Thwarted Belongingness and Suicide Risk in Primary Care: Perceived Burdensomeness and Psychache as Mediators

Suicide is a significant public health concern, particularly among primary care patients, given that many individuals who die by suicide visit their primary care provider in the months prior to their death. We examined constructs from two prominent theories of suicide, the interpersonal and psychache theories, including thwarted belongingness, perceived burdensomeness, and psychache. Among our sample (n = 224) of patients, perceived burdensomeness and psychache, individually and in serial, mediated the relation between thwarted belongingness and suicidal behavior. Thwarted belongingness was associated with greater perceived burdensomeness and, in turn, with more psychache and increased suicide risk. Our results elucidate the associations between the interpersonal and psychache theories of suicide. Clinical strategies that may reduce thwarted interpersonal needs and psychache, and which are appropriate for medical settings, are discussed.

Sexual Victimization and Suicide Ideation: An Atemporal Indirect Effects Model

INTRODUCTION

Suicide is a major public health concern among young adults. Moreover, college students are at elevated risk for sexual victimization, which is associated with elevated suicide risk. Nonetheless, not all college student survivors of sexual victimization think about suicide. Previous research has used the interpersonal psychological theory of suicide (IPTS) as a framework for understanding the association between interpersonal violence victimization and suicide ideation The current study aimed to replicate and extend the results of Poindexter et al. AQ1] by testing the serial indirect effects of IPTS constructs in the relationship between sexual victimization and suicide ideation among a sexually-victimized sample of college students. It was expected that depressive symptoms, thwarted belongingness, and perceived burdensomeness, in that order, would indirectly affect the association between cumulative sexual victimization history and suicide ideation in the past month.

METHOD

Data were collected from 796 college students via online survey. After exclusion criteria, 236 college students who reported at least one lifetime experience of sexual victimization were included in analysis.

RESULTS

Results indicated that the relationship between cumulative sexual victimization and past-month suicide ideation frequency was indirectly affected by depressive symptoms, thwarted belongingness, and perceived burdensomeness, in serial.

DISCUSSION

Results indicated that the indirect effects model proposed by Poindexter et al. was significant in that more frequent lifetime sexual victimization related to more frequent past-month suicide ideation, and this relationship was strengthened indirectly by depressive symptoms, TB, and PB, in that order. Results underscore the importance of screening survivors of sexual victimization for suicide ideation and associated risk factors, specifically depressive symptoms, TB, and PB.

Pilot randomized controlled trial of a brief strategy to prevent suicide after discharge from residential addiction treatment

INTRODUCTION

Veterans are at greater risk for suicide and veterans with substance use disorder (SUD) have an even greater risk. Little research has looked into brief interventions to prevent suicide in this population in residential substance use treatment programs.

METHOD

We conducted a pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients participating in the Residential Recovery Center (RRC) SUD 28-day program and deemed at risk for suicide. We measured changes in symptoms at 1-, 3-, and 6-months. We looked at social connectedness, suicidal ideation, hopelessness, thwarted belongingness, perceived burdensomeness, and treatment engagement.

RESULTS

The study enrolled twenty patients. One participant withdrew immediately after baseline. We found that adherence to VA BIC components was high, as 100 % of patients (N = 10) completed 70 % or more of the VA BIC visits. Furthermore, 80 % of intervention group patients (N = 8) completed all VA BIC components. During the six-month follow-up, suicidal ideation improved in patients assigned to VA BIC, while it worsened in the standard care arm. Similarly, patients assigned to VA BIC reported a reduction in perceived burdensomeness over the six-month follow-up period while it worsened in the standard care arm. Additionally, VA BIC may modestly improve treatment engagement in the first month postdischarge.

CONCLUSION

We were able to recruit and enroll patients from a residential SUD treatment program into a clinical trial of the VA BIC intervention. Our preliminary results suggest that VA BIC may be useful in reducing suicidal ideation and perceived burdensomeness in patients who are discharged from residential SUD treatment programs and increasing treatment engagement. Future trials of VA BIC should determine whether VA BIC can reduce the risk of suicide in patients who are discharged from residential SUD treatment programs.

Self-burdensomeness, other-burdensomeness, and suicidal ideation

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

Sleep quality and in-person versus online social interaction during the early COVID-19 pandemic lockdown: Impact on affect and interpersonal needs among young adults

We examined relationships among sleep quality and forms of social interaction (in-person vs. online) as predictors of change in affect and interpersonal needs (perceived burdensomeness, thwarted belongingness) - correlates of suicidal thoughts and behaviors - during the early COVID-19 pandemic lockdown. New York City undergraduates (N = 58) from four public colleges completed a baseline survey and daily diaries up to 30 days in April-June 2020. Adjusting for relevant covariates, better sleep quality and in-person communication predicted greater positive affect and lower negative affect over time, but online social interaction only predicted greater positive affect and did not predict negative affect. Better sleep quality predicted lower perceived burdensomeness but not thwarted belongingness. Both in-person and online social interaction - but not total hours on social media - predicted lower thwarted belonging and perceived burdensomeness. Greater hours spent on social media each day lessened the relationship between in-person interaction and positive affect and lessened the buffering effect of in-person interaction on perceived burdensomeness. Improving sleep quality and increasing in-person interaction may ameliorate psychological variables that increase risk for suicidal thoughts and behaviors. However, when in-person interaction is limited, such as during the COVID-19 pandemic, online social interaction might be encouraged - depending on the nature of the interactions - to increase positive affect and buffer against suicide-related factors.

Bisexual-specific minority stress in nonsuicidal self-injury: The mediating role of perceived burdensomeness

Background

Bisexual-identifying individuals are at heightened risk for engaging in non-suicidal self-injury (NSSI), with the odds up to six times higher compared to heterosexual individuals and up to four times higher compared to lesbian/gay (L/G) individuals. While research has established that sexual minorities may be at increased risk because minority stressors exacerbate psychological processes associated with NSSI, little research has examined bisexual-specific pathways of risk. In this study, we replicated findings that suggest Interpersonal Theory of Suicide (IPTS) variables (i.e., perceived burdensomeness and thwarted belongingness) mediate the association between minority stress and NSSI and extended these findings by examining whether such mediation is moderated by sexual minority identity. Furthermore, we explored whether IPTS variables mediate the association between bisexual-specific minority stress and NSSI.

Method

A sample of 259 cisgender L/G (n = 93) and bisexual (n = 166) MTurk workers completed measures assessing minority stress, NSSI, and IPTS variables.

Results

Mediation analyses replicated findings that experiences of minority stress increase NSSI by increasing perceived burdensomeness [PB], though moderated mediation analyzes failed to provide evidence that sexual minority identity moderated this indirect effect. Rather, minority stress from both heterosexual and L/G individuals increased NSSI through increased PB for bisexual individuals.

Limitations

The use of cross-sectional data does not allow conclusions of causal relationships.

Conclusions

These results suggest that for bisexual individuals, minority stress from both heterosexual and L/G individuals increases NSSI by increasing PB. Future researchers and clinicians should consider the additive burden of minority stress in bisexual individuals.

Perceived Burdensomeness and Thwarted Belongingness in Text Messages of Suicide Attempt Survivors

OBJECTIVE

Perceived burdensomeness and thwarted belongingness are considered interpersonal risk factors for suicide. Examining these themes in personal text messages may help identify proximal suicide risk.

