear of pain, would predict a higher lifetime prevalence of suicidality.

METHODS

Participants consisted of 184 youth with primary chronic pain conditions (10 to 18 y, M = 14.27 y). Measures included diagnostic clinical interviews assessing suicidality and self-report questionnaires assessing depressive symptoms, peer victimization, and fear of pain.

RESULTS

Forty-two (22.8%) participants reported suicidality. Regression analyses demonstrated that the occurrence of suicidality was associated with higher rates of depressive symptoms (β = 1.03, P = 0.020, 95% CI: 1.01, 1.06) and peer victimization (β = 2.23, P < 0.05, 95% CI: 1.07, 4.63), though there was no association between lower fear of pain and suicidality.

DISCUSSION

These results suggest that depressive symptoms and peer victimization are significant predictors of suicidality in adolescents with chronic pain; however, lower fear of pain was not shown to be a significant predictor. Given these findings, depression and peer victimization should be further explored and considered in the design and implementation of prevention and early intervention strategies that target chronic pain and suicidality in youth.

Long COVID and mental health correlates: a new chronic condition fits existing patterns

Background

Emerging Long COVID research indicates the condition has major population health consequence. Other chronic conditions have previously been associated with functional and mental health challenges - including depression, anxiety, post-traumatic stress disorder (PTSD), suicide ideation, substance use and lower life satisfaction.

Methods

This study explores correlations between self-reported Long COVID, functional and mental health challenges among a random community-based sample of people (n = 655) aged 20-50 years who contracted COVID-19 prior to vaccination in a Texas county. A random sample of eligible participants was mailed a link to participate in a semi-structured questionnaire. Participant responses, including open-ended responses regarding their experience following COVID-19, were paired with health system data.

Results

Long COVID was associated with increased presence of depression (13% increase), anxiety (28% increase), suicide ideation (10% increase), PTSD (20% increase), and decreased life satisfaction and daily functioning. Structural equation modeling, controlling for sociodemographic variables and imposing a theoretical framework from existing chronic disease research, demonstrated correlations between Long COVID and higher PTSD, suicide ideation and lower life satisfaction were mediated by higher daily functional challenges and common mental disorders.

Conclusions

Basic and applied, interdisciplinary research is urgently needed to characterize the population-based response to the new challenge of Long COVID.

Racial Differences in the Relationship Between Pain and Suicide Desire in Older Adults

Older adults are reported to die by suicide at higher rates than the general population. Suicide desire among older adults is associated with pain, and pain experiences have been found to differ based on race. To investigate the relationship between pain and suicidal desire, 437 racially diverse older adults who receive home-based services (home-delivered meals) in the Southeastern region of the United States completed standardized measures of psychological pain, chronic physical pain, and suicidal desire. Results identified race moderated the relationship between pain and suicidal desire, indicating a stronger relationship between pain and suicidal desire among Black older adults than White older adults. Chronic physical pain (i.e., emotional burden) interacted with race to predict Perceived Burdensomeness ( p = .011) and Thwarted Belongingness ( p = .032). Greater attention to pain experiences among Black older adults is warranted, considering the impact of COVID-19 on racial/ethnic minorities’ mental health.

Association between functional disability type and suicide-related outcomes among U.S. adults with disabilities in the National Survey on Drug Use and Health, 2015-2019

