The Interpersonal Needs Questionnaire: Statistical Considerations for Improved Clinical Application

Determining the MMPI-3 SUI scale's cross-sectional and prospective utility in suicide risk assessment

OBJECTIVE

In-depth suicide risk assessments are particularly important to long-term suicide prevention. Broadband measures of psychopathology, such as the Minnesota Multiphasic Personality Inventory (MMPI) instruments, assess suicide risk factors and various mental health comorbidities. With the recent release of the MMPI-3, the Suicidal/Death Ideation (SUI) scale underwent revisions to improve its construct validity and detection of suicide risk factors. Thus, we hypothesized the MMPI-3 SUI scale would demonstrate medium to large associations with suicidal experience and behaviors, future ideation, and interpersonal risk factors of suicide.

METHODS

A sample of 124 college students screened for elevated depressive symptoms completed a brief longitudinal study. Participants completed a baseline session including the MMPI-3 and criterion measures and three brief follow-ups every 2 weeks.

RESULTS

SUI scores were most robustly associated with increased risk for past suicidal ideation, planning, and perceived burdensomeness. Prospectively assessed suicidal ideation was also meaningfully associated with SUI. SUI scale elevations indicate an increased risk of suicide-related risk factors.

CONCLUSION

The MMPI-3 is a valuable tool to inform long-term suicide prevention for those experiencing elevated depressive symptoms as the SUI scale can assess past, current, and future suicide-related risk factors, including suicidal ideation and behaviors.

On the Selection of Item Scores or Composite Scores for Clinical Prediction

Recent shifts to prioritize prediction, rather than explanation, in psychological science have increased applications of predictive modeling methods. However, composite predictors, such as sum scores, are still commonly used in practice. The motivations behind composite test scores are largely intertwined with reducing the influence of measurement error in answering explanatory questions. But this may be detrimental for predictive aims. The present paper examines the impact of utilizing composite or item-level predictors in linear regression. A mathematical examination of the bias-variance decomposition of prediction error in the presence of measurement error is provided. It is shown that prediction bias, which may be exacerbated by composite scoring, drives prediction error for linear regression. This may be particularly salient when composite scores are comprised of heterogeneous items such as in clinical scales where items correspond to symptoms. With sufficiently large training samples, the increased prediction variance associated with item scores becomes negligible even when composite scores are sufficient. Practical implications of predictor scoring are examined in an empirical example predicting suicidal ideation from various depression scales. Results show that item scores can markedly improve prediction particularly for symptom-based scales. Cross-validation methods can be used to empirically justify predictor scoring decisions.

A Psychometric Evaluation of the Interpersonal Hopelessness Scale Among Individuals With Elevated Suicide Risk

The interpersonal theory of suicide hypothesizes that suicide ideation (SI) emerges specifically in the context of hopelessness about the immutability of thwarted belongingness (TB) and perceived burdensomeness (PB; i.e., interpersonal hopelessness). The psychometrics of the Interpersonal Hopelessness Scale (IHS), which could be used to test this hypothesis directly, have not been rigorously evaluated. Participants (U.S. adults reporting past-year SI) completed online self-report assessments at Waves 1 (W1; N = 595) and 2 (W2; N = 215), 1 week apart. Confirmatory factor analyses supported a two-factor structure, IHS-TB and IHS-PB. Correlations indicated strong concurrent validity. Hurdle negative binomial regressions indicated that W1 IHS-TB and IHS-PB scores were associated with SI presence and severity at both waves, but this was inconsistent when adjusting for other W1 variables. IHS-TB and IHS-PB demonstrated excellent internal consistency and moderate to good test-retest reliability. The IHS could improve theory testing and suicide risk assessment and management.

Obsessive-compulsive symptoms, perceived burdensomeness, and thwarted belongingness: Associations and implications among US veterans

OBJECTIVE

Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders worldwide, but has gone relatively unnoticed within the US veteran population. Simultaneously, suicide rates continue to remain high within this population despite the high volume of veterans who receive psychiatric care. With recent research demonstrating OCD's unique relationship with suicidality, it is imperative to explore this association and factors that may explain this association within veterans.

METHODS

The present study investigated OCD symptoms and their relationship with two known risk factors of suicide, perceived burdensomeness (PB) and thwarted belongingness (TB), in two samples of veterans.

