Evaluating the Clinical Utility of the Interpersonal Hopelessness Scale Among Adults With Past-Year Suicide Ideation.

The 15-item Interpersonal Needs Questionnaire (an assessment of thwarted belongingness and perceived burdensomeness) should be incorporated into suicide risk assessment. Among psychiatric inpatients, greater thwarted belongingness and perceived burdensomeness, as separate predictors, were associated with increased levels of distress due to suicide ideation, desire for death, and desire for suicide. The highest scores on thwarted belongingness and perceived burdensomeness indicated a 79% to 95% chance of experiencing an elevated level of distress due to suicide ideation, desire for death, or desire for suicide. Recommended clinical cutoff scores were provided. For example, thwarted belongingness cutoff score of 31 and perceived burdensomeness cutoff score of 22 maximized the sensitivity and specificity of the INQ to detect some level of desire for suicide.

ABSTRACTThe interpersonal theory of suicide proposes that thwarted belongingness (TB) and perceived burdensomeness (PB) predict psychological pain and desire for suicide. Brooding may be a mechanism in explaining how TB and PB predict pain. The conceptual similarity between rejection sensitivity (RS) and TB suggests that individuals with high RS may be likely to experience psychological pain in the context of TB. To test this model, 155 college students completed measures of psychological pain, TB, PB, brooding, and RS. As predicted, brooding mediated the relations between both TB and PB and psychological pain. RS interacted with TB in predicting psychological pain.

Background: People diagnosed with Borderline Personality Disorder (BPD) often endorse suicidality. One of the leading theories on the causes of suicidality, the interpersonal-psychological theory of suicide (IPTS), argues that this suicidal desire is driven by perceived burdensomeness (PB), the belief that others are better off without the individual, and thwarted belongingness (TB), the unmet need for social connection. Given that a distinguishing characteristic of BPD is the prevalence of interpersonal difficulties and negative cognitions, the IPTS is an important framework to use when looking at the link between BPD and suicidality. The relationship between BPD, PB, TB, and suicidality has been researched in the past, but this relationship within the context of a dialectical behavior therapy (DBT) partial hospital program (PHP) has yet to be analyzed. Objective: This study examined the relationship between these measures in a DBT PHP for adolescents/young adults. Method: One hundred seventy-six adolescents/young adults in a comprehensive DBT PHP completed surveys measuring suicidality, TB, PB, and BPD symptoms upon intake and discharge. Results: Analyses found that all outcome measures significantly improved from admission to discharge and that most variables were positively correlated. Results also showed that PB and depression scores emerged as unique predictors of suicidality at discharge. Conclusion: An adherent DBT PHP can be an effective treatment option for adolescents/young adults endorsing BPD symptoms, TB, PB, and suicidality. Future studies should examine the specific aspects of DBT that are most important in decreasing these symptoms.

The aim of the current study was to validate the Interpersonal Needs Questionnaire (INQ-15) and to test its reliability in Persian-speaking Iranian undergraduate students. In this cross-sectional study, 485 undergraduate students (age: 20.66 ± 1.42, 60% female) were assessed on the two subscales of perceived burdensomeness (PB) and thwarted belongingness (TB) and the Suicide Behavior Questionnaire-Revised (SBQ-R). Exploratory structural equation modelling (ESEM) confirmed the construct validity of INQ-14, excluding INQ#9. In addition, INQ#8, articulated in an equivalent Persian phrasing, loaded well on TB. The measurement model tested by confirmatory factor analysis (CFA) suggested INQ#11 to be eliminated, resulting in INQ-13-P to consist of PB and TB-7. The internal consistency and convergent/discriminant validity were established. The concurrent validity of PB was solidly established in terms of past year suicidal ideation (PY-SI) above and beyond anxiety, depression, prior suicidality, and TB-7. The effect of PB on PY-SI was stronger, where prior suicidality had already occurred or the perceived likelihood of future suicide (PLFS) was high. Moreover, TB-7 could only indicate PY-SI, where prior suicidality had already occurred or PLFS was high, albeit when PB was omitted. The interaction term was significant; however, beyond anxiety and depression, the effect of TB-7 on PY-SI was significant where PB was very high (n = 40, 8.25%). Therefore, future studies can utilize INQ-13-P as a valid and reliable instrument in Persian-speaking populations. However, further studies should examine the construct validity of TB and its relationship with suicide ideation in different populations.