METHOD

Twenty-six suicide attempt survivors provided personal text messages and reported dates for past periods characterized by positive mood, depressed mood, suicidal ideation (with no attempt), or the two-week period leading up to suicide attempt(s). Texts were then classified into the applicable period based on matching dates. Texts (N = 194,083; including n = 86,705 outgoing texts) were coded for perceived burdensomeness and thwarted belongingness by masked trained raters. Multilevel models were fit to examine whether the target themes (combined into one overall interpersonal risk variable due to low base rate) were more prevalent in texts sent during higher risk episodes (e.g., suicide attempt vs. depressed mood episodes).

RESULTS

0.57% of outgoing texts contained either target theme. As hypothesized, logistic models showed participants were more likely to send texts containing the target themes during suicide attempt episodes relative to suicidal ideation (with no attempt) episodes, depressed mood episodes, and positive mood episodes, and during suicidal ideation (with no attempt) episodes relative to positive mood episodes. All contrasts were robust to post-hoc correction except for suicide attempt episodes vs. ideation (with no attempt) episodes. No other significant pairwise differences for episode type emerged.

CONCLUSIONS

Despite the small sample size and low base rate of target themes in the texts, perceived burdensomeness and thwarted belongingness were associated with intra-individual suicide risk severity in personal text messages.

Self-hate, dissociation, and suicidal behavior in bulimia nervosa

BACKGROUND

Individuals with eating disorders (EDs) often struggle with markedly low self- esteem and are at risk for suicidal behavior. Dissociation and perceived burdensomeness are often cited as facilitators of suicidal outcomes. Specifically, perceived burdensomeness is comprised of self-hate and liability on others, although it remains unclear which variables most heavily influence suicidal behavior in EDs.

METHODS

In a sample of 204 women with bulimia nervosa, the present study examined the potential impact of self-hate and dissociation on suicidal behavior. We hypothesized that suicidal behavior would be equally, and potentially more strongly, related to self-hate than dissociation. Regression analyses investigated the unique effects of these variables on suicidal behavior.

RESULTS

Consistent with our hypothesis, a significant relationship emerged between self-hate and suicidal behavior (B = 0.262, SE = 0.081, p < .001, CIs = 0.035-0.110, R-squared =0.07) but not between dissociation and suicidal behavior (B = 0.010, SE = 0.007, p = .165, CIs = -0.389-2.26, R-squared =0.010). Additionally, when controlling for one another, both self-hate (B = 0.889, SE = 0.246, p < .001, CIs = 0.403-1.37) and capability for suicide (B = 0.233, SE = 0.080, p = .004, CIs = 0.076-0.391) were uniquely and independently associated with suicidal behavior.

LIMITATIONS

Future work should include longitudinal analyses to understand temporal relationships among study variables.

CONCLUSIONS

In sum, when considering suicidal outcomes, these findings support a view that highlights personal loathing rooted in self-hate rather than de-personalizing aspects of dissociation. Accordingly, self-hate may emerge as a particularly valuable target for treatment and suicide prevention in EDs.

Perceived abusive supervision and graduate students' suicidal ideation: from the perspective of interpersonal psychological theory of suicide

BACKGROUND

In recent years, the issue of suicide caused by the stress of a contradictory relationship between graduate students and academic supervisors has aroused heated discussion in society. Based on the interpersonal psychological theory of suicide, this study aims to examine the influence of the perceived abusive supervision on graduate students' suicidal ideation and the parallel mediating roles of thwarted belongingness and perceived burdensomeness.

METHODS

We conducted a cross-sectional online survey measuring perceived abusive supervision, interpersonal psychological needs and suicidal ideation among 232 Chinese graduate students. A structural equation model was constructed to test the hypothesis.

RESULTS

The results showed that abusive supervision directly exacerbated suicidal ideation (β = 0.160, 95% CI = [0.038, 0.281], p = 0.009) and indirectly influenced suicidal ideation through thwarted belongingness (β = 0.059, 95% CI = [0.008, 0.110], p = 0.019) and perceived burdensomeness (β = 0.102, 95% CI = [0.013, 0.191], p = 0.018). The indirect effect accounted for 50.15% of the overall effect.

CONCLUSIONS

These findings enrich our understanding of the influence of supervisor-student relationship by integrating the literatures on educational and organizational behaviour, and provide practical insights for psychosocial interventions from the perspective of the interpersonal psychological theory of suicide.

Longitudinal Relations Between Parenting Practices and Adolescent Suicidal Ideation in a High-Risk Clinical Sample: A Moderated Mediation Model

Parenting behaviors are associated with adolescent suicidal ideation (SI), but few studies have examined this relation longitudinally or investigated underlying mechanisms. We investigated a moderated mediation model to evaluate perceived burdensomeness as a mediator in the longitudinal relation between parenting behavior (warmth and verbal hostility) and adolescent SI. We hypothesized that this association would be particularly strong among adolescents with greater functional impairment. The sample included 147 adolescents (M_age = 14.9, Age Range = 12-18 years, 76.2% female) and a primary caregiver (M_age = 43.5, Age Range = 27-60 years, 81.4% female) enrolled in a clinical trial. Caregivers completed measures of warmth and verbal hostility (PCPR) and adolescents completed measures of functional impairment (CDI-2), perceived burdensomeness (INQ), and SI (SIQ-JR) at baseline, 12 and 18 months. Two moderated mediation path analyses, one for each parenting behavior, were conducted. Age, sex, treatment condition, baseline and 12-month SI, baseline perceived burdensomeness, and the alternate baseline parenting behavior were included as covariates. Neither model yielded a significant direct effect between baseline parental verbal hostility or warmth and 18-month SI. However, lower warmth and higher verbal hostility were positively associated with 18-month SI indirectly through greater 12-month perceived burdensomeness among youth with relatively higher levels of functional impairment. Perceptions of burdensomeness are a mechanism by which low parental warmth and high parental verbal hostility contribute to SI, but only among youth with greater functional impairment. Interventions to address youth perceptions of burdensomeness may be beneficial, particularly for the most highly impaired youth.

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.

Reciprocal/Authoritarian Filial Piety and Mental Well-Being in the Chinese LGB Population: The Roles of LGB-Specific and General Interpersonal Factors

Although filial piety is considered as a salient value in the Chinese culture, studies on the mental well-being of Chinese lesbian, gay, and bisexual (LGB) individuals rarely take filial piety into account or examine it in relation to other variables to clarify the mechanism between filial piety and mental well-being. A total of 1453 LGB participants from 30 provinces and regions in Mainland China completed the online survey. They provided demographic information and completed measures of filial piety, a general interpersonal factor (i.e., perceived burdensomeness and thwarted belongingness), an LGB-specific interpersonal factor (i.e., perceived parental support for sexual orientation), and mental well-being. Structural equation modelling results indicated that higher reciprocal filial piety was directly, and indirectly through lower thwarted belongingness, associated with better mental well-being. Lower authoritarian filial piety was indirectly associated with better mental well-being through higher perceived parental support for sexual orientation and lower thwarted belongingness. In addition, reciprocal filial piety had a stronger effect on perceived parental support for sexual orientation and perceived burdensomeness among lesbians and bisexual women than gay and bisexual men. These findings suggest that reciprocal filial piety is a protective factor, whereas authoritarian filial piety is a risk factor, for the mental well-being of Chinese LGB persons. Moreover, perceived parental support for sexual orientation and thwarted belongingness might be the mechanisms underlying the effect of reciprocal/authoritarian filial piety on mental well-being. Implications of findings for practice and research are discussed.

Perceived burdensomeness, but not thwarted belongingness, mediates the impact of PTSD symptom clusters on suicidal ideation modeled longitudinally

BACKGROUND

Studies examining Posttraumatic Stress Disorder symptom clusters, suicidal ideation, and variables described in the Joiner's interpersonal theory of suicidal behavior were cross-sectional.

