Burdensomeness, depression, and suicide in a sample of American-Indian college students

Depression and suicidal ideation among Black individuals in Canada: mediating role of traumatic life events and moderating role of racial microaggressions and internalized racism

PURPOSE

Although suicidal ideation (SI) is a serious concern in Canada, its prevalence and related factors among Black individuals are poorly documented. Using data from the Mental Health of Black Communities in Canada project (BeCoMHeal), this study aimed to assess the prevalence of SI in Black individuals aged 15-40 years old in Canada, the mediating role of traumatic life events in the association between depression and SI, and the moderating role of racial microaggressions and internalized racism.

METHODS

Eight hundred and sixty participants aged between 15 and 40 years (Mage =24.96, SD = 6.29) completed the online questionnaire assessing sociodemographic data, depression symptoms, traumatic life events, racial microaggressions, internalized racism, and SI.

RESULTS

Findings showed that 25.7% of the participants reported having experienced SI (26.5% women, 22.7% men, 𝛘2 = 1.08, p = .299). The moderated-mediation model revealed that traumatic life events fully mediated the association between depression and SI (B = 0.12, p = .004; 95% CI, [0.04, 0.20]) and that racial microaggressions (B = - 0.03, p = .042; 95% CI [-0.07, - 0.00]) and internalized racism (B = 0.06, p = .006; 95% CI [0.02, 0.10]) moderated this relationship.

CONCLUSION

These findings underscore the importance of addressing racial microaggressions and internalized racism in therapy contexts among Black individuals to mitigate the potential negative impacts on their mental health. They also emphasize the need to develop effective, culturally sensitive, and racially adapted suicide prevention and intervention programs for Black communities in Canada.

Interpersonal theory of suicide and stressful life events in a clinical sample of adolescents in Spain

AIMS

The interpersonal theory of suicide (ITPS) provides a theoretical model for suicidal behaviour. It includes two interpersonal variables, thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested the relationship between ITPS interpersonal variables and suicide risk (presence/absence of suicidal ideation and suicide attempts throughout life) in a clinical sample of Spanish adolescents. We also assessed the potential mediation effect of these variables in the well-established relationship between stressful life events (SLE) and suicide risk.

METHODS

We recruited 147 adolescents aged 11-17 from the Child and Adolescent Mental Health Outpatient Services of the Jiménez Díaz Foundation (Madrid, Spain). Different questionnaires were administered to assess suicidal behaviour and SLE (SITBI, The Stressful Life Events Scale) and to calculate proxy measures for ITPS interpersonal factors (SDQ, STAXI-NA, CDI).

RESULTS

TB and PB significantly correlated with suicide risk. PB played a mediating role in the relationship between SLE and suicide risk: adolescents reporting SLE were more likely to enact suicide behaviours when they experienced higher PB. Patients scoring higher PB were more likely to receive more intense treatment but tended to abandon intervention promptly.

CONCLUSIONS

ITPS seems useful for predicting suicide risk in an adolescent clinical sample. The results suggest an important role for PB in the SLE-suicide risk relationship and may impact the treatment process. Our exploratory findings should be addressed in future studies.

Is camouflaging autistic traits associated with defeat, entrapment, and lifetime suicidal thoughts? Expanding the Integrated Motivational Volitional Model of Suicide

INTRODUCTION

The current study explored whether camouflaging autistic traits is associated with defeat and entrapment and lifetime suicidal thoughts, as predicted by the Integrated Volitional Model of Suicide (IMV model).

METHODS

180 UK undergraduate students (76.7% female 18-67 years) completed a cross-sectional online survey from February 5 to March 23, 2020, including self-report measures of defeat and entrapment (SDES), autistic traits (AQ-10), depression (PHQ-9), anxiety (GAD-7), camouflaging autistic traits (CAT-Q), and lifetime suicidal thoughts and behaviors (SBQ-R item 1).