RESULTS

In the first study (N = 100), OCD symptoms were found to be uniquely related to both PB and TB even after covarying for demographics, trauma exposure, and probable depression. In the second study (N = 99), these relationships were replicated longitudinally. OCD symptoms at baseline were found to be indirectly related to suicidal ideation severity at a 1-month follow-up via PB and TB at post-treatment.

CONCLUSION

This study highlights the importance of assessing and addressing OCD symptoms within veterans due to the unique relationship these symptoms have with suicidal constructs. A deeper understanding of the impact of OCD within the veteran population will inform future prevention and intervention efforts.

Does the interpersonal theory of suicide explain relationships between muscle dysmorphia symptoms and suicidal ideation?

Muscle dysmorphia (MD) symptoms are robustly associated with suicidal thoughts/behaviors. Risk factors for suicidal ideation, such as perceived burdensomeness and thwarted belongingness, may help explain the relationship between MD symptoms and suicidal ideation. The current study extended past cross-sectional research by testing if perceived burdensomeness and/or thwarted belongingness mediated longitudinal relationships between MD symptoms and suicidal ideation. Two hundred and sixty-nine U.S. men recruited from Prolific completed self-report measures at three timepoints separated by one month each. Analyses used an adapted version of a longitudinal three-wave mediation model to test study hypotheses. Perceived burdensomeness mediated longitudinal relationships between MD symptoms and suicidal ideation. Thwarted belongingness did not show significant relationships with MD symptoms or suicidal ideation. Results extend past research by demonstrating that perceived burdensomeness may be a mechanism underlying longitudinal relationships between MD symptoms and suicidal ideation while establishing temporal ordering. Clinicians may consider targeting perceived burdensomeness in cases of comorbid MD/suicidality by using techniques that promote interpersonal effectiveness.

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.

Examination of real-time variation in interpersonal hopelessness and suicidal desire in a college student sample reporting past-2-week suicidal ideation

INTRODUCTION

Interpersonal hopelessness (IH), as outlined in the Interpersonal Theory of Suicide, is theorized to include two correlated, distinct constructs: hopelessness about one's thwarted belongingness (IH-TB) and about perceived burdensomeness on others (IH-PB). Few studies have explored IH, and none have explored its temporal stability or prospective prediction of suicidal desire.

METHODS

Undergraduates (N = 43) selectively recruited for past-2-week suicidal ideation completed five ecological momentary assessment surveys per day for 10-days. Intraclass correlations, root mean square of successive differences, and multilevel models were used to examine the data and test relationships among predictor variables.

RESULTS

IH-TB and IH-PB demonstrated greater temporal stability than general hopelessness. IH-TB, IH-PB, and their interaction were significant predictors of suicidal desire concurrently and prospectively. IH-PB was no longer significantly predictive of suicidal desire when adjusting for general hopelessness. Post-hoc models showed that suicidal desire was not predictive of IH-TB, IH-PB, or their interaction suggesting the relationship is not recursive.

CONCLUSION

Results showed that interventions aimed at decreasing one's hopelessness specific to TB and PB may be beneficial for decreasing suicidal desire. Future research should seek to replicate these results in larger and more diverse samples and consider the use of shorter ambulatory assessment intervals.

Clinically Significant Scores for Thwarted Belonging and Perceived Burden from the Interpersonal Needs Questionnaire (INQ-15)

Background: Social disconnection is associated with all-cause mortality and suicide. Measures of social disconnection with reliable cut-off scores are needed to aid in the assessment of clinically significant change. Aims: The current study sought to identify reliable clinical cut-off scores for the 15-item Interpersonal Needs Questionnaire (INQ-15), which assesses two indices of social disconnection associated with suicide ideation - thwarted belonging (TB) and perceived burden (PB) on others. Methods: The INQ-15 and measures of suicide ideation were administered to psychiatric outpatients (Nsample1 = 493; Nsample2 = 213) and psychiatric inpatients (Nsample3 = 79; Nsample4 = 87). Results: Reliable cut-off scores discriminating between the presence and absence of suicide ideation were identified across samples (TB ≥ 36 for psychiatric outpatients and ≥ 32 for inpatients; PB ≥ 12 for both psychiatric outpatients and inpatients). Limitations: Data are cross-sectional; thus, conclusions cannot be made about the predictive utility of INQ scores for future suicide ideation, attempts, or death. Conclusions: The INQ-15 yields scores with reliable cut-off scores for both TB and PB that represent clinically significant levels of social disconnection. These cut-off scores can be used in treatment trials and clinical practice to assess clinical improvement (or decline) in belonging and perceived burden.