METHODS

We tested whether the relation between the Posttraumatic Stress Disorder symptom clusters and suicidal ideation is mediated by perceived burdensomeness and thwarted belongingness (variables of the interpersonal theory of suicidal behavior) in military personnel with current suicidal ideation using longitudinal design. DSM-IV model with reexperiencing, avoidance, numbing, and hyperarousal clusters was used. Structural equation modelling was used to test separate models for each symptom cluster with a symptom cluster at baseline, month 1 perceived burdensomeness and thwarted belongingness, and month 3 suicidal ideation, controlling for baseline values of the month 1 and month 3 variables.

RESULTS

Analysis of direct non-mediation models showed that baseline reexperiencing (p = .08) and avoidance (p = .07) symptom clusters marginally predicted month 3 suicidal ideation. The mediation analyses showed indirect effects from baseline reexperiencing, avoidance, and hyperarousal to suicidal ideation at month 3 through perceived burdensomeness at month 1. Thwarted belongingness did not mediate the relations between symptom clusters and suicidal ideation.

LIMITATIONS

The mechanism driving development of suicidal ideation in military personnel with PTSD may be different from the mechanism in other samples. Doing a phone interview limited us to use questionnaires instead of a clinical interview.

CONCLUSIONS

Our findings suggest that interventions targeting perceived burdensomeness in military personnel with reexperiencing, avoidance, and hyperarousal symptoms may be beneficial to reduce suicidal ideation.

The Neural Processes Interlinking Social Isolation, Social Support, and Problem Alcohol Use

BACKGROUND

Subjective feeling of social isolation, as can be measured by perceived burdensomeness (PB), is a major risk factor for alcohol misuse. Heightened PB is associated with elevated stress response and diminished cognitive control, both of which contribute to problem drinking. Here, we sought to identify the neural substrates underlying the relationship between PB and alcohol misuse.

METHODS

We employed resting-state functional magnetic resonance imaging data collected from 61 problem drinkers to characterize the functional connectivity of the hypothalamus and ventral striatum (VS) in relation to PB. We specifically examined whether the connectivities of the hypothalamus and VS were differentially influenced by PB to produce contrasting effects on alcohol use. Finally, we evaluated how individual differences in social support modulate the inter-relationships of social isolation, neural connectivity, and the severity of problem drinking.

RESULTS

Whole-brain multiple regressions show a positive relationship between PB and hypothalamic connectivity with the hippocampus and an inverse pattern for VS connectivity with the middle frontal gyrus. Difference in strength between the 2 connectivities predicted the severity of problem drinking, suggesting an imbalance involving elevated hypothalamic and diminished prefrontal cortical modulation in socially isolated problem drinkers. A path analysis further revealed that the lack of social support was associated with a bias toward low prefrontal connectivity, which in turn increased PB and facilitated problem drinking.

CONCLUSIONS

Altered hypothalamus and VS connectivity may underlie problem drinking induced by social isolation. The current findings also highlight the important role of social support as a potential protective factor against alcohol misuse.

Perceived burdensomeness and neural responses to ostracism in the Cyberball task

Previous studies have identified the brain correlates of social pain processing during ostracism. However, the affective response to ostracism may vary according to individual differences in interpersonal needs and subsequent social actions. Despite this relationship, how the neural processes underlying ostracism may be modulated by interpersonal needs to regulate prosocial behaviors remains unknown. Here, in an fMRI study of 64 adults performing the Cyberball task, we quantified ball catching and tossing response time (RT) as a behavioral measure of participants' willingness to seek and reciprocate social interactions. Neural activations to social exclusion were identified and characterized in relation to individual differences in behavioral performance and perceived burdensomeness (PB), a measure of interpersonal needs. The results showed that social exclusion elicited activity in the anterior insula, middle frontal gyrus, postcentral gyrus, and dorsomedial prefrontal cortex, replicating previous studies on ostracism. Importantly, those with higher PB also exhibited greater brain activations to exclusion as well as reduced prosocial behaviors, as reflected by slower ball catching and tossing RT in the Cyberball task. Taken together, these findings suggest that emotional distress in ostracism may increase with PB, resulting in stronger neural responses to social pain and behavioral avoidance of social interactions.

Validation of the motivational phase of the integrated motivational-volitional model of suicidal behavior in a German high-risk sample

BACKGROUND

The Integrated Motivational-Volitional (IMV) model of suicidal behavior proposes in its motivational phase that perceptions of defeat and entrapment (total, internal and external entrapment) lead to the development of suicidal ideation and that thwarted belongingness and perceived burdensomeness moderate this process. The aim of this study was to test the motivational phase of the IMV model cross-sectionally in a German sample of psychiatric inpatients.

METHODS

A total of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) were included in the study and investigated within 14 days after psychiatric admission due to suicide attempt (53%) or acute suicidal crisis (47%). Statistical analyses included a mediation analysis and moderation analyses.

RESULTS

Results demonstrate a simple mediation of defeat via entrapment (total, internal and external entrapment) on suicidal ideation. The interaction between thwarted belongingness and perceived burdensomeness was confirmed as a motivational moderator.

LIMITATIONS

Limiting factors of the present study are the cross-sectional design and the retrospective assessment of suicidal ideation.

CONCLUSION

The main assumptions of the motivational phase of the IMV model could empirically be confirmed. Perceptions of defeat, internal and external entrapment, thwarted belongingness, and perceived burdensomeness should be taken into account with regard to prevention, risk assessment and interventions of suicidal ideation and attempts. However, future investigations based on prospective data are warranted.

Leader provided purpose: Military leadership behavior and its association with suicidal ideation

Suicide in U.S. Army Soldiers is of major concern as it is estimated that over 100 Soldiers die by suicide each year. Examining risk and protective factors is essential to develop both an understanding of Soldier suicide as well as inform systemic interventions to reduce suicide. One potential systemic approach is to embed preventive mechanisms within the structure of the military rather than the typical administration of primary intervention through mandatory training. To examine potential mechanisms of leader-based interventions, several leadership behaviors were assessed in a cross-sectional sample of n = 1,096 active duty Soldiers. Soldiers completed self-report measures of interpersonal predictors of suicide, suicidal ideation (SI), leadership behaviors, and unit cohesion. Logistic regression was used to identify leadership behaviors related to SI. Only the leader behavior attempting to foster a sense of purpose predicted SI. Leader provided purpose (LPP) was then entered into indirect effect analyses to evaluate the mechanisms of this relationship. Analyses revealed that LPP predicted SI through unit cohesion, thwarted belongingness, and perceived burdensomeness. Results demonstrate that specific aspects of military leadership such as fostering Soldier purpose may enhance resilience and reduce risk for SI.

A randomized clinical trial investigating perceived burdensomeness as a mediator of brief intervention effects on posttraumatic stress symptoms

OBJECTIVE

Posttraumatic stress disorder (PTSD) is a prevalent and impairing condition that often involves difficulties with interpersonal functioning. Targeting interpersonal difficulties may be a promising alternative approach to reducing PTSD symptoms, particularly given the relatively low rates of treatment engagement and efficacy for first-line treatments for PTSD. Recent research has identified perceived burdensomeness (i.e., feelings of being a burden on others) and thwarted belongingness (i.e., feeling isolated and as if one does not belong) as two specific interpersonal factors related to increased PTSD symptoms. Thus, the current study tested whether a brief, computerized intervention would reduce PTSD symptoms via reductions in perceived burdensomeness and thwarted belongingness, vs. a repeated contact control condition.

