Basic Need Satisfaction and Suicidal Ideation: A Self-Determination Perspective on Interpersonal Suicide Risk and Suicidal Thinking

This study investigated the relationship between the basic psychological needs, as outlined by self-determination theory, and the interpersonal predictors of suicidal desire, as outlined by the interpersonal-psychological theory of suicidal behavior. It was hypothesized that basic need satisfaction (collective feeling of autonomy, relatedness, and competence) would be related to suicidal ideation through thwarted belongingness and perceived burdensomeness. Mediation analyses demonstrated that thwarted belongingness and perceived burdensomeness both individually mediated the relationship between basic need satisfaction and suicidal ideation. Relatedness also predicted variance of the interaction of thwarted belongingness by perceived burdensomeness while controlling for depression. The clinical utility of assessing need satisfaction as an indication of suicide risk is discussed. Future research to investigate the temporal relationship of the study variables is recommended.     

Experiential avoidance,cognitive fusion,and suicide ideation among psychiatric inpatients: The role of thwarted interpersonal needs

Objective: The interpersonal theory of suicide posits the simultaneous presence of thwarted belongingness and perceived burdensomeness (i.e., thwarted interpersonal needs) leads to active suicide ideation. According to the psychological flexibility model, psychological inflexibility is in part a product of cognitive fusion (i.e., becoming entangled or wrapped up in one’s thoughts) and experiential avoidance (i.e., avoidance of internal private experiences, which include thoughts and feelings). We hypothesized that thwarted belongingness and perceived burdensomeness, in parallel, would mediate the positive relation between experiential avoidance and suicide ideation and between cognitive fusion and suicide ideation. Method: Participants were 118 adult psychiatric inpatients who completed self-report assessments of thwarted interpersonal needs, cognitive fusion, experiential avoidance, and suicide ideation. Results: Using bootstrapped parallel mediation regression procedures, results indicated thwarted belongingness and perceived burdensomeness mediated, in parallel, the positive relation between experiential avoidance and suicide ideation and between cognitive fusion and suicide ideation. Additionally, thwarted belongingness, but not perceived burdensomeness, independently mediated the relation between cognitive fusion and suicide ideation. Conclusion: The current findings indicate that psychological inflexibility variables are associated with increased thwarted interpersonal needs and suicide ideation. The findings of this study provide support for the integration of the interpersonal theory of suicide and psychological flexibility model to improve our conceptualization of suicide risk among psychiatric inpatients.

Clinical or methodological significance summary: The findings of this study provide support for the integration of the interpersonal theory of suicide and psychological flexibility model to improve our conceptualization of suicide risk among psychiatric inpatients.     

A Trait-Interpersonal Perspective on Suicide Risk in Criminal Offenders

Despite elevated rates of suicide among offenders, research has yet to adequately address theoretically driven risk models in this population. The present study addresses such a gap by investigating a synthesized framework using 2 well-developed theoretical models, the Five-Factor Model (FFM) of personality and the interpersonal-psychological theory of suicide (IPTS). Archival data from mitigation evaluations for pre-sentenced criminal offenders (n = 307) were analyzed using structural equation modeling (SEM). Results supported a hypothesized personality-IPTS-suicide framework in which neuroticism and extraversion predict IPTS components, namely perceived burdensomeness, thwarted belongingness, and acquired capability. IPTS constructs subsequently directly and indirectly (via suicidal ideation) predicted suicide potential. Findings have important implications for suicide theory, research, and risk assessment with offenders.     

The Role of Autonomy Needs in Suicidal Ideation: Integrating the Interpersonal-Psychological Theory of Suicide and Self-Determination Theory

This study investigated the role of autonomy satisfaction in the development of suicidal ideation by integrating two theoretical models of suicide-related behaviors. The first hypothesized a direct effect of autonomy on suicidal ideation. The second hypothesized an indirect effect of autonomy on suicidal ideation via perceived burdensomeness and thwarted belongingness. This was a cross-sectional study of 449 college students, who were predominantly female (73.1%) and Hispanic (70.6%), with a mean age of 20.40 years (SD = 4.38, range 18–50 years). Participants were recruited from a psychology participant pool and completed self-report survey measures for course credit. The model of indirect effects provided the best fit to the data; relatedness, autonomy, and competence were significantly associated with higher thwarted belongingness and perceived burdensomeness, which, in turn, were significantly associated with higher suicidal ideation. Future studies should test this model longitudinally and consider autonomy as a possible avenue for the prevention of suicide-related behaviors.     

