Interpersonal theory of suicide: prospective examination

Background The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies. Aims To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design. Method Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18–81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted. Results The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59–3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01). Conclusions The results challenge the theoretical validity of the IPTS and its clinical utility – at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.

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Role of thwarted belongingness and perceived burdensomeness in the relationship between violent daydreaming and suicidal ideation in two adult samples

Journal of Aggression Conflict and Peace Research ◽

10.1108/jacpr-10-2016-0255 ◽

2018 ◽

Vol 10 (1) ◽

pp. 11-23 ◽

Cited By ~ 1

Author(s):

Carol Chu ◽

Megan L. Rogers ◽

Anna R. Gai ◽

Thomas E. Joiner

Keyword(s):

Suicidal Ideation ◽

Self Report ◽

Interpersonal Theory ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Negative Attitudes ◽

Content Type ◽

Two Samples ◽

History Of ◽

The Relationship

Purpose Despite evidence that violent daydreaming is a correlate of suicidal ideation, no research has examined the mechanisms underlying this association. The interpersonal theory of suicide may provide insight. This theory postulates that individuals with high suicidal desire experience intractable feelings of perceived burdensomeness (PB) and thwarted belongingness (TB). Violent daydreaming may fuel negative attitudes toward others and oneself and turn attention away from loved ones, thereby increasing feelings that one is a burden on others (PB) and socially disconnected (TB). However, no studies have tested TB and PB as explanatory mechanisms. The purpose of this paper is to examine the relationships between violent daydreaming, PB, TB, suicidal ideation, and depression in two samples (n=818). Design/methodology/approach Study 1 was comprised of general undergraduates, and Study 2 selected for undergraduates with a history of ideation. Self-report measures were administered and indirect effects analyses were conducted. Findings In both studies, violent daydreaming was associated with increased feelings of PB, TB, and ideation severity. Consistent with the interpersonal theory, TB and PB were significant parallel mediators of the relationship between violent daydreaming and suicidal ideation, beyond sex and age. In contrast to Study 1, results were no longer significant in Study 2 after accounting for depression. Originality/value This was the first study to test TB and PB as mechanisms underlying the relationship between violent daydreaming and suicide risk. Findings highlight the importance of monitoring and addressing violent daydreams and interpersonal functioning throughout treatment to mitigate risk.

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How does someone who weighs so little feel like a burden to everyone?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2233 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S598-S598

Author(s):

F. Coutinho ◽

I. Brandão ◽

E. Pereira

Keyword(s):

Anorexia Nervosa ◽

Case Report ◽

Suicide Attempts ◽

Interpersonal Theory ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Interpersonal Theory Of Suicide ◽

Her Family ◽

Completed Suicide ◽

Competing Interest

IntroductionAnorexia nervosa (AN) is one of the most lethal psychiatric disorders, which is explained partially by starvation related health problems, but also because of high suicide rates. One of the proposed theories to explain a suicide attempt is the interpersonal theory of suicide (IPTS), with its three essential variables: feelings of thwarted belongingness, perceived burdensomeness and the acquired capacity for suicide.ObjectiveTo review the literature about suicidality in AN and to present a case report of a patient with restrictive AN who has committed suicide.MethodsTo review of the literature using the database Medline, through PubMed, with the keywords “anorexia nervosa”, “eating disorders” and “suicide”.ResultsSuicide attempts and completed suicide are highly prevalent among patients with AN, and some authors suggest that 20–40% of deaths in AN are due to suicide. Recently, the IPTS has been proposed as a mean to explain increased suicidality in AN patients.ConclusionWe present a case report about a patient with a long standing AN who has committed suicide after leaving a goodbye note describing strong feelings of perceived burdensomeness directed to her family. It is of utmost importance to continue the study about the phenomenon of suicide in AN to be able to prevent this tragic outcome.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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775 The Relationship Between Sleep and Suicidal Ideation in College Students

SLEEP ◽

10.1093/sleep/zsab072.772 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A301-A302

Author(s):