METHOD

Hypotheses were tested among 250 trauma-exposed participants who were randomized to receive one of two active computerized interventions designed to target interpersonal factors (i.e., perceived burdensomeness or thwarted belongingness) or anxiety sensitivity, or participate in a repeated contact control condition, as part of a larger randomized clinical trial. Participants were then followed over six-months.

RESULTS

Results indicated a direct effect of the active interventions on PTSD symptoms at month-one, that was not detected at months three or six. However, there was a significant indirect effect of condition at all-time points, such that reductions in perceived burdensomeness mediated condition effects on PTSD symptoms.

CONCLUSIONS

Findings identify perceived burdensomeness as a potential etiological factor in the maintenance of PTSD symptoms, and suggest that targeting perceived burdensomeness may be an effective approach to reducing PTSD symptoms.

Family network satisfaction moderates treatment effects among homeless youth experiencing suicidal ideation

OBJECTIVE

Limited research has evaluated the efficacy of suicide prevention interventions among homeless youth, especially considering how their connectedness with their family would impact treatment outcomes.

METHOD

Suicidal homeless youth (N = 150) between the ages of 18-24 years were recruited from a local drop-in center. Youth were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) or Treatment as Usual alone. Youth reported their family network satisfaction at the baseline assessment, whereas their suicidal ideation, perceived burdensomeness and thwarted belongingness were assessed at baseline and three additional times during a nine-month period.

RESULTS

A multiple-group autoregressive cross-lagged model suggests that CTSP was associated with lower suicidal ideation and lower thwarted belongingness only among those with high family network satisfaction. Among both groups, perceived burdensomeness predicted higher suicidal ideation, which in turn predicted lower perceived burdensomeness and thwarted belongingness. Additionally, only among youth with low family network satisfaction, thwarted belongingness predicted lower suicidal ideation.

CONCLUSIONS

Findings suggest that family network satisfaction may be an important factor when considering cognitive interventions with homeless youth, with implications to improve treatment efforts and to reduce premature mortality, hospitalization and loss of human capital in a very high-risk population.

Differential effects of state and trait social anhedonia on suicidal ideation at 3-months follow up

BACKGROUND

Recent work suggests that the social component of anhedonia is more associated with suicide ideation than the other component of pleasure. The present study investigated the differential effects of state and trait social anhedonia on suicidal ideation across two undergraduate samples based on the Interpersonal Theory and Three-Step Theory of Suicide.

METHODS

State social anhedonia was assessed with a single item (Loss of Interest in People) extracted from the Beck Depression Inventory, while trait social anhedonia was assessed using the Anticipatory and Consummatory Interpersonal Pleasure Scale. Suicidal ideation was re-administered at a 3-month follow-up.

RESULTS

In Study 1, higher state social anhedonia was associated with greater levels of suicidal ideation, while trait social anhedonia moderated the relationship between thwarted belongingness, perceived burdensomeness and suicidal ideation. In Study 2, state social anhedonia was margin significant predictor of suicidal ideation, while trait social anhedonia moderated the relationship between psychological pain and suicidal ideation.

CONCLUSIONS

These findings confirmed the presence of two different effects on suicidal ideation in state and trait social anhedonia: state social anhedonia directly was associated with suicidal ideation, while trait social anhedonia was indirectly related through their effects on other risk factors of suicidality.

A test of the interpersonal theory of suicide in college students

BACKGROUND

The interpersonal theory of suicide posits that perceived burdensomeness, thwarted belongingness, and acquired capability together interact to increase risk for lethal self-injury. Despite the prominence of this theoretical model, few studies have directly tested the three-way interaction central to the theory, with mixed findings reported in studies to date. The objective of this study was to test the theorized three-way interaction in relation to suicidal behaviors in a large sample of college students.

METHODS

Undergraduate students were recruited from two universities (N = 1,686; ages 18-29; 64.5% female). Participants completed measures of perceived burdensomeness and thwarted belongingness (Interpersonal Needs Questionnaire-25), fearlessness about death (Acquired Capability for Suicide Scale-Fearlessness About Death), and suicidal behaviors (Suicidal Behaviors Questionnaire-Revised).

RESULTS

Multiple linear regression was used to test the three-way interaction among burdensomeness, belongingness, and fearlessness about death on suicidal behaviors. Controlling for sex and depressive symptoms, results indicated the presence of a significant three-way interaction. The interaction was probed by dichotomizing burdensomeness at high and low values. There was a significant two-way interaction at high burdensomeness such that low belongingness was only related to suicidal behavior at high levels of fearlessness about death.

LIMITATIONS

The study is cross-sectional and uses a composite measure of suicidal behaviors.

CONCLUSIONS

This study adds to a small but growing body of research testing the three-way interaction among perceived burdensomeness, thwarted belongingness, and capability for suicide in relation to suicidal behaviors. Longitudinal studies using measures that distinguish between suicidal ideation and suicide attempt within the ideation-to-action framework are needed.

The association of trait impulsivity and suicidal ideation and its fluctuation in the context of the Interpersonal Theory of Suicide

BACKGROUND

Although the relationship of trait impulsivity and suicidal behavior is well established, its relationship with suicidal ideation and its fluctuation still remains unclear. Our aim is to examine (1) the relationship of trait impulsivity and suicidal ideation and behavior in the context of the Interpersonal Psychological Theory of Suicide (IPTS) and (2) the association of trait impulsivity with the fluctuation of suicidal ideation in an inpatient sample with unipolar depression.

METHOD

Eighty-four inpatients with unipolar depression and current and/or lifetime suicidal ideation were assessed with a baseline assessment including trait impulsivity, suicidal ideation, suicidal behavior and the constructs of the IPTS. Seventy-four of these patients underwent a 6-day ecological momentary assessment (EMA) with 10 assessments per day across six days assessing passive and active suicidal ideation. Mean squared successive differences (MSSD) across EMA assessments of suicidal ideation were calculated to test fluctuation as an indicator of temporal variability. Correlation analyses were conducted to test the associations.

RESULTS

There were no associations of trait impulsivity with suicidal ideation, thwarted belongingness and perceived burdensomeness, except the rather low but significant association between thwarted belongingness and the attention subdomain of trait impulsivity (r = 0.23*, p ≤ 0.05). Moreover, trait impulsivity showed a significant positive correlation with capability for suicide but not with the two subdomains of capability for suicide. The only significant but rather low correlation was identified between the motor aspect of trait impulsivity and fearlessness about death (r = 0.26, p ≤ 0.01). Suicidal behavior showed a positive correlation with trait impulsivity, but not with the different subdomains of trait impulsivity. Trait impulsivity showed a significant correlation with the MSSD of passive suicidal ideation (r = 0.26, p ≤ 0.05), but not with active suicidal ideation. Furthermore, the motor aspect of trait impulsivity (BIS motor) showed a significant correlation (r = 0.32, p ≤ 0.01) with the MSSD of passive suicidal ideation, but not with active suicidal ideation or the MSSD total score.

CONCLUSION

Overall the findings are in line with our assumptions and the IPTS and underline that trait impulsivity is related to suicidal behavior and the fluctuation of suicidal ideation, but not to suicidal ideation itself. Thus, trait impulsivity seems to act as a distal risk factor via capability for suicide and it seems to play a role for the dynamics of suicidal ideation. The results have to be investigated in larger samples, with a higher risk of suicide and in prospective studies. Moreover, the role of the fluctuation of suicidal ideation for the prediction of suicide risk should be investigated in future studies.