While research on suicidal behavior for people with disability (PWD) suggests they experience higher risk than people without disability, less is known about variations among individuals with different disability types. This nationally representative, cross-sectional study compared differences in suicide-related outcomes (ideation, planning, attempts) among PWD by functional disability type (hearing, vision, cognitive, mobility, complex activity) and number. Secondary analysis of adult PWD in the 2015-2019 National Survey on Drug Use and Health (unweighted N = 35,544; representing 47,723,378 PWD, weighted) was used to estimate relationships between suicide-related outcomes and disability type and number. Most respondents were female (55.9%), and 36.0% were aged ≥65 years. Adjusted odds ratios (AORs) from multivariable logistic regression indicated that suicidal ideation and suicide attempt, respectively, were significantly more likely among individuals with cognitive (AOR = 1.71, 95% CI = 1.24-2.35; AOR = 2.54, 95% CI = 1.31-4.91), complex activity (AOR = 1.96, 95% CI = 1.37-2.81; AOR = 2.67, 95% CI = 1.32-5.41), and ≥2 limitations (AOR = 2.02, 95% CI = 1.52-2.69; AOR = 3.46, 95% CI = 1.84-6.50) than hearing limitation. Also, relative to other disability types, suicide-related outcomes were significantly more likely among individuals with cognitive limitation and complex activity limitation (p < 0.001). Additionally, suicide-related outcomes elevated in likelihood as the number of limitations increased, with the largest associations among those with ≥5 limitations for suicidal ideation (AOR = 2.31, 95% CI = 1.46-3.66), suicide planning (AOR = 3.34, 95% CI = 1.97-5.68), and suicide attempt (AOR = 6.37, 95% CI = 3.76-10.79). Subgroup analyses showed that presence of cognitive limitation and multiple limitations differentiated between suicidal ideators and suicide attempters. Further research is needed to identify causes of these risks and develop suicide prevention efforts for these particularly vulnerable groups.

Pain, functional disability and mental disorders as potential mediators of the association between chronic physical conditions and suicidal ideation in community living older adults

OBJECTIVES

To examine the associations between chronic physical conditions and suicidal ideation and to assess whether associations are mediated by pain, anxiety, depression, post-traumatic stress syndrome (PTSS), and functional disability.

METHODS

The study sample includes 1533 older adults aged 65+ recruited in primary care clinics between 2011-2013 and participating in Quebec's Health Survey on Services "Étude sur la Santé des Aînés-Services" (ESA-S) study. Path analysis was used to assess the associations. The presence of suicidal behaviour was ascertained using 4 questions. PTSS was based on a validated scale for primary care older adults. Anxiety and depression were assessed according to DSM-IV criteria. Pain was self-reported on an ordinal scale and functional disability was based on the presence of disability in 8 dimensions of activities of daily living. The main predictors included a list of 13 physical disorders identified by diagnostic codes. Suicidal ideation was also controlled by a number of socio-demographic and psychosocial factors.

RESULTS

PTSS, depression, and functional disability mediate the association between various chronic conditions and suicidal ideation. Although pain and anxiety are associated with many physical disorders, they did not mediate the association with suicidal ideation.

CONCLUSIONS

Chronic physical disorders are associated with suicidal ideation, either directly or indirectly through PTSS, depression, and functional disability. The findings underscore the importance of early identification and management of older patients with specific chronic disorders in primary care as they may be most at risk for suicidal ideation.

Association Between Disability and Suicide-Related Outcomes Among U.S. Adults

INTRODUCTION

Although research has analyzed the sociodemographic and socioeconomic risks for suicide, only recently has suicide risk for people with disabilities been examined. This study investigates the associations between disability and distinct suicide-related outcomes, including suicidal ideation, suicide planning, and suicide attempt.

METHODS

This nationally representative, cross-sectional study comprised secondary analyses of the 2015-2019 National Survey on Drug Use and Health conducted in 2020 (N=198,640, representing 229,556,289 U.S. adults). Disability status comprised the presence of any disability; hearing, vision, mobility, cognitive, complex activity, or ≥2 limitations; and 1, 2, 3, 4, or ≥5 limitations. Suicide-related outcomes in the past year included none, suicidal ideation only, suicide planning, and suicide attempt. Multivariable logistic regression was applied to estimate the AORs.