Testing the main hypotheses of the interpersonal–psychological theory of suicidal behavior in a large diverse sample of United States military personnel

BackgroundPreliminary data indicate the suicide rate in the United States military decreased in 2013, but the National Guard saw a continued increase.MethodWe examined the utility of the interpersonal-psychological theory of suicidal behavior (IPTS) in a sample of US military personnel drawn largely from the National Guard (n = 934; 77.7% male; 59.5% white).ResultsResults indicated the interaction of thwarted belongingness and perceived burdensomeness predicted suicidal ideation and resolved plans and preparations for suicide. In each case, risk was greatest at higher levels of both predictors. Furthermore, results indicated the interaction of thwarted belongingness, perceived burdensomeness, and acquired capability for suicide predicted prior suicide attempts. In this interaction term, the relationship between suicidal desire (thwarted belongingness and perceived burdensomeness) and suicide attempts was significant and positive only at high levels of acquired capability. All analyses were cross-sectional.ConclusionsResults indicate the IPTS may be useful for conceptualizing suicide risk in the National Guard.     

The effect of perceived burdensomeness and thwarted belongingness on therapists' assessment of patients' suicide risk

Objective: The interpersonal theory of suicide posits that perceived burdensomeness and thwarted belongingness are two causal interactive suicidal risk factors. The aim of this study was to examine whether therapists are affected by these factors upon assessing patients' suicide risk. Method: Using an experimental design, 388 mental health professionals were presented with a text vignette describing a hypothetical patient with either high or low perceived burdensomeness and with either high or low thwarted belongingness. Results: The findings revealed that both factors affected therapists' risk assessment of psychache, suicidal ideation, suicide attempt and resilience. Conclusions: The study results highlight the interpersonal theory as an important theory for understanding the factors upon which therapists and mental health professionals rely when assessing suicide risk.     

Connectedness and Perceived Burdensomeness among Adolescents at Elevated Suicide Risk: An Examination of the Interpersonal Theory of Suicidal Behavior

The interpersonal theory of suicidal behavior emphasizes the constructs of perceived burdensomeness, thwarted belongingness, and acquired capacity, which warrant investigation in adolescents at risk for suicide due to interpersonal stressors. This study examined one component of the interpersonal theory of suicidal behavior, “suicidal desire” (suicidal ideation), in 129 adolescents (12–15 years) recruited from a general medical emergency department who screened positive for bully victimization, bully perpetration, or low interpersonal connectedness. Greater perceived burdensomeness combined with low family connectedness was a significant predictor of suicidal ideation. This suggests the importance of addressing connectedness and perceptions of burdensomeness in prevention and early intervention efforts with at-risk adolescents.     

Borderline Personality Disorder Diagnostic Criteria as Risk Factors for Suicidal Behavior Through the Lens of the Interpersonal Theory of Suicide

Borderline personality disorder diagnostic criteria, particularly affective dysregulation and behavioral dysregulation, are avenues through which suicide risk is conferred, though pathways are not well understood. The interpersonal theory of suicide may help elucidate these associations. The current study examined indirect relationships between affective and behavioral dysregulation and suicidal ideation through perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. 169 outpatients completed measures prior to their intake assessment. Perceived burdensomeness accounted for the relationship between affective dysregulation and suicidal ideation. The acquired capability did not explain the association between behavioral dysregulation and suicide attempt history. Affective and behavioral dysregulation may be key targets in treatment for reducing suicide risk.     