Examining sleep disturbance components as near-term predictors of suicide ideation in daily life

Suicide ideation emerges and fluctuates over short timeframes (minutes, hours, days); however, near-term predictors of such fluctuations have not been well-elucidated. Sleep disturbance is a distal suicide risk factor, but less work has examined whether daily sleep disturbance predicts near-term changes in suicide ideation. We examined subjective sleep disturbance components as predictors of passive and active suicide ideation at the within-person (i.e., day-to-day changes within individuals relative to their own mean) and between-persons (individual differences relative to the sample mean) levels. A transdiagnostic sample of 102 at-risk young adults ages 18-35 completed a 21-day ecological momentary assessment protocol, during which they reported on sleep and passive and active suicide ideation. At the within-persons level, nightmares, sleep quality, and wake after sleep onset predicted passive suicide ideation, and sleep quality and wake after sleep onset predicted active suicide ideation. At the between-persons level, nightmares, sleep onset latency, and sleep quality were associated with passive suicide ideation, and sleep onset latency was associated with active suicide ideation. In contrast, suicide ideation did not predict subsequent sleep at the within-person level. Specific sleep disturbance components are near-term predictors of intraindividual increases in suicide ideation and may hold promise for suicide prevention and intervention.

Evaluating the long-term (Three Year) durability of brief interventions targeting risk factors for psychopathology

Despite their brevity, prior work indicates that computer-based interventions can substantially impact risk factors for psychopathology including anxiety sensitivity (AS), thwarted belongingness (TB), and perceived burdensomeness (PB). However, very few studies have assessed the long-term (> 1 year) effects of these interventions. The primary aim of the current study was to evaluate post-hoc, the long-term (3 year) durability of brief interventions targeting risk factors for anxiety and mood psychopathology using data from a pre-registered randomized clinical trial. Moreover, we were interested in evaluating whether mitigation in these risk factors mediated long-term symptom change. A sample determined to be at-risk for anxiety and mood pathology based on elevations on several risk factors (N = 303) was randomly assigned to one of four experimental conditions focused on: (1) reducing TB and PB; (2) reducing AS, (3) reducing TB,PB, and AS; or (4) a repeated contact control condition. Participants were assessed at post-intervention, one, three, six, 12, and 36 month follow-ups. Participants in the active treatment conditions showed sustained reductions in AS and PB through long-term follow-up. Mediation analyses suggested that reductions in AS mediated long-term reductions in anxiety and depression symptoms. These findings suggest that brief and scalable risk reduction protocols have long-term durability and efficacy both in terms of reducing risk factors for psychopathology.

Integrating the interpersonal theory of suicide and the dualistic model of passion among adults at risk for suicide

The dualistic model of passion proposes two passion types, harmonious and obsessive, representing adaptive and maladaptive passion, respectively. Studies suggest interpersonal experiences explain harmonious passion benefits and obsessive passion negative consequences. However, research has not examined passion among individuals with clinically elevated suicide risk, nor the associations between passion types and suicide-related outcomes. The present study presents a conceptual model linking the dualistic model of passion and the interpersonal theory of suicide constructs [specifically, thwarted belongingness (TB) and perceived burdensomeness (PB)]. U.S. adults with clinically elevated suicide risk (N = 484) completed online, cross-sectional assessments of harmonious and obsessive passion, TB, PB, and future dispositions (i.e., positive focus, negative focus, and suicide orientation). A mediation model indicated the effects of harmonious and obsessive passion on positive and negative focus and suicide orientation were largely explained by TB and PB. The present findings suggest engaging in a passion activity may be meaningfully related to suicide-related interpersonal perceptions (i.e., TB and PB).

Examining the relationship between dysmorphia symptoms and suicidality through the lens of the Interpersonal Theory of Suicide

OBJECTIVE

Using the Interpersonal Theory of Suicide (IPTS) as a framework, this two-study investigation tested whether burdensomeness and low belongingness explained the association between body and muscle dysmorphia symptoms and suicidal ideation (tested in Study 1 and Study 2), and if fearlessness about death and pain tolerance explained the association between dysmorphia symptoms and previous suicide attempt frequency (tested in Study 2).

METHODS

Study 1 used a community sample (n = 273) and Study 2 used an at-risk population sample (n = 261). Participants completed cross-sectional questionnaires online.