RESULTS

After controlling for age, gender, current depression, and anxiety symptoms, autistic traits accounted for significantly more of the variance in defeat and entrapment (1.1%), and camouflaging accounted for a further 3.2% of the variance. The association between autistic traits and lifetime suicidality was significantly mediated by camouflaging, defeat, and entrapment. After controlling for age, gender, current depression, and anxiety symptoms, defeat and entrapment (but not camouflaging) accounted for significantly more variance in lifetime suicidal thoughts. The interaction between camouflaging, defeat and entrapment predicted significantly less variance in lifetime suicidal thoughts than either variable alone.

CONCLUSION

Results suggest that camouflaging autistic traits is a transdiagnostic risk factor for lifetime suicidality, relevant to the defeat and entrapment constructs of the IMV model.

Coping competence and hopelessness moderate the influence of perceived burdensomeness on suicidal ideation in undergraduate college students

According to the interpersonal theory of suicide, the perception of imposing a burden on loved ones increases the risk for suicidal ideation. Little research, however, has examined the interaction of burdensomeness with cognitive variables in predicting suicidal ideation in college students even though the relationship between burdensomeness and ideation may be contingent on levels of cognitive risk factors. The present study thus examined the relationships between burdensomeness, hopelessness, coping competence, and suicidal ideation. Questionnaires were administered to 279 undergraduate students from a university in the Midwest United States. After controlling for depression, hopelessness, and coping competence, burdensomeness significantly predicted ideation and accounted for variance above and beyond the control variables. Moreover, the relationship between burdensomeness and suicidal ideation was significantly moderated by coping competence and hopelessness. The findings suggest that perceived burdensomeness plays a critical role in the risk for suicide in college students. More specifically, the findings suggest that coping competence and hopelessness can be ideal targets for interventions as changes in these variables may attenuate the association between perceived burdensomeness and suicidal ideation.

Family-of-origin rejection on suicidal ideation among a sexual minority sample

Suicide is a leading cause of death in the United States. Among sexual minority populations, suicide risk is elevated; this can be explained by minority stress. One such source of minority stress is family-of-origin rejection, a known risk factor for suicide among lesbian, gay, and bisexual (LGB) adolescents; however, less is known about this association among sexual minority adults. While navigating the intersection of minority stress theory and the interpersonal theory of suicide, this study sought to evaluate the impact of family-of-origin rejection distress on suicidal ideation among a sample of adults with marginalized sexual orientations. Recruited for two larger studies, 325 LGB participants (64.3% cisgender, 35.7% transgender or nonbinary) completed an online survey concerning minority stressors, depressive symptoms, and suicide. Using cross-sectional mediation analysis, family-of-origin rejection distress was indirectly associated with suicidal thoughts through depressive symptoms. Clinical implications and suggestions for future research are discussed.

Mental and physical health in service member and veteran students who identify as American Indians and Alaskan natives

OBJECTIVE

The purpose of this study was to explore (a) current utilization rates of university mental health services among American Indian/Alaskan Native/Native Hawaiian (AI/AN/NH) student veterans and (b) predictors of mental health service utilization among AI/AN student veterans. Participants: Data for this cross-sectional study were obtained from the American College Health Association (ACHA)'s 2011-2014 National College Health Assessment II (n = 103). Methods: University mental health service utilization rates were calculated as a percentage for AI/AN/NH student veterans. Multivariable logistic regression was used to determine predictors of mental health service utilization. Results: Results showed that 14% of AI/AN/NH student veterans have used university mental health services. Predictors of mental health service utilization in this population included financial stress, lack of deployment during service, suicidal ideation, and a diagnosis of depression, model χ 2 (13) = 162. 128, p < 0.001, Nagelkerke R2 = 0.130. Conclusion: This research identified gaps in service provision for AI/AN service member and veteran students on college campuses and provided possible models for intervention development.

