A systematic review of interpersonal processes and their measurement within experience sampling studies of self-injurious thoughts and behaviours

Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks.

The moderating effects of school resources on the impact of a school-based intervention on the social information-processing skills of third graders in rural China

Using a school-based intervention, Let's Be Friends (LBF), designed to promote the social information-processing (SIP) skills of third-grade children in rural China, the specific aim of this study was to assess the moderating effects of school characteristics on program outcomes. We systematically tested the moderating effects of six school-resource variables (i.e., student-teacher ratio, school size, number of library books per student, number of computers per 100 students, percentage of teachers with middle- and high-level titles, and percentage of teachers with high-level title or "backbone" recognition) on outcomes in a controlled trial of LBF program. School resources (i.e., small school size, low student-teacher ratio, and more teachers with high-level title or backbone) were associated with SIP skill acquisition, reduced aggressive behavior, and higher cognitive concentration. School contextual characteristics condition the impact of social-emotional education programs in Chinese rural primary schools.

Attachment and need to belong as moderators of the relationship between thwarted belongingness and suicidal ideation

BACKGROUND

In the Interpersonal Theory of Suicide, thwarted belongingness is presented as a main predictor for suicidal ideation. Studies only partially support this prediction. The aim of this study was to examine whether the heterogenous results are due to moderating effects of attachment and the need to belong on the association between thwarted belongingness and suicidal ideation.

METHODS

Four hundred forty-five participants (75% female) from a community sample aged 18 to 73 (M = 29.90, SD = 11.64) filled out online questionnaires about romantic attachment, their need to belong, thwarted belongingness, and suicidal ideation cross-sectionally. Correlations and moderated regression analyses were conducted.

RESULTS

The need to belong significantly moderated the relationship between thwarted belongingness and suicidal ideation and was associated with higher levels of anxious attachment and avoidant attachment. Both attachment dimensions were significant moderators of the relationship between thwarted belongingness and suicidal ideation.

CONCLUSION

Anxious and avoidant attachment as well as a high need to belong are risk factors for suicidal ideation in people with thwarted belongingness. Therefore, attachment style and need to belong should both be considered in suicide risk assessment and therapy.

Investigating the role of residential migration history on the relationship between attachment and sense of belonging: A SEM approach

With the rate of both domestic and international migration steadily increasing, the psychological impact of residential migration remains largely unexplored. Attachment, the emotional bond we establish with those close to us, and sense of belonging, the feeling of connectedness to a community, may be vulnerable to frequent migration. This study investigates the association between individuals' early attachment style, sense of belonging, and migration history. A large international sample (N = 465) aged between 18 and 50 years old (M = 21.85; SD = 4.48), completed a survey on early attachment primary attachment style questionnaire (PASQ), sense of belonging (SOBI), and migration. Results comparing non-movers (n = 240) to domestic movers (n = 52), international movers (n = 109), and domestic-international movers (n = 64), indicate important group differences related to early attachment and its relationship to one's sense of belonging. Moreover, insecure attachment was associated with increased migration early in life and, more in general, predictive of a negative sense of belonging later in life. Implications for both research and practice are discussed.

Is Violence, Violence no Matter Where it Strikes? Adjudicated Boys, Thwarted Belongingness, Perceived Burdensomeness, and Acquired Capability for Suicide

This study explores treating violence against others as a precursor to self-directed violence. It tests the utility of including violence against others in the measure of acquired capability to test assumptions from the interpersonal theory of violence. Four theoretical hypotheses are assessed that are consistent with the theory: (1) thwarted belongingness (parental abandonment and rejection) and perceived burdensomeness (exposure to parental interpersonal violence and child abuse) independently increase the likelihood of suicidal ideation; (2) the interaction of thwarted belongingness and perceived burdensomeness increases the likelihood of suicidal ideation controlling for other pertinent variables; (3) the three-way interaction of thwarted belongingness, perceived burdensomeness, and acquired capability (violence against others and prior suicidal attempts) increases the likelihood of suicidal attempts controlling for other pertinent variables; and (4) self-harm responds to the theoretical variables and similarly, to attempts. Subjects are court-adjudicated males (ages 13-18) who were residents for up to 1 year at the Ocean Tides School and rehabilitation center from 1975-2019. The data span 44 years and include 2195 youth. Depression, drug/alcohol use, race, ethnicity, socioeconomic status, and interaction terms between SES and race and SES and ethnicity are also examined. Backward conditional logistic regression analyses find mixed support for the hypotheses, but strong support for including violence against others in the concept of acquired capability. Support is also found for conceptualizing child abuse and exposure to parental interpersonal violence as perceived burdensomeness in tests of this theory as well as measures of depression. Major implications for programming in the treatment and rehabilitation of delinquent boys include conceptualizing and approaching violence against others as a precursor to suicidal attempts and other self-directed harm.