RESULTS

In Study 1, both types of dysmorphic symptoms related to suicidal ideation through burdensomeness, but only body dysmorphic symptoms related to suicidal ideation through low belongingness. In Study 2, results were replicated as both types of dysmorphic symptoms related to suicidal ideation through burdensomeness. While both types of symptoms related to low belonging, low belonging did not relate to suicidal ideation. Neither dysmorphic symptoms nor capability for suicide related to frequency of suicide attempts.

CONCLUSIONS

Results suggest that improving interpersonal needs, such as feeling more effective, may be important treatment targets for individuals with dysmorphic symptoms who also experience suicidal ideation. Future work should continue to identify mediators for suicide attempts among individuals with dysmorphia symptoms.

Caring Texts, a strength-based, suicide prevention trial in 5 native communities: Research design and methods

BACKGROUND

Despite their intrinsic strengths and resilience, some American Indian and Alaska Native (AI/AN) communities experience among the highest rates of suicide of any racial and ethnic group. Caring Contacts is one of the only interventions shown to reduce suicide in clinical trials, but it has not been tested in AI/AN settings.

OBJECTIVE

To compare the effectiveness of Enhanced Usual Care (control) to Enhanced Usual Care augmented with a culturally adapted version of Caring Contacts (intervention) for reducing suicidal ideation, suicide attempts, and suicide-related hospitalizations.

METHODS

We are implementing a single blind randomized controlled trial of Caring Contacts in five AI/AN communities across the country (South Dakota, Montana, Oklahoma, and Alaska). Eligible participants have to be (1) actively suicidal or have made a suicide attempt within the past year; (2) at least 18 years of age; (3) AI/AN; (4) able to speak and read English; (5) able to participate voluntarily; (6) willing to be contacted by text, email or postal mail; and (7) able to provide consent. Following consent and baseline assessment, participants are randomized to receive either Enhanced Usual Care alone, or Enhanced Usual Care with 12 months (25 messages) of culturally adapted Caring Contacts. Follow-up assessments are conducted at 12 and 18 months.

CONCLUSIONS

If effective, this study of Caring Contacts will inform programs to reduce suicide in the study communities as well as inform future research on Caring Contacts in other tribal settings. Modifications to continue the trial during the COVID-19 pandemic are discussed.

CLINICAL TRIALS REGISTRATION

NCT02825771.

Longitudinal mediation by perceived burden of the pathway from thwarted belonging to suicidal ideation

INTRODUCTION

Whereas the interpersonal theory of suicide entails the assumption that thwarted belongingness and perceived burdensomeness are equally important, mutually moderating, proximal causes of active ideation, evidence suggests these may not be co-moderating processes. We tested an alternative perspective, hypothesizing that burden mediates the longitudinal relationship of thwarted belonging with active ideation.

METHODS

A 6-week, four-wave prospective online survey was completed by 298 undergraduates. We tested cross-sectional and cross-lagged panel models (CLPM, with and without random effects) with belonging, burden, and ideation at 2-week lags, and post hoc models with burden as a concurrent mediator of ideation.

RESULTS

Approximately 28% of undergraduates reported active ideation at baseline. Cross-sectionally, thwarted belonging had no direct influence on ideation but indirectly affected ideation via burden. This result was not confirmed in the 2-week CLPM analyses. In post hoc analyses, we found belonging operated indirectly via later burden to influence contemporaneous ideation.

CONCLUSIONS

Findings suggest thwarted belonging influences active ideation indirectly via perceived burden. The effect of burden as a mediator appears to depend on its temporal proximity to ideation. Future research should delimit the period during which perceived burden is an active mediator, accommodate dual-process approaches, and explore other mediation alternatives to co-moderation.

The relevance of the interpersonal theory of suicide for predicting past-year and lifetime suicidality in autistic adults

Background

While there are known risk factors for suicidality in autistic adults, these are often unconnected from theoretical frameworks that might explain why risk is elevated and guide clinical interventions. The present study investigated the relevance of constructs from the Interpersonal Theory of Suicide (ITS), including perceived burdensomeness, thwarted belongingness and acquired capability for suicide, and explored mechanisms through which certain risk factors (relationship status, age at diagnosis) might elevate suicide risk.

Methods

Autistic adults (n = 314) completed an online study including measures of depression, anxiety and constructs from the ITS. Linear and multinomial regression analysis disentangled contributions of ITS variables from effects of depression and anxiety for past-year suicide ideation, past-year and lifetime suicide attempts. Mediation analyses examined associations between risk factors and these suicide outcomes via mechanisms proposed by the ITS.