Technology-facilitated sexual violence and suicide risk: A serial mediation model investigating bullying, depression, perceived burdensomeness, and thwarted belongingness

Technology-facilitated sexual violence (TFSV) is a comprehensive term used to encompass all sexually aggressive and harassing behaviours involving technology. Although there is a growing knowledge base investigating the prevalence and consequences of TFSV, relatively little is known about the extent of aversive consequences experienced by victims and the pathways from victimization to suicidal affect, cognition, and behaviour. TFSV victimization and subsequent suicide has been a subject of several high-profile media cases in recent years. We examine TFSV in relation to two main constructs embedded within the interpersonal theory of suicide (ITS), perceived burdensomeness (PB) and thwarted belongingness (TB). Quantitative survey data ( N = 521) were used to evaluate PB and TB in the context of TFSV victimization. The objective was to analyze mechanisms underlying the relationship between TFSV victimization and suicide risk, exclusively accounting for mediating factors of interpersonal victimization, depression, TB, and PB. Pathway results showed that TFSV victimization increased suicide risk (i.e., suicidal affect, cognition, and behaviour) serially through bullying, depression, and PB—suggesting a cascade of victimization experiences. TB was not a significant mediator. The present results provide novel quantitative data substantiating the devastating risks of TFSV victimization and thus evidencing the importance of legal protections for victims of TFSV.

Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample

The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18–23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.

Alcohol use and the interpersonal theory of suicide in American Indian young adults

Suicide is the second leading cause of death for American Indian (AI) young adults. Alcohol use is a well-established risk factor for suicide. On average, AIs ages 12 to 20 exhibit the second-highest rate of binge drinking compared to all other ethnic groups. The current study investigated the relation between alcohol use and suicide ideation in an AI sample and examined these relations in the context of the interpersonal theory of suicide (ITS). It was hypothesized that perceived burdensomeness and thwarted belongingness would each significantly moderate the relations between alcohol use and suicide ideation in an AI sample. College students who self-identified as American Indian (N = 84) completed measures of alcohol use and associated problems, perceived burdensomeness and thwarted belongingness, and suicidality. Results indicated that perceived burdensomeness significantly moderated the relation between alcohol use and suicide ideation, and this interaction was significant at high levels of perceived burdensomeness. However, thwarted belongingness was not a significant moderator of the relation between alcohol use and suicide ideation. Findings suggest that AI young adults who engage in increased alcohol use may be at increased risk for suicide, especially if they also experience stronger perceptions of being a burden on others. The current study provides support for continued examinations of the relationship between alcohol use and suicide to inform culturally appropriate interventions for AI young adults.

Understanding the Pathways from Depression to Suicidal Risk from the Perspective of the Interpersonal-Psychological Theory of Suicide

Suicide is a major public health concern, especially in adolescence. Identifying risk factors for suicide is important to effectively prevent such behavior. Depression is one of the most widely examined risk factors for suicidal risk. How depression and suicidal risk are related, however, is still not clear. This study tested a model with three key constructs of the interpersonal-psychological theory of suicidal behavior (IPTS)-perceived burdensomeness, thwarted belongingness, and nonsuicidal self-injury (NSSI)-as mediators in the relationship between depression and suicidal risk among Chinese adolescents. Chinese high school students (N = 1,074; 54.2% male; M_age  = 13.87 years, SD = 1.48) completed questionnaires assessing all study variables. Results suggested that perceived burdensomeness and NSSI partially mediated the relationship between depression and suicidal risk. Findings of this study emphasize the importance of the IPTS framework in understanding the possible mechanisms underlying the relationship between depression and suicidal risk, and suggest a possible avenue for suicide interventions.

Predicting suicidal ideation by interpersonal variables, hopelessness and depression in real-time. An ecological momentary assessment study in psychiatric inpatients with depression

OBJECTIVE

To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time.

METHODS

This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%).

RESULTS

Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI.

CONCLUSIONS

This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.

Understanding Indigenous Suicide Through a Theoretical Lens: A Review of General, Culturally-Based, and Indigenous Frameworks

Many American Indian/Alaska Native (AI/AN) communities throughout North America continue to experience the devastating impact of suicide. Theoretical explanations of suicide from a psychological, sociological, cultural, and Indigenous perspective all differ in focus and applicability to AI/AN communities. These diverse theoretical frameworks and models are presented herein to examine the potential applicability, strengths, and limitations in understanding AI/AN suicide. In providing these perspectives, continued discussions and empirical examinations of AI/AN suicide can guide informative, culturally-informed suicide prevention and intervention efforts.