Extracurricular Activities are Associated with Lower Suicidality through Decreased Thwarted Belongingness in Young Adults

Research has shown a negative association between extracurricular activities (ECAs) and suicidality. This study builds upon past research by using the interpersonal psychological theory of suicide to better understand the mechanisms involved in the relationship between ECAs and suicide risk. A total of 121 community and online-recruited adults ages 18 to 24-years-old participated. Self-report measures of suicidality, thwarted belongingness, and perceived burdensomeness were collected. Duration and breadth of participation in ECAs were assessed. ECA involvement was negatively associated with thwarted belongingness and perceived burdensomeness. An indirect effect of ECAs on suicidality through thwarted belongingness was statistically significant, but not for perceived burdensomeness. ECA involvement was associated with decreased suicidality through lower levels of thwarted belongingness. Interventions utilizing ECAs may be a low-cost, high-access option for decreasing suicide risk.     

Need for Affect,Interpersonal Psychological Theory of Suicide,and Suicide Proneness

The present study expands upon the Interpersonal Psychological Theory of Suicide (IPTS), examining its relationship with the need for affect (NFA), a construct explaining attitudes toward seeking both positive and negative emotions. A sample of 576 emerging adults completed measures of NFA, IPTS, suicide proneness, and demographics online. Findings include NFA accounting for a small significant amount of suicide proneness, a positive association between approaching emotions and one indicator of suicide proneness, negative association between approaching emotions and thwarted belongingness, and positive associations between avoidance of emotions with both perceived burdensomeness and thwarted belongingness. Findings are discussed concerning NFA as a theoretically and practically relevant factor for understanding suicide.     

Depressive Symptoms and Perceived Burdensomeness Mediate the Association between Anxiety and Suicidal Ideation in Adolescents

A relationship between anxiety disorders and suicide-related behaviors has been demonstrated in adolescents, with a paucity of research examining mediators of this association. The present study hypothesized that anxiety would be associated with suicidal ideation via a serial mediation pathway through depressive symptoms and perceived burdensomeness and/or thwarted belongingness. A sample of 80 adolescents (68.8% female, 65.8% Hispanic), 13–19 years of age (mean?=?16.93, SD?=?1.66), completed 3 interviews as part of a randomized controlled trial. Results indicated a significant serial mediation from anxiety to suicidal ideation via depressive symptoms and perceived burdensomeness, but not thwarted belongingness. Clinicians and mental health service providers working with adolescents experiencing elevated anxiety should regularly assess for perceived burdensomeness and suicidal ideation.     

Death ideation in older adults: psychological symptoms of depression,thwarted belongingness,and perceived burdensomeness

Death ideation is commonly reported by older adults in the United States; however, the factors contributing to death ideation in older adults are not fully understood. Depressive symptoms, as well as components of the interpersonal theory of suicide, perceived burden, and thwarted belonging may contribute to death ideation.

Objectives: The purpose of this study was to investigate the moderating relationship of the psychological symptoms of depression on the relation between perceived burdensomeness and death ideation, and thwarted belongingness and death ideation.

Method: A sample of 151 older adults completed questionnaires assessing numerous covariates, as well as perceived burdensomeness, thwarted belongingness, death ideation, and the psychological symptoms of depression.

Results: The results of this study indicated that the proposed moderating relationship was supported for the relationship between perceived burdensomeness and death ideation, but was not supported for the relationship between thwarted belongingness and death ideation when covariates (loneliness and hopelessness) were controlled.

Conclusion: This suggests that the psychological symptoms of depression are significantly associated with death ideation in older adults experiencing feelings of perceived burdensomeness. Additionally, the findings suggest that loneliness and hopelessness are also important factors to consider when assessing death ideation in older adults.     

La théorie interpersonnelle du suicide. Présentation et application dans la compréhension des idées suicidaires chez l’étudiant en médecine : étude dans un groupe de 178 étudiants