Krishna Taneja ◽

Andrew Tubbs ◽

Fabian-Xosé Fernandez ◽

Michael Perlis ◽

Michael Grandner

Keyword(s):

College Students ◽

Suicidal Ideation ◽

Suicide Risk ◽

Severity Index ◽

Interpersonal Theory ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Interpersonal Theory Of Suicide ◽

Short Sleep ◽

Sleep Control

Abstract Introduction Suicide is the second-leading cause of death for young adults and insomnia increases suicide risk. However, the data on disrupted sleep and suicidal ideation in college students is mixed, including whether disrupted sleep fits into the framework of the Interpersonal Theory of Suicide. Therefore, the present study explored how four different sleep variables influenced recent suicidal ideation in a collegiate sample. Methods Data from N=506 respondents were collected as part of the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) Survey in college students. The primary outcome, active suicidal ideation in the last 3 months, was assessed using several self-report questions derived from the Columbia Suicide Severity Rating Scale. The predictors were weekday short sleep (≤6h; assessed by retrospective sleep diary), Insomnia Severity Index (ISI) score, Brief Inventory of Sleep Control (BRISC) score, and Disturbing Dreams and Nightmares Severity Index (DDNSI) score. Binomial logistic regression models estimated the associations between suicidal ideation and sleep variables in models that were unadjusted, adjusted for age, sex, race, and ethnicity, and additionally adjusted for thwarted belongingness or perceived burdensomeness (constructs from the Interpersonal Theory of Suicide). Results A total of N=121 (23.9%) respondents endorsed suicidal ideation in the last 3 months. Individuals with suicidal ideation were in poorer health (p<0.001) and had more severe depression (p<0.001) and anxiety (p<0.001). In unadjusted models, individuals were more likely to report suicidal ideation if they had short sleep (OR 1.93 [1.23–3.05]), ISI scores of 8 or more (OR 3.01 [1.94–4.74]), and DDNSI scores of 10 or more (OR 2.66 [1.69–4.19]). Higher BRISC scores were associated with lower odds of suicidal ideation (OR 0.53 [0.41–0.68]). Adjusting for age, sex, race, ethnicity, thwarted belongingness, and perceived burdensomeness attenuated but did not eliminate any of these relationships. Conclusion Insomnia, short sleep, nightmares, and less perceived sleep control were all associated with recent suicidal ideation in college students. Moreover, these findings were generally independent of the Interpersonal Theory of Suicide. Further research is needed to understand how sleep affects suicide risk in this population, and whether sleep interventions can reduce this risk. Support (if any):

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Shame and Suicidal Ideation among Undergraduates in China: The Mediating Effect of Thwarted Belongingness and Perceived Burdensomeness

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072360 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2360 ◽

Cited By ~ 2

Author(s):

Jingjing Zhao ◽

Yanna Chi ◽

Yanli Ju ◽

Xiyao Liu ◽

Jingjing Wang ◽

...

Keyword(s):

Suicidal Ideation ◽

Undergraduate Students ◽

Psychological Intervention ◽

Mediating Effect ◽

Interpersonal Theory ◽

Mediating Effects ◽

Suicide Risk Assessment ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Interpersonal Theory Of Suicide

Undergraduate students with shame are more likely to experience suicidal ideation, but there remains a lack of research investigating the factors underlying this relationship. The interpersonal theory of suicide posits that suicidal ideation is influenced by the simultaneous presence of thwarted belongingness and perceived burdensomeness. We examined the prevalence of suicidal ideation among undergraduate students in China and examined the association between shame and suicidal ideation mediated by perceived burdensomeness and thwarted belongingness. A survey was conducted in July 2018 involving 2320 undergraduate students, and the twelve-month prevalence of suicidal ideation was 8.95%. Shame played a crucial role in predicting suicidal ideation, and the mediating effects of perceived burdensomeness and thwarted belongingness between shame and suicidal ideation were significant. Suicidal ideation is common among undergraduate students in China and merits greater attention. Shame, perceived burdensomeness, and thwarted belongingness may be important factors to assess among undergraduate students in suicide risk assessment and psychological intervention.