RESULTS

Overall, 19.8% reported any disability. Results showed that people with disabilities were significantly more likely than those without disabilities to report suicidal ideation (AOR=2.13, 95% CI=1.93, 2.36), suicide planning (AOR=2.66, 95% CI=2.27, 3.11), and suicide attempt (AOR=2.47, 95% CI=2.05, 2.98). Furthermore, individuals within each limitation count group were significantly more likely than people without disabilities to report suicide-related outcomes (p<0.001), with the largest magnitudes among those with ≥5 limitations for suicidal ideation (AOR=3.80, 95% CI=2.32, 6.23), suicide planning (AOR=6.45, 95% CI=3.52, 11.80), and suicide attempt (AOR=8.19, 95% CI=4.45, 15.07).

CONCLUSIONS

People with various types of functional disabilities had an elevated risk for suicide-related outcomes, compared with people without disabilities. The more limitations a person had progressively increased their risk. These findings call for focused attention to the mental health of people with disabilities, including suicide prevention efforts that accommodate their needs.

Ecological momentary assessment of interpersonal theory of suicide constructs in people experiencing psychotic symptoms

BACKGROUND

People with psychotic disorders are at an increased risk of suicide, but there is little understanding of suicidal ideation (SI) in this population. The Interpersonal Psychological Theory of Suicide posits that perceived burdensomeness (PB) and thwarted belonginess (TB) contribute to SI. To our knowledge there are no studies using ecological momentary assessment (EMA) to assess these interpersonal risk factors in a sample of individuals with psychotic disorders. This study investigated the validity and variability of PB and TB, and whether SI, EMA-measured psychotic symptoms, mood, and social context relate to PB and TB.

METHOD

Ninety-six participants with a psychotic disorder, including mood disorders with psychosis completed in-lab assessments of current SI, and then EMA surveys on a smartphone 3×/day for 10 days, answering questions about burdensomeness, belongingness, symptoms (i.e., hearing voices, experiencing suspiciousness), mood (i.e., happy, sad), and social context.

RESULTS

Burdensomeness varied within-participants less than belongingness (t (95) = -3.74, p=< .001). Participants with SI had higher mean burdensomeness ratings (t (94) = -2.70, p < .01) and lower mean belongingness ratings (t (94) = 3.68, p < .001) than did participants without SI. Being with others, greater psychotic experiences, less happiness, and greater sadness related to greater burdensomeness. SI status, being alone, greater psychotic experiences, less happiness, and greater sadness related to less belongingness.

CONCLUSIONS

This study examined the real-time influences of SI and psychotic symptoms on burdensomeness and belongingness. Hearing voices, suspiciousness, mood, and SI are related to interpersonal suicide-related risk factors. In this sample, social context had a differential effect on burdensomeness and belongingness.

The Mediating Role of Depressive Symptoms, Hopelessness, and Perceived Burden on the Association Between Pain Intensity and Late-Life Suicide in Rural China: A Case-Control Psychological Autopsy Study

Background: Few studies have investigated the roles of psychosocial factors such as depressive symptoms and hopelessness on the relationship between pain and suicide with inconsistent results. The study aimed to analyze the impact of pain intensity on suicide death and to estimate the degree to which depressive symptoms, hopelessness, and perceived burden may explain the association in Chinese rural elderly. Methods: Using a 1:1 matched case-control design, we collected data from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including sociodemographic characteristics, pain intensity, depression, hopelessness, perceived burden, physical diseases, and social support. Conditional logistic regression was employed to assess the association between pain intensity and completed suicide. Mediation analysis using the KHB method was applied to explore the mediation effects from depressive symptoms, hopelessness, and perceived burden. Results: The result of multivariable logistic regression showed that unemployment [odds ratio (OR) = 5.06, 95% confidence interval (CI): 1.76-14.49], higher levels of hopelessness (OR = 7.72, 95% CI: 3.49-17.10), depressive symptom (OR = 15.82, 95% CI: 4.53-55.25), and severe pain (OR = 3.46, 95% CI: 1.31-9.13) were significantly associated with elevated suicide risk in older adults in rural China. Depressive symptoms, hopelessness, and perceived burden significantly mediated 43.71% of the pain-suicide association (p = 0.020), with 17.39% due to depressive symptoms, 17.63% due to hopelessness, and 8.69% due to perceived burden. Conclusions: Regular screening of pain, depressive symptoms, hopelessness, and perceived burden using simple but sensitive questions or scales for older adults with pain is vital for the prevention and early detection of suicide risk in Chinese rural areas. Moreover, the importance of pain management and psychological interventions targeted on depressive symptoms and hopelessness should be emphasized.