Retrospective Cyberbullying and Suicide Ideation: The Mediating Roles of Depressive Symptoms, Perceived Burdensomeness, and Thwarted Belongingness

Research suggests that being cyberbullied is associated with increased risk for suicide ideation; however, few studies have examined the underlying mechanisms of this relation, and fewer have examined this relation within a theory of suicide. Specifically, the interpersonal theory of suicide posits that thwarted belongingness (indicated by loneliness and a lack of reciprocal caring relationships) and perceived burdensomeness (indicated by feelings of liability and self-hatred) increase risk for suicide ideation. The current study aimed to examine depressive symptoms, thwarted belongingness, and perceived burdensomeness as mediators between intensity of being cyberbullied and suicide ideation. Participants were college students ( N = 348) who completed assessments of retrospective peer victimization, thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness), and suicide ideation. The results indicated that after adjusting for sexual orientation, depressive symptoms significantly mediated the relation between intensity of being cyberbullied and suicide ideation. Furthermore, depressive symptoms and perceived burdensomeness serially mediated the relation between intensity of being cyberbullied and suicide ideation; however, thwarted belongingness was not a significant mediator. Clinical and research implications, limitations, and future directions are discussed.

The indirect effect of perceived burdensomeness on the relationship between indices of social support and suicide ideation in college students

OBJECTIVE

Research has demonstrated that a lack of social support is related to suicide risk. This study examines perceived burdensomeness and thwarted belongingness, of the Interpersonal Theory of Suicide, as mechanisms of the social support-suicide relationship in college students.

METHOD

The study consisted of 207 students from a Midwestern university. Data were collected from 2007 to 2008. Two multiple mediation analyses were conducted to examine whether perceived burdensomeness and thwarted belongingness mediated the relationship between indices of social support and suicide ideation.

RESULTS

Perceived burdensomeness mediated the relationships between perceived social support and suicide ideation (95% confidence interval [CI] -.02 to -.00, effect size = -.01) and social connectedness and suicide ideation (95% CI -.03 to -.00, effect size = -.03). Thwarted belongingness did not mediate either relationship.

CONCLUSIONS

Results suggest that a lack of social support could lead to perceptions of being a burden on others, which could lead to suicide ideation.

Are autistic traits associated with suicidality? A test of the interpersonal-psychological theory of suicide in a non-clinical young adult sample

Autism spectrum conditions (ASC) has recently been associated with increased risk of suicidality. However, no studies have explored how autistic traits may interact with current models of suicidal behavior in a non-clinical population. The current study therefore explored how self-reported autistic traits interact with perceived burdensomeness and thwarted belongingness in predicting suicidal behavior, in the context of the Interpersonal-Psychological Theory of Suicide (IPTS). 163 young adults (aged 18-30 years) completed an online survey including measures of thwarted belonging and perceived burdensomeness (Interpersonal Needs Questionnaire), self-reported autistic traits (Autism Spectrum Quotient), current depression (Centre for Epidemiological Studies Depression Scale), and lifetime suicidality (Suicide Behavior Questionnaire-Revised). Results showed that burdensomeness and thwarted belonging significantly mediated the relationship between autistic traits and suicidal behavior. Both depression and autistic traits significantly predicted thwarted belonging and perceived burdensomeness. Autistic traits did not significantly moderate the relationship between suicidal behavior and thwarted belonging or perceived burdensomeness. Results suggest that the IPTS provides a useful framework for understanding the influence of autistic traits on suicidal behavior. However, the psychometric properties of these measures need be explored in those with clinically confirmed diagnosis of ASC. Autism Res 2017, 10: 1891-1904. © 2017 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc.

LAY SUMMARY

Recent research has shown that people with high autistic traits are more likely to attempt suicide. However, no studies have explored why. We found that people with high autistic traits were more likely to experience feelings that they do not belong in the world, are a burden on others, and depression, which may increase their likelihood of attempting suicide. These results suggest that promoting inclusion and independence in those with high autistic traits could help prevent people attempting suicide.