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Predicting suicidal ideation in a nationally representative sample of young adults: a 12-month prospective study

Psychological Medicine ◽

10.1017/s0033291720005255 ◽

2021 ◽

pp. 1-8

Author(s):

Karen Wetherall ◽

Seonaid Cleare ◽

Sarah Eschle ◽

Eamonn Ferguson ◽

Daryl B. O'Connor ◽

...

Keyword(s):

Suicidal Ideation ◽

Prospective Study ◽

Theoretical Models ◽

Interpersonal Theory ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Interpersonal Theory Of Suicide ◽

Nationally Representative ◽

The Relationship

Abstract Background Evidence-based theoretical models outlining the pathways to the development of suicidal ideation may inform treatment. The current research draws from the Interpersonal Theory of Suicide (IPT) and the Integrated Motivational-Volitional (IMV) Model of suicidal behaviour and aims to test the interaction between perceived burdensomeness and thwarted belongingness as proposed by the IPT model, and the defeat-entrapment pathway as proposed by the IMV model, in the prediction of suicidal ideation at 12-month follow-up. Methods The Scottish Wellbeing Study is a nationally representative prospective study of young people aged 18–34 years (n = 3508) from across Scotland, who completed a baseline interview and a 12-month follow-up (n = 2420). The core factors from both the IPT (perceived burdensomeness and thwarted belongingness) and the IMV model (defeat, internal and external entrapment) were measured alongside demographics, depressive symptoms and suicidal ideation at baseline. At 12-month follow-up, suicidal ideation was assessed again. Results In multiple regression analysis perceived burdensomeness and internal entrapment, with baseline suicidal ideation, predicted 12-month suicidal ideation. No support for the interaction between perceived burdensomeness and thwarted belongingness in predicting 12-month suicidal ideation was found. However, there was evidence that internal, but not external, entrapment mediated the relationship between defeat and 12-month suicidal ideation, but no support was found for the moderation of burdensomeness and belongingness on the entrapment to suicidal ideation pathway. Conclusions The current findings highlight the importance of targeting perceived burdensomeness and internal entrapment to reduce the likelihood that suicidal ideation emerges in at risk individuals.

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Suicidal Ideation in Elite Schools: A Test of the Interpersonal Theory and the Escape Theory of Suicide

10.31234/osf.io/8nb5y ◽

2019 ◽

Author(s):

Hélène Landrault ◽

Nemat Jaafari ◽

Mohamed Amine ◽

Gabriel Malka ◽

Leila Selimbegovic ◽

...

Keyword(s):

Regression Analysis ◽

Suicidal Ideation ◽

Suicide Ideation ◽

Suicide Attempts ◽

Interpersonal Theory ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Elite Schools ◽

Escape Theory ◽

And Control

Objective: The present study compared the ability of two contemporary theories of suicidal behavior—the interpersonal and escape theories of suicide—to predict suicidal ideation. The interpersonal theory proposes that the interaction of perceived burdensomeness and thwarted belongingness predicts suicidal ideation. The escape theory proposes that feelings of failure predict suicidal ideation and that escape motivation mediates this relationship. The present study intended to determine which of the two theories more successfully explains suicidal ideation. Method: A sample of 306 students from elite schools in Morocco (193 women, Mage = 21.21 years, predominantly Muslims) completed a questionnaire assessing feelings of failure and escape motivation, perceived burdensomeness and thwarted belongingness, suicide ideation, and control variables. Results: In line with previous research, separate tests revealed support for the two theories. Interestingly, when entered simultaneously in a multiple regression analysis, the two frameworks explained a unique and cumulative part of the variance in suicidal ideation. Moreover, the effects remained significant after controlling for past suicide attempts, depression, hopelessness, and stress. Conclusions: The findings suggest that combining the interpersonal and escape theories of suicide could help better explain the emergence of suicidal ideation among college students.