Suicidal Ideation Profiles in Patients with Fibromyalgia Using Transdiagnostic Psychological and Fibromyalgia-Associated Variables

Several studies have emphasized the heterogeneity of fibromyalgia patients. Furthermore, fibromyalgia patients are considered a high-risk suicide group. The ideation-to-action framework proposes a set of transdiagnostic psychological factors involved in the development of suicidal ideation. The present study aims to explore the existence of different subgroups according to their vulnerability to suicidal ideation through these transdiagnostic psychological variables and a set of variables typically associated with fibromyalgia. In this cross-sectional study, 151 fibromyalgia patients were assessed through the Revised Fibromyalgia Impact Questionnaire, Beck Depression Inventory-II, Plutchik Suicide Risk Scale, Interpersonal Needs Questionnaire, Defeat Scale, Entrapment Scale, Psychache Scale, and Beck Hopelessness Scale. A K-means cluster analysis identified two clusters, one (45.70%) according to a low vulnerability, and a second (54.30%) with a high vulnerability to suicidal ideation. These clusters showed statistically significant differences in suicidal ideation and suicide risk. However, no differences were observed in most socio-demographic variables. In conclusion, fibromyalgia patients who present a clinical condition characterized by a moderate-high degree of physical dysfunction, overall disease impact and intensity of fibromyalgia-associated symptoms, along with a high degree of perceived burdensomeness, thwarted belongingness, defeat, entrapment, psychological pain and hopelessness, form a homogeneous group at high risk for suicidal ideation.

Frustrated interpersonal needs as a motivational moderator in the integrated motivational-volitional model

A theoretical assumption of the integrated motivational-volitional (IMV) model positions perceived burdensomeness (PB) and thwarted belongingness (TB) as moderators on the entrapment-suicidal ideation/intention relationship. The present study analyzed the expected combined effects of PB × TB on the relationship between entrapment and suicidal ideation/intention. Data were collected using an online questionnaire (N = 644) selected by sex, age, and education level. The PB × TB × Entrapment interaction was statistically significant, according to a moderating effect. A high degree of frustration of interpersonal needs enhances the entrapment-suicidal ideation/intention relationship.

Understanding suicidal ideation and behaviour in individuals with chronic pain: a review of the role of novel transdiagnostic psychological factors

Individuals with chronic pain are at an elevated risk of suicide, yet psychosocial factors that might be involved in increasing or decreasing vulnerability for suicidal ideation and behaviour have received little attention. Extant literature on the topic of suicide in individuals with chronic pain incorporates only a few of the wide array of known vulnerability and protective factors. This Review focuses on transdiagnostic psychological processes, (ie, those of relevance for both chronic pain and suicide). We reviewed a selection of published literature on chronic pain and suicide, concentrating on previously unexplored and underexplored lines of research, including future orientation, mental imagery, and psychological flexibility. A greater degree of crosspollination between the fields of chronic pain and suicide research is required to progress our understanding of why some people with chronic pain become suicidal and others do not.

A population-based examination of suicidality in comorbid generalized anxiety disorder and chronic pain

BACKGROUND

Generalized anxiety disorder (GAD) and chronic pain conditions commonly co-occur, and are both independently associated with suicidality; however, little is known about the impact of chronic pain on suicidality among individuals with GAD. The aim of this study was to examine the associations between comorbid GAD and chronic pain conditions with suicide ideation, plans, and attempts in a population-based sample.