ObjectivesThe current paper presents firstly the Interpersonal Psychological Theory of Suicide (IPTS) and its interest in the risk of suicide in physicians and/or medical students and secondly an original study on 178 medical students.MethodsIn total, 178 medical students of the Université Libre de Bruxelles filled out an ad hoc questionnaire rating suicidal ideations (life-time), recent suicidal plans and recent suicidal ideations rated by the 9th item of the Beck Depression Inventory-II (BDI). The subjects completed the French version of the Interpersonal Needs Questionnaire (INQ) rating Perceived burdensomeness and Thwarted belongingness and the Acquired Capability for Suicide Scale (ACSS) as well as the Beck Depression Inventory-II (BDI-II). Among the 178 medical students, 95 had no suicide risk, 24 had life-time suicidal ideation, 28 had recent suicidal ideations and 26 had recent suicidal plans. The four groups were compared for gender and age as well as for the different rating scales using Chi² tests or analyses of variance (ANOVA).ResultsThe four groups had no significant differences for age, gender and scores on the ACSS. ANOVA revealed significant differences for perceived burdensomeness, thwarted belongingness and depression. To control the potential effect of depression, analyses of covariance (ANCOVA) were done taking as covariate a subscale of the BDI-II rating the cognitive component of depression. The two ANCOVA were significant. Post hoc tests comparing two by two the different groups reported that students with recent suicidal ideations or suicidal plans have significantly higher thwarted belongingness than students without suicide risk or students with life time suicidal ideations. Moreover, higher level of perceived burdensomeness was found only in students with suicidal plans comparatively with the three other groups.ConclusionHigh levels of thwarted belongingness and perceived burdensomeness characterize medical students with recent suicidal ideations or suicidal plans independently of the level of depression.     

The interpersonal needs questionnaire with a shortened response scale for oral administration with older adults

Objectives: The purpose of this paper is to examine the psychometric properties and construct validity of the interpersonal needs questionnaire (INQ) using a modified three-point response scale for oral administration with older adults.

Methods: In-home interviews were conducted with 269 participants aged 60 and older who were completing an eligibility interview for a randomized control trial. The INQ was administered orally, as were measures of social support, death and suicide ideation, and meaning in life.

Results: A confirmatory factor analysis demonstrated acceptable fit, with all of the items loading significantly onto the associated latent variable of thwarted belongingness or perceived burdensomeness. Construct validity of the measure was supported through an examination of discriminant validity using constructs hypothesized by the interpersonal theory of suicide to be related to the measured constructs, including social support and social integration for thwarted belongingness, social worth and death ideation for perceived burdensomeness, and meaning in life and suicide ideation for both.

Conclusion: The INQ yields reliable and valid scores of thwarted belongingness and burdensomeness when administered orally using a shortened response scale with older adults. These results help establish the measure as a valuable and practical tool for use in the field of late-life suicide prevention.     

Pain and Suicidal Behavior in Primary Care Patients: Mediating Role of Interpersonal Needs

Individuals experiencing chronic pain are at greater risk for suicidal behavior. The mechanism of action for this association is unexplored, but may involve the influence of pain on interpersonal functioning. We examined the mediating role of unsatisfied interpersonal needs on the relation between pain severity and interference, and suicidal behavior. Low income, uninsured participants completed self-report measures of pain severity and interference, thwarted interpersonal needs and suicidal behavior. Our hypotheses were partially supported; in simple mediation models, an indirect only effect existed for both thwarted belongingness and perceived burdensomeness in the relation between pain severity and pain interference and suicidal behavior. These effects did not persist in multiple mediation analyses. Our findings suggest that, for patients experiencing pain, assessment and improvement of the quantity and quality of interpersonal relationships may reduce risk for suicide ideation and attempts.     

Mechanisms of Action Contributing to Reductions in Suicide Attempts Following Brief Cognitive Behavioral Therapy for Military Personnel: A Test of the Interpersonal-Psychological Theory of Suicide

Brief cognitive behavioral therapy (BCBT) is associated with significant reductions in suicide attempts among military personnel. However, the underlying mechanisms of action contributing to reductions in suicide attempts in effective psychological treatments remain largely unknown. The present study conducted a secondary analysis of a randomized controlled trial of BCBT versus treatment as usual (TAU) to examine the mechanisms of action hypothesized by the interpersonal-psychological theory of suicide (IPT): perceived burdensomeness, thwarted belongingness, and fearlessness about death. In a sample of 152 active duty U.S. Army personnel with recent suicide ideation or attempts, there were significantly fewer suicide attempts in BCBT, but there were no differences between treatment groups from baseline to 6 months postbaseline on any of the 3 IPT constructs or their interactions. Tests of the moderated mediation failed to support an indirect effect for the IPT model, regardless of which IPT variables were specified as mediators or moderators. Results suggest that the IPT’s hypothesized mechanisms of action do not account for reductions in suicide attempts in BCBT. Implications for clinical practice and research are discussed.     