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Trauma-Related Shame, Sexual Assault Severity, Thwarted Belongingness, and Perceived Burdensomeness Among Female Undergraduate Survivors of Sexual Assault

Crisis ◽

10.1027/0227-5910/a000549 ◽

2019 ◽

Vol 40 (2) ◽

pp. 134-140 ◽

Cited By ~ 2

Author(s):

Christopher R. DeCou ◽

Stephanie P. Kaplan ◽

Julie Spencer ◽

Shannon M. Lynch

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Sexual Assault ◽

Self Report ◽

Psychosocial Risk ◽

Thwarted Belongingness ◽

Female Undergraduate ◽

Perceived Burdensomeness ◽

Cross Sectional ◽

And Behavior

Abstract. Background and Aim: This study evaluated trauma-related shame as a mediator of the association between sexual assault severity and perceived burdensomeness and thwarted belongingness. Method: A total of 164 female undergraduates who reported attempted or completed sexual assault completed self-report measures of sexual assault, trauma-related shame, perceived burdensomeness, and thwarted belongingness. Results: Using path analysis, trauma-related shame mediated the association between sexual assault severity and perceived burdensomeness, and between sexual assault severity and thwarted belongingness. Limitations: The findings of this study are limited by the retrospective, self-report, and cross-sectional nature of these data, and do not allow for causal inference. Conclusion: Trauma-related shame warrants additional investigation as a mechanism that explains the association between sexual assault and psychosocial risk factors for suicidal ideation and behavior.

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Pet Attachment and the Interpersonal Theory of Suicide

10.31234/osf.io/p67bu ◽

2020 ◽

Author(s):

Valerie Jane Douglas ◽

Mun Yee Kwan ◽

Kathryn H. Gordon

Keyword(s):

Suicide Risk ◽

Attachment Anxiety ◽

Interpersonal Theory ◽

Pet Ownership ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Attachment Avoidance ◽

Interpersonal Theory Of Suicide ◽

Pet Attachment ◽

The Relationship

Objective: Pet ownership is often assumed to have mental health benefits, but the effect of pets on suicide risk has a scant literature. Method: Using the interpersonal theory of suicide, we examined the relationships between perceived burdensomeness, thwarted belongingness, overall attachment to one’s pet (quality of the relationship), pet attachment avoidance (distrustful of the relationship) or anxiety (afraid of abandonment), and suicide risk. Three hypotheses were investigated: 1) higher levels of attachment would be associated with lower suicide risk via lower levels of thwarted belongingness/perceived burdensomeness, 2) lower levels of pet attachment would be associated with higher levels of suicide risk via attachment avoidance/attachment anxiety, and 3) attachment avoidance/anxiety would be associated with higher suicide risk via thwarted belongingness/perceived burdensomeness. Undergraduates (N = 187) completed surveys and indirect effect analyses were utilized. Results: Higher overall attachment was associated with decreased attachment anxiety, which was associated with lower suicide risk. Attachment anxiety was correlated with increased suicide risk. Overall attachment, attachment avoidance and attachment anxiety were not found to indirectly affect suicide risk. Conclusions: Findings suggest that pet ownership may provide both protective and deleterious effects in a nonclinical sample.

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M32. THE NATURE OF THE RELATIONSHIP OF SUICIDALITY WITH SCHIZOTYPY AND PSYCHOSIS EXPERIENCE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.344 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S146-S146

Author(s):

Richard Linscott ◽

Ellen Wright ◽

Theresa Parker ◽

Kirstie O’Hare

Keyword(s):