METHODS

We analyzed data from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH; N = 25,113). Multiple logistic regressions examined the associations between comorbid GAD and chronic pain conditions (i.e., arthritis, migraine, back pain; reference = GAD alone) with suicidality (i.e., ideation, plans, and attempts).

RESULTS

After adjusting for sociodemographics, other psychiatric conditions, and other chronic pain conditions, results indicated that compared to GAD alone, comorbid GAD and migraine was associated with increased odds of suicide ideation and plans (adjusted odds ratio (AOR) range: 2.55-3.00) and comorbid GAD and arthritis was associated with increased odds of suicide attempts (AOR = 4.10, 95% CI [1.05-16.01]).

LIMITATIONS

The cross-sectional nature of the survey design does not permit causal assumptions regarding the emergent associations and the self-report assessment of chronic pain conditions may be associated with response biases.

CONCLUSIONS

Results highlight the burden of chronic pain on suicidality among individuals with GAD. These results emphasize the importance of assessing risk of suicidality among individuals with comorbid GAD and chronic pain conditions, particularly migraine and arthritis.

Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide

PURPOSE

The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS.

METHODS

A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module.

RESULTS

Participants' mean age was 48.6 (SD = 13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk.

CONCLUSIONS

PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.

INQ-15 cut-off scores for suicidal ideation screening of women with chronic, invisible illnesses

In the interpersonal theory of suicide, perceived burdensomeness (PB) and thwarted belongingness (TB) are proximal triggers of suicidal ideation. Using the 15-item version of the Interpersonal Needs Questionnaire (INQ-15), suicidal ideation in psychiatric inpatients was predicted by the PB and TB scales, and cut-off scores were recommended. In this study, women (N = 942) who reported one or more chronic, invisible illnesses completed an online survey including the INQ-15 and the Suicide Behaviours Questionnaire-Revised (SBQ-R). PB and TB correlated significantly with SBQ-R total scores (r = 0.575 and 0.437, respectively; p < 0.01). In a Receiver Operating Characteristic analysis, scores of 17 for PB and 37 for TB maximized the correct classification of high-risk and low-risk participants, with slightly higher classification accuracy for PB than TB (AUCs = 0.781 and 0.701, respectively). These results support the INQ-15 scales in screening for suicidal ideation among chronically ill women.

The role of psychological flexibility in relation to suicidal thinking in chronic pain

BACKGROUND

Suicidal thinking (ST) is common in people with chronic pain. It is relevant as it can be associated with suicidal attempts, and typically reflects significant suffering. While little is known about the psychological processes that contribute to ST, current psychological models, such as the Psychological Flexibility (PF) model, could help guide further investigation. This study investigates relations between ST and components of PF in chronic pain.

METHODS

Participants were 424 adults attending treatment for chronic pain in the UK. Included in measures administered before treatment were standardized measures of depression, pain, pain-related interference, and measures of PF, including acceptance, cognitive defusion, committed action, and self-as-context. An item from the measure of depression was used to reflect ST.

RESULTS

A large proportion of the sample reported ST, 45.7%. ST was uncorrelated with participant background characteristic, medications taken, or pain intensity. However, it was correlated with the presence of widespread pain, pain-related interference, and depression. Each component of PF was found to be significantly negatively associated with ST, as predicted. General acceptance correlated with ST at a level equal to that achieved by the depression score. In adjusted multivariate logistic regression general acceptance and committed action remained significantly uniquely associated with it.

CONCLUSION

This preliminary study suggests for the first time that components of PF are associated with part of a pattern of suicidal behaviour in people with chronic pain. They may be relevant for reducing avoidance in general and providing more positive behavioural options.

SIGNIFICANCE

This study provides evidence that components of psychological flexibility are associated with a reduced frequency of suicidal thinking in people with chronic pain. Treatments targeting psychological flexibility may help mitigate the impact of chronic pain on suicidal thinking.