Results

Past-year suicide ideation was associated with burdensomeness, mental rehearsal of suicide plans (a facet of acquired capability), and depression. Greater feelings of burdensomeness, and reduced fear of death, marked out participants who had attempted suicide in comparison to those who had experienced suicide ideation in the past year. Relationship status was indirectly associated with past-year suicide ideation via the mediators of depression and burdensomeness, and was associated with past-year attempts via its effect on ideation. Age at diagnosis was unrelated to any variables.

Limitations

Cross-sectional research is insensitive to causality and temporal dynamics, which is likely why interaction hypotheses from the ITS were unsupported. Normative measures may be invalid in autistic samples. There was no control group. The autistic sample was unrepresentative of the whole population, particularly autistic people with intellectual disabilities, ethnic/racial minorities, and gender minorities.

Conclusions

Perceived burdensomeness and acquired capability appear potentially important to suicide in autistic people, and may mediate the effects of some risk factors. Future research should explore the temporal dynamics of suicide trajectories in longitudinal, prospective designs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-022-00495-5.

Suicide Ideation and Thwarted Interpersonal Needs among Psychiatric Inpatients: A Network Approach

We aimed to demonstrate the utility of an item-level network analysis approach to suicide risk by testing the interpersonal psychological theory of suicide (IPTS) among 402 psychiatric inpatients. We hypothesized specific thwarted belongingness (TB) or perceived burdensomeness (PB; Interpersonal Needs Questionnaire items) facets would positively relate to passive or active suicide ideation, and these facets would positively relate to each other and form distinct clusters. We also tested TB and PB facets central to the networks as predictors of suicide ideation compared to the full TB and PB subscales. Face-valid items congruent with latent constructs proposed by the IPTS (i.e., feelings of burden on society, feeling that one does not belong) were the only two facets uniquely predictive of passive and active suicide ideation. Facets of TB and PB did not form distinct clusters. Item-level network analysis may have important conceptual, assessment, predictive, and clinical implications for understanding suicide risk.

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.

Mental health distress in homebound older adults: Importance of the aging network

Homebound older adults may be at risk of suicide due to elevated loneliness, social isolation, and depression. The Interpersonal Theory of Suicide posits that thwarted belongingness, perceived burdensomeness, and reduced fear of death are key components of suicide risk. To better understand suicide risk among culturally diverse, homebound older adults, we collected baseline data on the prevalence of psychological distress, thwarted belongingness, perceived burdensomeness, and past/present suicidality. Standardized measures were completed by 493 adults (ages 60-103) during in-home interviews, and results were compared to existing cutoffs to assess current risk. In total, 15.62% scored above the suicide risk cutoff, 23.73% of homebound older adults reported a history of suicidal ideation or behavior, 65 adults in this sample (13.18%) indicated the possibility of attempting suicide in the future, and 2.43% described a future attempt as "likely" or "very likely." There were no differences in suicide risk, thwarted belongingness, or perceived burdensomeness based on sex and race. However, there was a significant difference in psychological distress (F(3,428) = 2.624, p = .05), with White females (M = 7.90, SD = 5.63; N = 78) scoring higher than Black males (M = 5.43, SD = 5.04; N = 81). Using Aging Network services such as nutrition services (e.g.home-delivered meal programs) to intervene with at-risk older adults represents a strategy to prevent suicide. Implications for suicide intervention, including the potential to deliver services by linking them to nutrition services programs, are discussed.

Making the Case for a Preferences in Information Processing Model of Suicide

Introduction: In recent years, practice friendly models of suicidal behavior have emerged in the form of “ideation-to-action” frameworks. These frameworks focus on processes influencing both the formation of suicidal ideation and the translation of that ideation to suicide attempt and death. In this paper, we proffer an emerging model of suicide, Preferences in Information Processing (PIP), to augment contemporary suicide theories. First, we provide a primer on dual-process models of information processing theory and research as the foundation for the PIP. Next, drawing on a number of initial cross-sectional studies, we outline a rationale and examples of how preferences in motivated affect (i.e., Need for Affect) and cognition (i.e., Need for Cognition) may be integrated into existing ideation-to-action frameworks. Methods: We conducted secondary analysis of our pooled community sample PIP data. Results: We present new findings suggesting Need for Affect avoidance and Need for Cognition may be clinically relevant for persons at escalated risk for suicide. Discussion: The PIP offers new testable propositions within ideation-to-action suicide frameworks. We end with recommendations for a research agenda to further investigate the potential validation and utility of a PIP approach to suicidology.