Relevance of the interpersonal theory of suicide in an adolescent psychiatric inpatient population

The interpersonal theory of suicide (IPTS) has been widely studied in adults, but not adolescent populations at acute risk for suicide. Accordingly, this study aimed to evaluate IPTS clinical utility in a high-risk sample of suicidal adolescent inpatients. We assessed whether constructs of the IPTS (1) are associated with suicidal thoughts and behaviors (STBs) on admission to a psychiatric hospitalization, and (2) prospectively predict suicide attempt (SA) or psychiatric rehospitalization 90 days after discharge. On admission, adolescent patients self-reported recent STBs, perceived burdensomeness (PB), thwarted belongingness (TB), and depression. Parents reported their child's rehospitalization and suicide attempts 90 days after discharge. Generalized linear regression modelling was used to determine how key constructs of the IPTS are associated with STBs prior to admission and whether they prospectively predict SA or rehospitalization 90 days after discharge. IPTS constructs did not predict rehospitalization or SA within 90 days of discharge. Although PB and TB interacted to associate with prehospitalization SI frequency, and PB, TB and NSSI interacted to associate with prehospitalization SA, the nature of these interactions were not as the IPTS predicts. IPTS constructs are relevant proximal predictors of prehospitalization STB in adolescents, but may operate differently than in adults.

Assessing interpersonal and mood factors to predict trajectories of suicidal ideation within an inpatient setting

BACKGROUND

A limited amount of research has assessed how suicide risk changes over time, and how changes can be predicted. The current study assessed suicidal ideation and risk factors throughout inpatient visits to a psychiatric facility to refine prediction of suicide risk.

METHOD

In total, 491 patients (73% Female; mean age = 39.21) at a psychiatric inpatient facility self-reported the frequency of their suicidal thoughts, perceived burdensomeness, thwarted belongingness, hopelessness, depression, and anxiety in the prior 24 h on a daily basis. Levels of suicidal ideation and risk factors at each quarter of an inpatient's stay were identified, and latent class growth analysis used to identify common patterns of change over time.

RESULTS

Changes in mood and interpersonal factors were associated with changes in suicidal ideation over days and weeks. Further, they contributed to the prediction of future levels of suicidal ideation. Thwarted belongingness at admission predicted whether patients had pervasively high suicidal thoughts over the course of inpatient visits or showed marked improvements, while perceived burdensomeness predicted which patients would develop suicidal thoughts during their visit.

LIMITATIONS

The use of single item measures may limit specificity of measurement of suicide risk factors. Hourly, rather than daily measurement used in the current study, may more accurately identify suicide risk.

CONCLUSIONS

Change in suicidal ideation is associated with changes in a number of psychological risk factors. Regular assessment of interpersonal risk factors may identify warning signs and aid clinical interventions in reducing suicidal thoughts and associated self-injurious behaviours.

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.

Positive mental health as a moderator of the association between risk factors and suicide ideation/behavior in psychiatric inpatients

In recent studies positive mental health has been shown as a resilience factor related to suicide ideation/behavior. It is not known if positive mental health buffers the effect of various risk factors (depression, perceived burdensomeness, hopelessness, childhood maltreatment) on suicide ideation/behavior in psychiatric inpatients-a high risk population. A total of 100 psychiatric inpatients were included in the survey. Four hierarchical regression analyses were conducted to examine, whether positive mental health moderates the association between the four risks factors and suicide ideation/behavior. Positive mental health was shown to moderate the association between perceived burdensomeness and suicide ideation/behavior. The association between the other three risk factors and suicide ideation/behavior was not moderated by positive mental health. Given the cross-sectional nature of the data, conclusions on causality cannot be drawn. The buffering effect of positive mental health suggests that positive mental health may improve the identification of individuals at risk of suicide ideation/behavior and may be an important area to target in the prevention and treatment of individuals at risk of suicide. Further research is needed.

The Self-Hate Scale: Development and validation of a brief measure and its relationship to suicidal ideation

BACKGROUND

The "self" has been implicated in the development of a range of psychological disorders. While a growing body of literature has emerged exploring the Interpersonal Psychological Theory of Suicide (IPTS), little research has been conducted on the construct of self-hate and its relationship with suicidal ideation. The aims of this study were to: 1) develop and validate a brief self-report instrument of self-hate; and, 2) explore the relationship between self-hate, suicidal ideation, and the two main factors of the IPTS, perceived burdensomeness and thwarted belongingness.

METHODS

Initial development of the item pool involved an expert panel and the development of the Self-Hate Scale included exploratory and confirmatory factor analyses using a large community sample.

RESULTS

A 7-item Self-Hate Scale was developed, which exhibited a reliable unidimensional factor structure. High self-hate was found to predict suicidal ideation, while the relationship between low/moderate self-hate and suicidal ideation was partially moderated by the level of thwarted belongingness. The study provided limited evidence for the IPTS' main predictions.

LIMITATIONS

While the current study provided support for the psychometric properties of the Self-Hate Scale, the scale will need to be replicated and validated using clinical populations.

CONCLUSIONS

The Self-Hate Scale is a brief, psychometrically valid measure of self-hate that has the potential to be useful in suicide risk assessment.

The interaction between personality and interpersonal needs in predicting suicide ideation

The Interpersonal Psychological Theory of Suicide (i.e., IPTS) proposes that suicidal desire occurs when an individual simultaneously experiences thwarted belongingness (TB) and perceived burdensomeness (PB) (i.e., interpersonal needs). However, interpersonal needs have been inconsistent in predicting suicide ideation in Koreans. Therefore, we examined depressogenic personality dimensions-sociotropy and autonomy-as individual differences that may alter the effects of TB and PB on suicide ideation. We hypothesized that sociotropy will amplify the influence of TB on suicide ideation and that autonomy will regulate the degree to which PB leads to suicide ideation. This study was conducted with undergraduate students from a university located in Seoul, Korea. 313 students of whom 113 were males (36.1%) and 200 were females (63.9%) were included in the final analyses. Among the 313 participants, 42 (20.3%) endorsed suicide ideation. Significant correlations were identified between sociotropy and depression, and autonomy and depression. PB and sociotropy were valid predictors of suicide ideation even after controlling for depression. In addition, significant interactions were found between sociotropy and TB, and autonomy and PB.

Rejection sensitivity and suicide ideation among psychiatric inpatients: An integration of two theoretical models

Rejection is a direct threat to an individual's need to belong that has serious consequences for mental health. Rejection sensitivity may explain why some individuals are more likely to perceive rejection in social situations and experience subsequent psychological distress. The current study examined suicide ideation among psychiatric inpatients (N = 103) through the lenses of the rejection sensitivity model and the interpersonal theory of suicide. We hypothesized that rejection sensitivity would be indirectly associated with suicide ideation (i.e., a cognitive-affective reaction to social rejection) through greater perceptions of rejection (i.e., thwarted belongingness and perceived burdensomeness, constructs from the interpersonal theory of suicide), in parallel. Results from bootstrapped parallel mediation regression procedures indicated that the relation between rejection sensitivity and suicide ideation was significantly indirectly associated through the additive effect of thwarted belongingness and perceived burdensomeness, such that greater rejection sensitivity was associated with greater thwarted belongingness and perceived burdensomeness and subsequently greater suicide ideation. Further, rejection sensitivity was significantly indirectly associated with suicide ideation independently through thwarted belongingness, but not perceived burdensomeness. These findings provide support for the rejection sensitivity model and the interpersonal theory of suicide in an effort to advance our conceptualization of suicide risk among psychiatric inpatients.

Insomnia predicts increased perceived burdensomeness and decreased desire for emotional support following an in-laboratory social exclusion paradigm

BACKGROUND

Research suggests that insomnia is associated with elevated perceptions of loneliness and social disconnection; however, few quasi-experimental studies have tested the relationship between these constructs. This study examined whether insomnia symptom severity predicts changes in perceptions of interpersonal connectedness and desire for emotional support following in-laboratory participation in a social exclusion paradigm.