Moral injury, depression, and anxiety symptoms among health and social care workers during the COVID-19 pandemic: The moderating role of belongingness

BACKGROUND

The COVID-19 pandemic can affect health and social care workers' (HSCWs') mental health in their role as frontline workers in this crisis. The pandemic poses unique challenges to HSCWs as they face morally daunting decisions while working with limited knowledge and resources. This study primary objective was to examine the moderating role of thwarted belongingness in the relationships between HSCWs' exposure to potentially morally injurious events (PMIEs) and moral injury symptoms, depression, and anxiety.

METHOD

A sample of 296 Israeli HSCWs completed validated self-report questionnaires that include measures of depression, anxiety, PMIE exposure, moral injury symptoms, and a sense of thwarted belongingness.

RESULTS

About one-third (33.6%) of the sample met the criteria for major depression and 21.5% for generalized anxiety. Beyond demographic and work-related characteristics, PMIEs contributed to depression and anxiety levels. The indirect effect of PMIE exposure on anxiety/depression symptoms through MI symptoms was significant only at high levels of thwarted belongingness among HSCWs. Thus, greater PMIE exposure contributes to more MI symptoms, which, in turn, is linked to higher levels of anxiety/depression symptoms among HSCWs with high levels of thwarted belongingness.

LIMITATIONS

Cross-sectional design, self-report questionnaires, sample limited to Israeli HSCWs.

CONCLUSIONS

The study's findings highlight the mental burden of HSCWs during the COVID-19 pandemic and the critical contribution of PMIE exposure and thwarted belongingness to this burden. Clinicians treating HSCWs coping with depression and anxiety following the COVID-19 should also attend to moral injury symptoms as well to the belongingness experience.

The Association between Parental Attachment and Youth Suicidal Ideation: A Three-Level Meta-analysis

Youth suicidal ideation is regarded as a serious psychological problem that hinders their mental health development. Parental attachment is considered a critical factor linked with youth suicidal ideation, but existing findings are still inconsistent. The present study was based on the PRISMA method; it employed a three-level meta-analysis to obtain reliable estimates of effect size and examined a range of moderators (sample, publication, outcome). Through the retrieval of articles published before November 2020, a systematic search yielded 31 independent studies (N = 12848) from which 109 effect sizes could be extracted. The present meta-analysis revealed a significant negative correlation between parental attachment and youth suicidal ideation (r = -0.108, p < 0.001), implying that youths show a higher level of suicidal ideation when they experienced lower quality of parental attachment. Moreover, the overall association was influenced by different parental attachment patterns. More specifically, youth suicidal ideation was more strongly associated with parental alienation (r = 0.501, p < 0.001) than with parental communication (r = -0.173, p < 0.001). The moderator analyses also showed that the type of instrument used was a significant moderator of the association between parental attachment and youth suicidal ideation. The strength of the overall association was significantly stronger when measured with the IPPA (Inventory of Parent and Peer Attachment) (r = -0.181, p = 0.003) than with the ECR (Experiences in Close Relationships) (r = 0.085, p = 0.003). These results indicate that assessing parental attachment is important in strengthening interventions that target suicidal ideation among youths.HIGHLIGHTSOur analysis revealed a significant negative association between parental attachment and youth.Specifically, the presence of a secure relationship with parents, as perceived by the youth, brings forth feelings of appreciation, acceptance, safety, and confidence, that predispose the individual to seek help in a more consistent manner and to resist to maladjusted behavior when faced with adversity. However, a low quality of attachment produces cognitions associated with perceived burdensomeness and failed belongingness, which increase a youth's vulnerability to suicidal ideation.The parental attachment pattern showed a significant moderating effect on the association between parental attachment and youth suicidal ideation.Regarding the association between parental attachment and youth suicidal ideation, we observed that the manner in which parental attachment is measured is another moderating effect.