Insomnia and suicide risk: a multi-study replication and extension among military and high-risk college student samples

OBJECTIVE/BACKGROUND

A clear link between insomnia concerns and suicidal ideation has been shown in a variety of populations. These investigations failed to use a theoretical lens in understanding this relationship. Research within the veteran population has demonstrated that feelings of thwarted belongingness (TB), but not perceived burdensomeness (PB), mediate the insomnia and suicidal ideation relationship. Using two high risk samples, the present investigation replicated and extended this line of inquiry to include interpersonal hopelessness about TB, a key component of the Interpersonal Psychological Theory of Suicide.

METHODS/RESULTS/CONCLUSIONS

Using medical record review and survey data, study 1 replicated the finding that TB is a stronger explanatory factor of the insomnia to suicidal ideation/suicide risk relationship in a sample of N = 200 treatment-seeking active-duty personnel. Study 2 found that insomnia symptoms had an indirect effect on suicidal ideation through TB and PB but not interpersonal hopelessness in a sample of N = 151 college students with a history of suicidal thoughts and/or behaviors. TB was the only mediator of the insomnia-suicide attempt likelihood link and insomnia to clinically significant suicide risk screening status. Limitations include cross-sectional design of both studies and the lack of formal diagnoses of insomnia. Implications and future research directions are discussed.

Chinese versions of the Interpersonal Needs Questionnaire: Psychometric properties, measurement invariance across gender and cultures

Associations between unmet interpersonal needs and different aspects of suicide have been observed in both Western and non-Western cultures using the Interpersonal Needs Questionnaire (INQ). However, measurement invariance is a prerequisite for comparing differences between culturally different groups, and to date, no studies have examined measurement invariance of INQ across cultures. This study aimed to (a) validate Chinese versions of the INQ, (b) assess measurement invariance across gender for the Chinese INQ, (c) assess measurement invariance across Australian and Chinese cultures for the INQ, and (d) comprehensively assess the association of interpersonal needs with suicide ideation. A sample of 469 Australian undergraduates and a sample of 854 Chinese undergraduates were used in this study. For testing measurement invariance across gender, the sample of Chinese undergraduates was split by gender into the Chinese male and Chinese female samples. Five versions of INQ (10-, 12-, 15-, 18- and 25-item) were tested. The 10- and 15-item Chinese INQ demonstrated adequate psychometric properties through various analyses (i.e., reliability, confirmatory factor analysis, and structural equation modeling) and also demonstrated measurement invariance across gender via multigroup confirmatory factor analysis. The 10-item INQ demonstrated measurement invariance across Australian and Chinese cultures. Of the two interpersonal factors, only perceived burdensomeness was significantly associated with suicide ideation. Multigroup structural equation modeling demonstrated that perceived burdensomeness may be a greater risk factor of suicide among Australian undergraduates than among Chinese undergraduates. Practical and theoretical contributions of this study are discussed.

Using categorical data analyses in suicide research: Considering clinical utility and practicality

OBJECTIVE

Categorical data analysis is relevant to suicide risk and prevention research that focuses on discrete outcomes (e.g., suicide attempt status). Unfortunately, results from these analyses are often misinterpreted and not presented in a clinically tangible manner. We aimed to address these issues and highlight the relevance and utility of categorical methods in suicide research and clinical assessment. Additionally, we introduce relevant basic machine learning methods concepts and address the distinct utility of the current methods.

METHOD

We review relevant background concepts and pertinent issues with references to helpful resources. We also provide non-technical descriptions and tutorials of how to convey categorical statistical results (logistic regression, receiver operating characteristic [ROC] curves, area under the curve [AUC] statistics, clinical cutoff scores) for clinical context and more intuitive use.

RESULTS

We provide comprehensive examples, using simulated data, and interpret results. We also note important considerations for conducting and interpreting these analyses. We provide a walk-through demonstrating how to convert logistic regression estimates into predicted probability values, which is accompanied by Appendices demonstrating how to produce publication-ready figures in R and Microsoft Excel.

CONCLUSION

Improving the translation of statistical estimates to practical, clinically tangible information may narrow the divide between research and clinical practice.

Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation

BACKGROUND

Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear.

METHODS

We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO.

RESULTS

A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons.

CONCLUSIONS

Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.