METHODS

Young adults (N = 70) completed self-report measures assessing constructs of interest before and after engaging in a social exclusion paradigm (Cyberball). Linear regression analyses were used to evaluate whether baseline insomnia symptom severity predicted perceived burdensomeness, desire for emotional support, and thwarted belongingness after playing Cyberball; analyses controlled for baseline perceived burdensomeness, desire for emotional support, and thwarted belongingness, respectively, as well as baseline social anxiety and depression symptoms.

RESULTS

Greater insomnia symptom severity significantly predicted greater feelings of perceived burdensomeness following Cyberball participation, beyond baseline perceived burdensomeness, social anxiety symptoms, and depression symptoms (β= .24, p = .001). More severe insomnia symptoms also significantly predicted lower desire for emotional support after playing Cyberball, beyond baseline desire for emotional support and social anxiety symptoms (β= -.14, p = .03) but not beyond baseline depression symptoms (β= -.16, p = .07). Insomnia symptoms were not significantly associated with thwarted belongingness after Cyberball (β= -.05-.08, p = .27-.57).

LIMITATIONS

Replication in larger samples and using other sleep disturbance indices is needed.

CONCLUSIONS

Findings suggest that individuals with more severe insomnia symptoms in the past two weeks experience greater perceptions of being a burden on others and less desire for emotional support in response to social exclusion.

Problematic alcohol use and suicidal ideation among firefighters: A multi-study investigation of the explanatory roles of perceived burdensomeness and thwarted belongingness

BACKGROUND

Firefighters are at increased risk for both problematic alcohol use and suicidality. Research has found that problematic alcohol use is related to suicidality among this population; however, limited data exist regarding what might account for this association. The present two-study investigation (1) examined the association between suicidality and problematic alcohol use among two large samples of firefighters and (2) tested whether interpersonal theory of suicide constructs-perceived burdensomeness (PB) and thwarted belongingness (TB)-serve as indirect indicators of this relationship.

METHODS

Participants in Study 1 were 944 U.S. firefighters (12.5% female); participants in Study 2 were 241 U.S. women firefighters. Participants completed the Interpersonal Needs Questionnaire, Alcohol Use Disorders Identification Test, and the Depressive Symptom Inventory-Suicidality Subscale (Study 1) or the Self-Injurious Thoughts and Behaviors Interview-Short Form (Study 2). Bias-corrected bootstrap indirect effects path analyses were utilized.

RESULTS

In Study 1, more problematic alcohol use was significantly associated with more severe career suicidal ideation via PB but not TB. In Study 2, problematic alcohol use was associated with career suicidal ideation via both PB and TB. PB seems to account for the relationship between problematic alcohol use and career suicidal ideation among male and female firefighters.

LIMITATIONS

Limitations include use of a cross-sectional design, use of retrospective measures of suicidal ideation, and our findings derived from subsamples of two existing datasets.

CONCLUSIONS

Findings suggest that PB and TB may explain the relationship between problematic alcohol use and suicidal ideation, but that this effect is discrepant based on gender.

Thwarted interpersonal needs mediate the relation between facets of mindfulness and suicide ideation among psychiatric inpatients

Previous research suggests a negative association between mindfulness and suicide ideation, yet limited research has examined the specific role of mindfulness on suicide ideation or attempted to link this construct with theory-driven risk factors for suicide among high-risk individuals. The current study examined the mediating role of thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness) in the relation between facets of mindfulness and suicide ideation among psychiatric inpatients. Participants were 118 psychiatric inpatients who completed self-report assessments of mindfulness, thwarted belongingness, perceived burdensomeness, and suicide ideation. Results indicated that the additive effect of thwarted belongingness and perceived burdensomeness mediated the relation between the act with awareness, non-judging, and non-reactivity mindfulness facets, and suicide ideation. Facets of mindfulness appear to be differentially related to thwarted interpersonal needs and subsequent suicide ideation. Continued examination of specific facets of mindfulness, as they relate to suicide ideation, may highlight potentially important distinctions and better inform suicide risk assessment and treatment.

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.

A longitudinal test of the predictions of the interpersonal-psychological theory of suicidal behaviour for passive and active suicidal ideation in a large community-based cohort

BACKGROUND

The Interpersonal-Psychological Theory of Suicide (IPTS) aims to elucidate the key antecedents of suicide deaths. Limited research has tested the IPTS in a community setting, and very little longitudinal research has been conducted. The current study longitudinally tested the predictions of the IPTS for suicidal ideation in a large population-based sample.

METHODS

The PATH through Life study assesses three age cohorts (20's, 40's, 60's) every four years. Two interpersonal factors were estimated at the third wave of assessment: thwarted belongingness (TB) and perceived burdensomeness (PB). The roles of these factors in suicide ideation (active and passive) four years later were estimated using logistic regression models (n = 4545).

RESULTS

A one SD increase in TB was associated with increased odds of 37% for passive ideation and 24% for active ideation. For PB, odds were increased 2.5-fold for passive ideation and 2.4-fold for active ideation. A significant negative PB × TB interaction was found for passive but not active ideation. Effects were not consistent by age group or gender.

LIMITATIONS

Proxy measures were used to assess the constructs. The extended timeframe and low prevalence of suicidal ideation limited power to find effects within subgroups.

CONCLUSIONS

Although TB and PB were individually associated with suicidal thoughts, little evidence was found for the key predictions of the IPTS longitudinally. Further investigation of the dynamic interplay between interpersonal factors over time is needed.

Empirical extension of the interpersonal theory of suicide: Investigating the role of interpersonal hopelessness

The Interpersonal Theory of Suicide posits that hopelessness about thwarted belongingness and perceived burdensomeness is an important risk factor for the desire for suicide and suicide risk. Past research has indicated that general feelings of hopelessness interact with the constructs of thwarted belongingness and perceived burdensomeness to predict suicide ideation. However, no research has explicitly tested whether hopelessness specific to the interpersonal constructs of thwarted belongingness and perceived burdensomeness predicts suicide ideation and suicide risk. Participants in the current study (N = 173) were undergraduate students oversampled for history of suicide ideation, planning for suicide, and suicide attempt(s). Participants completed study measures online, including a new measure of hopelessness about thwarted belongingness and perceived burdensomeness. Results indicated that a three-way interaction of thwarted belongingness, perceived burdensomeness, and hopelessness about these interpersonal constructs, but not general hopelessness, predicted unique variance of suicide ideation and suicide risk. Results suggest that hopelessness about thwarted belongingness and perceived burdensomeness may be an important target for reducing suicidal desire.

The Influence of Traditional Culture and the Interpersonal Psychological Theory on Suicide Research in Korea

Korea has the highest suicide rate amongst the OECD countries. Yet, its research on suicidal behaviors has been primitive. While the Interpersonal Psychological Theory of Suicide has gained global attention, there has only been a few researches, which examined its applicability in Korea. In this article, we review the previous studies on suicide and examine the association between the Interpersonal Psychological Theory of Suicide and traditional Korean culture, with an emphasis on Collectivism and Confucianism. We propose that pathways to suicide might vary depending on cultural influences. Clinical implications and suggestions for future research will be discussed.