Perceived burdensomeness, thwarted belongingness and suicidal ideation in patients with fibromyalgia and healthy subjects: a cross-sectional study

Perceived burdensomeness and thwarted belongingness are key factors in the development of suicidal behaviors that have been frequently observed among patients with fibromyalgia. The aim of the present study was to compare these two factors in patients with fibromyalgia with and without suicidal ideation and healthy subjects. Secondary objectives were to evaluate the relationship between these two factors and the secondary variables included in the study, such as depression, sleep quality or the degree of marital adjustment. Perceived burdensomeness and thwarted belongingness were assessed with the Interpersonal Needs Questionnaire, depression and suicidal ideation with the Patients Health Questionnaire-9, suicidal risk with the Plutchik Suicide Risk scale, sleep with the Insomnia Severity Index, and marital adjustment with the Locke-Wallace Marital Adjustment scale. Questionnaire scores were compared with the Kruskal-Wallis test. 49 healthy subjects, 38 patients with fibromyalgia without suicidal ideation and 15 patients with fibromyalgia and suicidal ideations were included. Perceived burdensomeness scores were significantly higher in patients with suicidal ideation than in patients without suicidal ideation and controls; thwarted belongingness scores were significantly higher in patients with suicidal ideation than in controls. Marital adjustment was also significantly poor in patients with suicidal ideation than in patients without suicidal ideation and controls. Among patients with fibromyalgia, perceived burdensomeness seems to be strongly related with suicidal ideation, whereas thwarted belongingness seems to play a less relevant role at this respect. Poor marital adjustment could be related with depression.

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

Self-perceived burden, perceived burdensomeness, and suicidal ideation in patients with chronic pain

Background: Self-perceived burden and perceived burdensomeness are two apparently related constructs that have arisen independently from research in physical and mental health, respectively. Although both are associated with suicidal ideation in individuals with chronic pain, they have yet to be examined concurrently in the same group of patients.

Aims: The aim of this study was to investigate the relationship between the two constructs and their differential prediction of suicidal ideation.

Methods: Participants were 260 outpatients of an interdisciplinary chronic pain treatment program. Each participant completed the Self-Perceived Burden Scale (SPBS), the Interpersonal Needs Questionnaire Perceived Burdensomeness Scale (INQPBS), the Beck Scale for Suicide Ideation, and the thoughts of self-harm item of the Patient Health Questionnaire-9.

Results: The SPBS and the INQPBS were both unifactorial measures with good internal consistency. They correlated significantly with one another (r = 0.50, P < 0.001), as well as with scores on the two measures of suicidal ideation (rs ranging from 0.29 to 0.62, Ps < 0.001). However, the INQPBS correlated more highly with suicidal ideation than did the SPBS. In regression analyses, the INQPBS predicted unique variance in suicidal ideation after adjusting for the SPBS. Conversely, the SPBS did not contribute uniquely when the INQPBS was entered first.

Conclusions: Patients with chronic pain who believe that they have become “a burden to others” are at increased risk for suicidal ideation. The conceptual similarities and differences between the constructs of self-perceived burden and perceived burdensomeness are reviewed to explain why perceived burdensomeness is the stronger predictor of this increased risk.

Physical disability and suicide: recent advancements in understanding and future directions for consideration

Recent research indicates a heightened risk of suicide in this population, a concern given that suicide may be more accepted for those with physical disabilities than for those without such disabilities. The relationship between physical disability and suicide has begun to be examined within empirically supported frameworks of suicide and indicates that interpersonal factors (e.g. perceived burdensomeness) and pain are mechanisms contributing to this heightened risk of suicide. The suicide rate after acquiring a physical disability, such as a spinal cord injury, and the greater odds of suicide after reporting having a disability further support the association between physical disability and suicide. The multifaceted nature of physical disability is reflected in its relationship with suicidal ideation and behaviors.