Dynamic Associations of Parent-Adolescent Closeness and Friend Support With Adolescent Depressive Symptoms Across Ages 12-19

Supportive relationships with parents and friends reduce adolescent risk for depression; however, whether and how the strength of these associations changes across adolescence remains less clear. Age-varying associations of mother-adolescent and father-adolescent closeness and friend support with depressive symptoms were examined across ages 12.5-19.5 using data from the National Longitudinal Study of Adolescent to Adult Health (N = 4,819). Positive relationships with mothers, fathers, and friends were associated with lower depressive symptoms across adolescence, and the associations were generally stable across age. The association between father-adolescent closeness and depressive symptoms was stronger for girls than for boys during mid-adolescence. Mother-adolescent closeness was more strongly negatively associated with depressive symptoms in the context of higher friend support during mid-adolescence.

Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression

Objective

Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression.

Methods

Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents.

Results

There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents.

Conclusion

Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

Coronavirus Anxiety and Psychological Adjustment in College Students: Exploring the Role of College Belongingness and Social Media Addiction

The psychological health of people all around the world is severely affected due to the COVID-19 outbreak. This study examined a moderated mediation model in which college belongingness mediated the relationship between coronavirus anxiety and psychological adjustment, and this mediation effect was moderated by social media addiction. A total of 315 undergraduate students (M = 21.65±3.68 years and 67% females) participated in this study. The results demonstrated that college belongingness partially mediated the association between coronavirus anxiety and psychological adjustment. The mediating part from coronavirus anxiety to college belongingness was moderated by social media addiction. In comparison with the high level of social media addiction, coronavirus anxiety had a stronger predictive effect on college belongingness under the low and moderate levels of social media addiction condition. Our findings highlight that college belongingness is a potential mechanism explaining how coronavirus anxiety is related to psychological adjustment and that this relation may depend on the levels of social media addiction.

The Relationship Between Adult Attachment and Suicidal Thoughts and Behaviors: A Systematic Review

We aimed to (1) determine the extent of the relationship between attachment and suicidal thoughts and behaviors (STB), (2) investigate whether any gender differences exist, and (3) conduct a theoretical synthesis of the included studies. A systematic search of the databases Web of Science; EBSCO Host Medical and Psychology-related resources, which includes CINAHL, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, and PsycINFO; and EMBASE was conducted, with 52 studies meeting the inclusion criteria. While secure attachment acts as protective factor, insecure attachment orientations appear to be vulnerability factors compromising an individual's capacity to cope with relationship issues, increasing suicide risk. There is insufficient evidence about gender differences. The theoretical synthesis suggests that attachment, interacting with other psychological traits in response to negative life events, acts as a vulnerability or protective factor for STB. Implications for treatment are also discussed.

The role of psychological and social factors in the relationship between attachment and suicide: A systematic review

Insecure attachment is widely accepted to be a risk factor for suicidal thoughts and behaviour. To increase our understanding of this distal association, the current systematic review aimed to evaluate empirical evidence that has investigated the role of psychosocial mechanisms within this relationship. Sixteen original research articles were identified, with the majority carrying out mediational analyses to test their hypotheses. Substantial heterogeneity was found across studies with regards to their theoretical approach to assessing attachment, suicide-related outcomes, sample population, statistical analyses, and the psychological factors under investigation. Nevertheless, this emergent evidence base indicates that a range of predisposing, precipitating, and crisis-state factors may mediate the association between attachment security and suicidality. Studies that investigated moderating factors did not report significant findings, and the mediating role for psychiatric diagnoses remains unclear. Furthermore, this emerging research base is limited by an over-reliance on cross-sectional designs and self-reported data. Longitudinal and experimental designs are required to verify causal pathways and to investigate whether trait vulnerabilities interact with acute stressors to increase suicide risk. Finally, disorganized attachment has been overlooked so far and should be given greater consideration going forward.