Entrapment, perceived burdensomeness and thwarted belongingness as predictors of suicide ideation

The Integrated Motivational-Volitional (IMV) Model of suicide posits that perceived burdensomeness and thwarted belongingness moderate the association between perceptions of entrapment and suicide ideation. However, the proposed moderation is yet to be tested. Possible moderator effects were investigated in an online sample (N = 480; 74% female; M_age = 28.5, SD_age = 11.1). Entrapment and perceived burdensomeness predicted suicide ideation. However, neither perceived burdensomeness nor thwarted belongingness moderated the association between entrapment and suicide ideation. The present results do not support a key assumption of the IMV-Model. Nonetheless, they underscore the importance of perceived burdensomeness and entrapment in the prediction of suicide ideation.

Cross-cultural relevance of the Interpersonal Theory of suicide across Korean and U.S. undergraduate students

This study investigated the cross-cultural relevance and validity of the Interpersonal Theory of Suicide (ITS) utilizing young adult samples from South Korea (n =554) and the United States (U.S.; n =390). To examine the ITS, all participants completed self-report questionnaires measuring Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide. We examined whether each construct significantly predicted the severity of suicidal risk in both samples. We also determined whether the strength of the effects of Thwarted Belongingness and Perceived Burdensomeness on suicidal ideation differed between the two samples due to the greater degree of importance placed on interpersonal relationships in collectivistic cultures such as South Korea. Structural equation modeling was used to examine these hypotheses. Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide significantly predicted elevated suicidal risk. However, there were no significant differences in the paths from Thwarted Belongingness or Perceived Burdensomeness to suicide risk between the South Korean and U.S.

SAMPLES

These findings support the cross-cultural relevance and applicability of the ITS, whereby Thwarted Belongingness and Perceived Burdensomeness serve as indicators of suicide risk in both Western (U.S.) and East Asian (Korean) samples.

Testing the main prediction of the Interpersonal Theory of Suicide in a representative sample of the German general population

OBJECTIVE

To evaluate the main prediction of the Interpersonal Theory of Suicide (IPTS): 3-way-interaction of perceived burdensomeness (PB), thwarted belongingness (TB), and acquired capability (AC) for the prediction of suicidal behavior in a representative population sample.

METHOD

A total of 2513 participants completed measures of suicidal behavior, TB, PB, acquired capability (AC-FAD), and symptoms of depression and anxiety.

RESULTS

The two-way-interaction of TB and PB, and the three-way interaction of TB, PB and AC-FAD predict suicidality.

LIMITATIONS

Given the cross-sectional nature of the data, conclusions on causality should be handled carefully.

CONCLUSION

The main prediction of the IPTS has been proven in a general population sample.

The application of the interpersonal-psychological theory of suicide to a sample of Swiss patients attending a psychiatric emergency department for a non-lethal suicidal event

BACKGROUND

Visits to emergency departments (EDs) for suicidal ideation or a suicide attempt have increased in the past decades. Yet comprehensive models of suicide are scarce, potentially enhancing misunderstandings from health professionals. This study aimed to investigate the applicability of the interpersonal-psychological theory of suicide (IPTS) in a population visiting EDs for suicide-related issues.

METHODS

Three major hypotheses formulated by the IPTS were tested in a sample of 167 individuals visiting EDs for suicidal ideation or a suicide attempt.

RESULTS

As predicted by the IPTS, greater levels of perceived burdensomeness (PB) were associated with presence of current suicidal ideation. However, contrary to the theory assumptions, thwarted belongingness (TB) was not predictive of current suicidal ideation (Hypothesis 1). Similarly, the interaction between PB, TB and hopelessness did not account for the transition from passive to active suicidal ideation (Hypothesis 2). The interaction between active suicidal ideation and fearlessness of death did not either predict the transition from active suicidal ideation to suicidal intent (Hypothesis 3).

LIMITATIONS

The cross-sectional design limited the interpretation of causal hypotheses. Patients visiting EDs during nights and weekends were underrepresented. A general measure of hopelessness was considered, not a measure of hopelessness specifically related to PB and TB.

CONCLUSIONS

Although the three hypotheses were only partially verified, health professionals might consider the IPTS as useful for the management of patient with suicide-related issues. Clinical intervention based on perceived burdensomeness could notably be proposed shortly after ED admission.

Social anxiety and suicidal ideation: Test of the utility of the interpersonal-psychological theory of suicide

Social anxiety is related to greater suicidality, even after controlling for depression and other psychopathology. The Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005) proposes that people are vulnerable to wanting to die by suicide if they experience both perceived burdensomeness (sense that one is a burden to others) and thwarted belongingness (a greater sense of alienation from others). Socially anxious persons may be especially vulnerable to these interpersonal factors. The current study tested whether interpersonal IPTS components independently and additively mediate the social anxiety-suicidal ideation (SI) relation among 780 (80.5% female) undergraduates. Social anxiety was significantly, robustly related to SI and to thwarted belongingness and perceived burdensomeness. Social anxiety was indirectly related to SI via thwarted belongingness and perceived burdensomeness. The sum of these indirect effects was significant. Moderated mediation analyses indicated that perceived burdensomeness only mediated the relation between social anxiety and SI at higher levels of thwarted belongingness. Findings highlight that difficulties in interpersonal functioning may serve as potential pathways through which social anxiety may lead to greater suicidality. Findings highlight that difficulties in interpersonal functioning may serve as potential pathways through which social anxiety may lead to greater suicidality.

Cross-sectional and temporal association between non-suicidal self-injury and suicidal ideation in young adults: The explanatory roles of thwarted belongingness and perceived burdensomeness

Non-suicidal self-injury (NSSI) is a strong predictor of suicidal ideation and attempts. Consistent with the interpersonal theory of suicide, preliminary evidence suggests that NSSI is associated with higher levels of perceived burdensomeness (PB) and thwarted belongingness (TB). However, no study to date has examined the cross-sectional and prospective relationships between NSSI, TB, PB, and suicidal ideation (SI). To fill this gap, this study examined the mediating role of TB and PB in the relationship between NSSI and SI at baseline and follow-up. Young adults (N=49) with and without histories of NSSI completed self-report measures of TB, PB, and SI at three time points over two months. NSSI history was associated with higher levels of PB, TB, and SI at all time points. TB and PB significantly accounted for the relationship between NSSI history and SI at baseline. However, the relationship between NSSI history and SI at follow-up was mediated by PB, not TB. Findings provide evidence for the roles of TB and PB in the relationship between NSSI and SI, and partial support for the interpersonal theory of suicide. Future research and clinical implications are discussed.

Thwarted interpersonal needs and suicide ideation: Comparing psychiatric inpatients with bipolar and non-bipolar mood disorders

Psychiatric inpatients are at heightened risk for suicide, and evidence suggests that psychiatric inpatients with bipolar mood disorders may be at greater risk for suicide ideation compared to those with non-bipolar mood disorders. There is a paucity of research directly comparing risk factors for suicide ideation in bipolar versus non-bipolar mood disorders in an inpatient sample. The current study sought to clarify the association between two constructs from the interpersonal theory of suicide (i.e., perceived burdensomeness and thwarted belongingness) in leading to suicide ideation among psychiatric inpatients with bipolar and non-bipolar mood disorders. Participants were (N=90) psychiatric inpatients with a bipolar (n = 20) or non-bipolar mood disorder (n=70; per their medical charts). Perceived burdensomeness, but not thwarted belongingness, was significantly associated with suicide ideation after adjusting for other covariates. This suggests perceived burdensomeness may play a key role in suicide ideation among psychiatric inpatients with any mood disorder and highlights the importance of assessment and intervention of perceived burdensomeness in this population. Contrary to our hypothesis, mood disorder group (i.e., bipolar versus non-bipolar) did not moderate the relations between perceived burdensomeness/thwarted belongingness and suicide ideation.