Perfectionism Moderates the Relationship between Thwarted Belongingness and Perceived Burdensomeness and Suicide Ideation in Adolescents

Psychiatric Quarterly - According to the Interpersonal Theory of Suicide, suicide ideation is associated with thwarted belongingness and perceived burdensomeness. According to the Perfectionism...     

A Case Controlled Examination of the Interpersonal Theory of Suicide in the Second Half of Life

The interpersonal theory of suicide proposes that the most proximal cause of suicide is the combination of thwarted belongingness and perceived burdensomeness coupled with a pre-existing vulnerability of reduced fear of death and increased pain tolerance. This pre-existing vulnerability develops in response to painful and provocative life events. According to the theory, empirically demonstrated risk factors for suicide operate by increasing the likelihood of one or more of the theory's constructs. The current study examined the relations of the major constructs of the interpersonal theory with suicide case status compared to living controls in the second half of life. The current study used a pre-existing psychological autopsy database to compare suicide decedents to living controls 50 years and older. Theory constructs were measured by composite scores of thwarted belongingness, perceived burdensomeness, and painful and provocative experiences using an a priori selection of items comprising each construct. Suicide decedents experienced greater levels of all three of the theory's constructs when examined independently compared to living controls. When examined simultaneously while also controlling for Major Depression, greater perceived burdensomeness and painful and provocative experiences were associated with suicide case status (vs. control). The interpersonal theory is a comprehensive framework that may be useful in understanding risk for death by suicide in the second half of life. Clinical management of suicide risk for adults in the second half of life could include a focus on perceived burdensomeness, as the IPTS proposes that this psychological state is amenable to change via therapeutic intervention.     

Suicidal Ideation and Interpersonal Needs: Factor Structure of a Short Version of the Interpersonal Needs Questionnaire in an At-Risk Military Sample

Objective: The interpersonal-psychological theory of suicide posits that perceived burdensomeness (PB; i.e., the belief that others would be better off if one were dead) and thwarted belongingness (TB; i.e., the belief that one lacks meaningful social connections) are both necessary risk factors for the development of suicidal ideation. To test these relations, measures are needed that are well validated, especially in samples of at-risk adults. Method: The current study was designed to examine the factor structure of an eight-item version of the Interpersonal Needs Questionnaire (INQ) in a sample of 405 U.S. past and current military personnel (M_age = 31.57 years, SD = 7.28; 90.4% male) who endorsed either current suicidal ideation and/or a past suicide attempt. Analyses were conducted using confirmatory factor analysis (CFA). Results: A bifactor model comprising a general factor, labeled interpersonal needs, and two specific factors, labeled PB and TB, fit the data best. The general factor captured a high proportion of overall variance (81.9%). In contrast, the TB factor captured only a modest amount of variance in items meant to capture this factor (59.1%) and the PB factor captured very little variance in items meant to capture this factor (13.5%). Further, only the interpersonal needs factor was associated with lifetime and past-week suicidal ideation as well as suicidal ideation frequency and duration. Conclusions: The current findings indicate that, for the INQ-8 in high-risk military personnel, a general interpersonal needs factor accounted for the relations PB and TB share with suicidal ideation.     

The Relationship of Self-reported Executive Functioning to Suicide Ideation and Attempts: Findings from a Large U.S.-based Online Sample

An increasing number of studies demonstrate that individuals with a history of suicidality exhibit impaired executive functioning abilities. The current study examines whether these differences are linked to suicidal thoughts or suicidal acts—a crucial distinction given that most people who think about suicide will not act on their thoughts. A large online sample of U.S. participants with a history of suicide ideation (n = 197), suicide attempts (n = 166), and no suicidality (n = 180) completed self-report measures assessing executive functioning, suicide ideation and attempts; in addition, depression, self-efficacy, and history of drug abuse and brain injury were assessed as potential covariates. Individuals with recent suicide attempts reported significantly worse executive functioning than ideators. This difference was not accounted for by depression, self-efficacy, history of drug abuse or brain injury. Self-reported executive functioning may represent an important short-term risk factor for suicide attempts.