Interoceptive deficits, non-suicidal self-injury, and suicide risk: a multi-sample study of indirect effects

BACKGROUND

Interoceptive deficits (ID) have been associated with non-suicidal self-injury (NSSI) and suicidal behavior in multiple studies. Many of these studies are limited in scope, and have not fully examined possible mechanisms explaining how ID affect suicidal behavior.

METHODS

This study assesses how self-reported ID relate to suicide ideation and attempts in six distinct and geographically diverse samples of adults (n = 2706) and one sample of adolescents (n = 436). Participants responded to a variety of self-report questionnaires and interviews.

RESULTS

Contrary to our hypothesis, self-reported ID were only associated with suicidal ideation in two samples, one of which was the adolescent sample. Largely consistent with our predictions, self-reported ID exhibited an indirect effect on suicide attempts through versatility of NSSI in four of the five adult samples tested. Finally, the indirect effects of self-reported ID on suicide attempts through NSSI versatility did not act indirectly through behaviorally assessed pain tolerance.

CONCLUSIONS

We found that, in adults, self-reported ID are not associated with suicidal ideation, but are connected with a history of suicide attempts, through an indirect effect via NSSI. Our findings also indicate that the mechanism of action leading from self-reported ID to suicidal behavior may differ between adolescents and adults, and relate to suicidal behavior independent of pain tolerance. Clinical implications and future directions are discussed.

A longitudinal study on the relationship among childhood emotional abuse, gratitude, and suicidal ideation of Chinese adolescents

BACKGROUND AND OBJECTIVE

Suicidal ideation is a significant predictor of suicidal attempt. Based on the developmental psychopathology perspective and the resilience theory, this study examines whether trait gratitude mediates the relationship between childhood emotional abuse and adolescent suicidal ideation.

PARTICIPANTS AND SETTING

A sample of 909 Grade 8 to Grade 9 adolescents aged 12-18 years in Hong Kong, a Special Administrative Region in China, was recruited from six secondary schools.

METHOD

A two-wave longitudinal study was conducted. Participants completed the same measures on Gratitude Quesitonnaire-6, Suicidal Ideation Scale, emotional subscale of Child Abuse and Trauma Scale at two time points 12 months apart.

RESULTS

Results of cross-lagged analyses showed that adolescents' suicidal ideation was positively associated with childhood emotional abuse and negatively associated with gratitude; further, the association between childhood emotional abuse and suicidal ideation was mediated by gratitude.

CONCLUSIONS

Findings of this study implied that while exposure to parental emotional abuse might have an adverse impact on the development of gratitude, adolescents' current level of gratitude still exerts its protective effect by directly reducing their suicidal ideation. Gratitude or other resilience factors that might comprise additional mediating mechanisms from childhood emotional abuse to mental health problems in later life is worthy of further investigation.

A mediational model linking perceptions of security, alexithymia and behavior problems of sexually abused children

BACKGROUND

Perceptions of security toward parents are related with internalized and externalized problems among victims of child sexual abuse (CSA). Alexithymia, which is difficulty in identifying and expressing feelings, is associated with the quality of parent-child relationships (Oskis et al., 2013) and behavior problems in children (Di Trani et al., 2013).

OBJECTIVE

The current study tested the mediational role of alexithymia in the relationship between perceptions of security toward parents and behavior problems among CSA victims.

PARTICIPANTS AND METHOD

Using a short-term multi-informant prospective design, 263 victims of CSA aged 6-12 years completed the Kerns Security Scale (Kerns, Klepac, & Cole, 1996), which evaluates perceived attachment security to mothers and fathers. Parents completed the Child Behavior Checklist (Achenbach & Rescorla, 2001) at Time 1 to provide baseline scores of behavior problems and again four months later. At Time 2, parents also assessed the children's alexithymia using the Children's Alexithymia Measure (Way et al., 2010).

RESULTS

Perceptions of security were both associated with alexithymia, as well as with internalizing and externalizing problems (p < .05). A mediational model showed that perception of security toward fathers outweighed the mother-child relationship in predicting children's alexithymia. Path analysis revealed that the father-child relationship predicted decreased behavioral problems at Time 2 through a lower level of alexithymia. The model explained 46.9% of internalizing problems and 56.1% of externalizing problems (p < .05).