Hoarding and depression: The mediating role of perceived burdensomeness

Despite clear indications that hoarding behaviors contribute to social isolation and strained family relationships, no research to date has examined the associations between hoarding and several important interpersonal constructs (i.e., perceived burdensomeness and thwarted belongingness). Moreover, no research has examined how these various interpersonal needs may account for the associations between symptoms of hoarding and depression. Community participants (N = 125) with elevated hoarding symptoms were assessed on the interpersonal constructs of interest. Hoarding severity was significantly associated with perceived burdensomeness even after controlling for overall levels of negative affect. Moreover, perceived burdensomeness significantly mediated the relationship between hoarding severity and depressive symptoms. To our knowledge this is the first study to examine potential mechanisms that may account for the robust associations between hoarding and depression. Future investigations should attempt to replicate these findings using clinical samples.

Body dysmorphic disorder symptoms and risk for suicide: The role of depression

Body dysmorphic disorder (BDD) is associated with elevated suicidality. Little is known about why BDD patients are at increased risk. The interpersonal-psychological theory of suicide (IPTS) could clarify suicidality in BDD, and theorizes that perceived burdensomeness and thwarted belongingness lead to suicidal desire, while an acquired capability for suicide is necessary to attempt suicide. No study has investigated how BDD symptoms relate to IPTS constructs or mediators of the relationship between BDD and suicidality. Individuals (N=235) enrolled in Amazon.com's Mechanical Turk (MTurk), who had appearance concerns, completed questionnaires about BDD, depression, eating pathology, and suicide risk. MTurk is an online data collection platform in which participants complete surveys for payment. BDD symptoms predicted suicidal desire, but not acquired capability for suicide. Depression mediated the relationship between BDD and suicidal desire. Research should examine how fluctuations in BDD affect suicide risk. Replication in a clinical sample may inform treatments for BDD.

Thinking or doing? An examination of well-established suicide correlates within the ideation-to-action framework

Limited research has examined differences in well-established suicide correlates between individuals with various histories of suicidality within the ideation to action framework. We hypothesized that individuals without a history of elevated suicidality would exhibit lowest levels of suicide correlates (perceived burdensomeness, thwarted belongingness, emotion dysregulation, depressive symptoms), and group differences would not be present between those with a history of suicidal ideation relative to those with a history of suicide attempts on variables not theorized to contribute to the capability for suicide. Lastly, we hypothesized that those with a prior history of suicide attempt(s) would exhibit higher levels of lifetime painful and provocative events and fearlessness about death relative to those with a history of ideation only. A community sample of adults (N=378) recruited in part on the basis of a history of suicidality completed self-report questionnaires online. The results were largely consistent with our hypotheses. However, there were no differences in fearlessness about death between those with a history of suicidal ideation and those with a history of attempts. Many variables considered robust correlates of suicide may only directly relate to suicidal ideation rather than suicide attempts, thereby limiting their utility in understanding the transition from ideation to action.

Perceived burdensomeness and suicide ideation in adult outpatients receiving exposure therapy for anxiety disorders

Perceived burdensomeness is considered a proximal risk factor for suicide ideation. However, there is a lack of prospective studies. Furthermore, it is unclear in as much psychotherapy for anxiety disorders is associated with a decrease in suicide ideation. A total of 105 adult outpatients suffering from panic disorder, agoraphobia, or specific phobia received manualized exposure-therapy. Perceived burdensomeness was considered as predictor of suicide ideation concurrently, after the fourth and the tenth therapy session and posttreatment - controlling for baseline symptom distress, suicide ideation, number of therapy sessions and age. Furthermore, pre-to post-changes in suicide ideation and perceived burdensomeness were assessed. Perceived burdensomeness emerged as a significant predictor of suicidal ideation concurrently and after the fourth and the tenth therapy session, but not at the end of therapy. Treatment had no effect on suicide ideation and only a marginal effect on perceptions of burdensomeness. In conclusion, the current study highlights the importance of perceptions of burdensomeness in understanding suicide ideation.

A test of the interpersonal theory of suicide in a large sample of current firefighters

Recent research suggests that firefighters experience elevated rates of suicidal ideation and behaviors. The interpersonal theory of suicide may shed light on this finding. This theory postulates that suicidal desire is strongest among individuals experiencing perceived burdensomeness and thwarted belongingness, and that the combination of suicide desire and acquired capability for suicide is necessary for the development of suicidal behaviors. We tested the propositions of the interpersonal theory in a large sample of current United States firefighters (N=863). Participants completed self-report measures of perceived burdensomeness, thwarted belongingness, fearlessness about death (FAD; a component of acquired capability), and career suicidal ideation and suicide attempt history. Regression models were used to examine the association between interpersonal theory constructs, career suicidal ideation severity, and the presence of career suicide attempts. In line with theory predictions, the three-way interaction between perceived burdensomeness, thwarted belongingness, and FAD was significantly associated with career suicide attempts, beyond participant sex. However, findings were no longer significant after accounting for years of firefighter service or age. Contrary to predictions, the two-way interaction between perceived burdensomeness and thwarted belongingness was not significantly related to career suicidal ideation severity. Applications of the theory to firefighters and future research are discussed.

The German version of the Interpersonal Needs Questionnaire (INQ)--Dimensionality, psychometric properties and population-based norms

PURPOSE

The Interpersonal Needs Questionnaire (INQ) assesses the two interpersonal constructs perceived burdensomeness (PB) and thwarted belongingness (TB) that lead to suicidal ideation, according to the interpersonal theory of suicide (IPTS). The present study investigates dimensionality and psychometric properties of the German version of the INQ in a population-based representative sample and delivers norm values.

METHODS

The German INQ as well as measures of depression and past suicidality were administered to a population-based representative sample of the German general population (n=2513) to analyze its dimensionality and construct validity by confirmatory factor analysis and correlational analysis.

RESULTS

Results of the confirmatory factor analysis were in line with the assumption of two-dimensionality of the INQ. The two subscales showed very good internal consistencies (α ≥ 0.89) as well as correlations with depression and suicidality that indicate convergent validity. There were no gender effects but slight age effects in the scores of both subscales. Population-based norms are provided.

LIMITATIONS

Convergent validity was solely examined with measures of depression and suicidal thoughts instead of further suitable constructs like loneliness and social support. Divergent validity was not investigated in the study.

CONCLUSION

The German version of the INQ shows good psychometric properties making it a promising tool for assessing PB and TB. The provided norms enable researchers to compare INQ scores of their samples with reference values of a population-based representative sample.

A systematic review of the predictions of the Interpersonal-Psychological Theory of Suicidal Behavior

CONTEXT

Since the development of the Interpersonal Psychological Theory (IPTS; Joiner, 2005), a growing body of literature has emerged testing different aspects of the theory across a range of populations.

OBJECTIVE

The aim of this review was to identify support for the IPTS, and critical gaps in the evidence base, by systematically reviewing current evidence testing the effects of thwarted belongingness, perceived burdensomeness, and acquired capability on suicide ideation and attempt.

METHODS

PsycInfo and PubMed databases were electronically searched for articles published between January 2005 and July 2015. Articles were included if they directly assessed the IPTS constructs as predictors of suicidal ideation or suicide attempt.

RESULTS

Fifty-eight articles reporting on 66 studies were identified. Contrary to expectations, the studies provided mixed evidence across the theory's main predictions. The effect of perceived burdensomeness on suicide ideation was the most tested and supported relationship. The theory's other predictions, particularly in terms of critical interaction effects, were less strongly supported.

CONCLUSIONS

Future research focused on expanding the availability of valid measurement approaches for the interpersonal risk factors, and further elaborating upon their mixed relationships with suicide ideation and attempt across multiple populations is important to advance theoretical and clinical progress in the field.