Suicidal Ideation ◽

Suicide Attempts ◽

Population Sample ◽

Interpersonal Theory ◽

Magical Thinking ◽

Interpersonal Theory Of Suicide ◽

Magical Ideation ◽

Causal Connections ◽

History Of ◽

Using Data

Abstract Background Meehl portrayed pervasive, chronic suicidality as a key sign of schizotypy. Consistent with this view, positive schizotypy predicts concurrent and future suicidality, is particularly predictive of greater lethality, and is a more potent predictor of suicidality than other psychopathology. Whereas the most prominent explanation for this relationship is that it is spurious, several possible causal connections have not been tested. Also, most existing evidence relates to positive schizotypy and psychosis experience. We describe three studies of the schizotypy – suicidality link. Methods In the first, we tested whether, as Meehl argued, schizotypy is associated with suicide dread. A general population sample (n = 350) of young adults (18 to 24 years) reported on schizotypy and suicidality, including efforts to avert suicide attempts. In univariate analyses, positive, negative, and disorganized components of schizotypy each significantly predicted persistent or frequent suicidal ideation in the past month (ORs from 2.10 to 3.71), history of attempts with intent to die (1.59 to 2.15), fear or dread of the possibility of making an attempt (1.58 to 1.63), and worry about acting on an unwanted impulse to attempt suicide (2.48 to 2.62). In fully-adjusted analyses (controlling for depression, anxiety, stress, and all schizotypy components), positive schizotypy predicted reporting of greater worry about impulsive suicidal behaviour (OR = 1.71, p = .009, 95% CI 1.15 to 2.56). In the second, we tested whether the schizotypy – suicidality link can be understood using contemporary suicide theory. In a random sample of high school pupils (n = 177), schizotypy components predicted classification as an active suicidal ideator (R2 = 0.76, 95% CI 0.56 to 0.95). These effects were accounted by the influences of magical thinking, unusual perceptual experiences, and suspiciousness being mediated in part by perceived burdensomeness, as per the interpersonal theory of suicide. However, direct effects were also observed from social anxiety and magical ideation components of schizotypy. In the third, we modelled latent growth mixtures of suicidality using data from five waves of the Dunedin Multidisciplinary Health and Development Study. We test how growth in suicidality (from 18 to 38 years) is related to psychosis experience (age 11 years) and schizotypy (age 13 and 15 years). Schizotypy predicted membership of a growth class characterised by chronically death- and suicidal-ideation that, in turn, predicted attempt behaviour. Results See above. Discussion The complexity of the observed links of schizotypy and psychosis experience with suicidality do not lend themselves to being discounted as spurious or due to common underlying causal factors. Research addressing possible causal connections is warranted, as are efforts to identify whether reduction of suicidality may result from interventions targeting features of subclinical psychosis.

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Associations of Discrimination, Suicide Ideation Severity and Attempts, and Depressive Symptoms Among Sexual and Gender Minority Youth

Crisis ◽

10.1027/0227-5910/a000718 ◽

2020 ◽

pp. 1-8

Author(s):

Adeline Wyman Battalen ◽

Ethan Mereish ◽

Jennifer Putney ◽

Christina M. Sellers ◽

Melinda Gushwa ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Childhood Trauma ◽

Suicide Ideation ◽

Suicide Attempts ◽

Thwarted Belongingness ◽

Perceived Burdensomeness ◽

Sociodemographic Variables ◽

Sexual And Gender Minority ◽

And Gender

Abstract. We examined the unique associations among discrimination, suicidal thoughts, suicide attempts, and depressive symptoms in a sample of sexual and gender minority (SGM) youth as well as interpersonal mediators of these associations. Participants included 94 SGM youth ( Mage = 18; SD = 2.88) recruited from SGM-specific drop-in centers. We used mediation analyses to test the mediating effects of perceived burdensomeness and thwarted belongingness on the associations between discrimination and suicidal ideation, suicide attempts, and depressive symptoms, accounting for childhood trauma and sociodemographic variables (age, gender identity, race, and sexual orientation). Within our nonclinical community sample of SGM youth, 49% reported a lifetime suicide attempt, 84% reported current suicide ideation, and 82% reported current depressive symptoms. Experiencing discrimination was associated with greater likelihood of suicide attempts and depressive symptoms, and greater perceived burdensomeness and thwarted belongingness, over and above the effects of childhood trauma and sociodemographic variables. Discrimination was indirectly associated with greater depressive symptoms through perceived burdensomeness and thwarted belongingness, and with greater severity of suicidal ideation through perceived burdensomeness. Findings suggest clinicians should assess for discrimination and include a focus on perceived burdensomeness and thwarted belongingness as targets of intervention for suicide and depression.

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