CONCLUSIONS

The findings support the relevance of alexithymia as an intervention target for CSA victims and underscore the importance of the father-child relationship.

The Security Scale as a measure of attachment: meta-analytic evidence of validity

This meta-analysis evaluated the psychometric properties of the Security Scale (SS; k = 57 studies), a measure specifically designed to assess attachment in middle childhood, using several criteria: stability over time, associations with other attachment measures, relations with caregiver sensitivity, and associations with theoretically driven outcomes. The SS demonstrated moderate stability and meaningful associations with other attachment measures and caregiver sensitivity. Furthermore, the SS showed significant associations with developmental correlates of attachment: school adaptation, emotional and peer social competence, self-esteem, and behavioral problem. Some effect sizes varied as a function of socioeconomic status (SES; peer social competence and maladjustment) and publication status (emotional competence, peer social competence, and self-esteem). The association between the SS and our constructs of interest were, for the most part, independent of geographical location and child gender or age. Overall, findings suggest that the SS is a robust measure of attachment in middle childhood and early adolescence.

Reactive Aggression and Suicide-Related Behaviors in Children and Adolescents: A Review and Preliminary Meta-Analysis

The empirical literature on the association between reactive aggression and suicide-related behaviors in children and adolescents was reviewed. A narrative review of seven studies that met inclusion/exclusion criteria is followed by a preliminary meta-analysis to provide insight into the strength of the association between reactive aggression and suicide-related behaviors. Each of the seven studies reported a statistically significant association between reactive aggression and suicide-related behaviors, including suicide, nonfatal suicide attempt, and suicide ideation. Results from the meta-analysis indicated a consistent, medium-sized association (k = 7; N = 4,693; rbar = .25). The narrative review and results of the preliminary meta-analysis support the promise of pursuing future research on reactive aggression and suicide-related behaviors in children and adolescents. A theoretical model is proposed to guide the development of future research.

Artificial neural network coding of the child attachment interview using linguistic data

Assessing attachment in adolescents is important due to relations between insecurity and psychopathology. The child attachment interview (CAI) holds promise in this regard, but is time-consuming to code, which may render it inaccessible. The aim of this study was to develop computerized neural network models to predict attachment classifications on the CAI and to determine whether the models could achieve the CAI's benchmark qualification of 80% on reliability training cases. Four hundred and ninety interviews from inpatient adolescents served as model training and testing samples. The CAI's 30 standard reliability cases were treated as the independent holdout sample, in which the performance of the final models was evaluated against the 80% benchmark. Models demonstrated moderate accuracy and high correct classification rates, as compared to human coders. Performance was poorer when models were applied to the reliability training cases, but automated coding of the CAI holds promise for future development.

Interpersonal stress and suicidal ideation in adolescence: An indirect association through perceived burdensomeness toward others

BACKGROUND

Research has documented significant associations between life stress, especially interpersonal stress, and suicidal ideation in adolescents. Little is known about variables that explain the association between interpersonal stress and suicidal ideation.

METHODS

The present study evaluated a conceptual model in which interpersonal stress (chronic and episodic) predicted suicidal ideation indirectly via thwarted belongingness and perceived burdensomeness among 180 inpatients (65.0% girls) ages 12-17 years (M=14.72, SD=1.49). Non-interpersonal stress was also examined to determine whether the model was specific to interpersonal stress or common to stress in general.

RESULTS

Structural equation modeling identified a significant indirect effect of chronic interpersonal stress on suicidal ideation via perceived burdensomeness. Episodic interpersonal stress was significantly correlated with thwarted belongingness and suicidal ideation, but was not a significant predictor of suicidal ideation in a model that controlled for depressive and anxious symptoms. No significant associations were found between non-interpersonal stress and suicidal ideation.

LIMITATIONS

Adolescents were the sole informant source, data on psychiatric diagnoses were not available, and the optimal time interval for examining stress remains unclear. The cross-sectional study design prevents conclusions regarding directionality.

CONCLUSIONS

These findings highlight the role of chronic interpersonal stress in suicidal ideation in adolescents, as well as the potential promise of perceived burdensomeness as a target for programs designed to prevent or reduce suicidal ideation.