Perceived social problem-solving deficits are associated with suicide risk; however, little research has examined the mechanisms underlying this relationship. The interpersonal theory of suicide proposes 2 mechanisms in the pathogenesis of suicidal desire: intractable feelings of thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested whether TB and PB serve as explanatory links in the relationship between perceived social problem-solving (SPS) deficits and suicidal thoughts and behaviors cross-sectionally and longitudinally. The specificity of TB and PB was evaluated by testing depression as a rival mediator. Self-report measures of perceived SPS deficits, TB, PB, suicidal ideation, and depression were administered in 5 adult samples: 336 and 105 undergraduates from 2 universities, 53 homeless individuals, 222 primary care patients, and 329 military members. Bias-corrected bootstrap mediation and meta-analyses were conducted to examine the magnitude of the direct and indirect effects, and the proposed mediation paths were tested using zero-inflated negative binomial regressions. Cross-sectionally, TB and PB were significant parallel mediators of the relationship between perceived SPS deficits and ideation, beyond depression. Longitudinally and beyond depression, in 1 study, both TB and PB emerged as significant explanatory factors, and in the other, only PB was a significant mediator. Findings supported the specificity of TB and PB: Depression and SPS deficits were not significant mediators. The relationship between perceived SPS deficits and ideation was explained by interpersonal theory variables, particularly PB. Findings support a novel application of the interpersonal theory, and bolster a growing compendium of literature implicating perceived SPS deficits in suicide risk. (PsycINFO Database Record

Perceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment. Participants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross-lagged panel models (AR-CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment. Motivation was significantly negatively correlated with PB and TB at all timepoints. In AR-CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR-CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint. This study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

Evaluating the interpersonal theory of suicide among post-9/11 veterans: Suicidal desire and intent in the early transition to civilian life.

PurposeDespite 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/approachStudy 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.FindingsIn 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/valueThis 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.

Research has identified non-suicidal self-injury (NSSI) as a robust correlate of suicidal thoughts and behaviors; however, little is known regarding why these constructs may be related. Consistent with the interpersonal theory of suicide, this study investigated thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide (CS) as explanatory links in the association between NSSI, ideation, and suicide attempt history. Military service members and veterans (N = 973; agemean = 29.9 years, 78.8% male, 63.8% Caucasian/White) completed measures of lifetime NSSI and suicide attempts; current suicidal ideation; TB, PB, and CS; and related psychiatric symptoms. Bootstrap moderated mediation analyses were employed to examine whether (a) TB moderated the mediating effect of PB on NSSI and ideation, (b) PB moderated the mediating effect of TB on NSSI and ideation, and (c) CS moderated the mediating effect of TB and PB on NSSI and attempts. TB and PB significantly accounted for the relationship between lifetime NSSI and current ideation. TB did not moderate the mediating effect of PB on NSSI and ideation, and PB did not moderate the mediating effect of TB. However, CS significantly moderated the mediating effects of TB and PB on NSSI and attempt history. The interpersonal theory of suicide hypotheses were partially supported. Consistent with the theory, the interaction of TB and PB only explained NSSI and attempt history among service members with high levels of CS. TB and PB only individually explained the association between lifetime NSSI and recent suicidal ideation. Prospective studies are warranted to replicate these findings across other military samples. (PsycINFO Database Record

The interpersonal theory of suicide posits that perceived burdensomeness (PB) and thwarted belongingness (TB) are central to suicidal ideation (SI), where either one is sufficient for passive SI but both required for active SI. This study used continuous-time modeling to examine the relationship between PB, TB, and both passive and active SI. Three independent samples (N = 141) of participants with recent suicidal thoughts and behaviors completed 3-15 surveys per day for 28-30 days; each survey assessed PB, TB, passive SI, and active SI. Continuous-time residual dynamic structural equation models estimated auto- and cross-drift effects (instantaneous rates of change) between PB, TB, and their interaction on passive and active SI. Negative drift rates indicate resistance to shifts away from equilibrium. Both passive and active SI had negative auto-drift effects. There were significant negative cross-drift effects of PB, TB, and their interaction on both active and passive SI. The effects of PB, TB, and their interaction lasted 5-5.5 and 4.5-5 hr on passive SI and active SI, respectively. Auto-drift effects were significantly larger than cross-drift effects, which did not differ from each other. Both passive and active SI reduce their own rates of change, resisting shifts away from their equilibrium. Contrary to the interpersonal theory of suicide, these findings suggest that rather than precipitating SI, PB, TB, and their interaction resist shifts away from a person's typical levels of passive and active SI. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BackgroundThwarted Belongingness (TB) and Perceived Burdensomeness (PB) are considered risk factors of suicide behavior in the Interpersonal Theory of Suicide and constitute the main factors of the Interpersonal Needs Questionnaire—INQ.AimsThe present study analyzes the internal consistency, construct validity, and invariance across sex and age of the INQ-15, which comprises two subscales, in a sample of Spanish community adolescents.MethodsParticipants were 1,536 adolescents from 12 to 19 years old. The INQ-15, the total number of non-suicidal self-injuries (NSSI), the Hopelessness Scale, and the Purpose in Life Test-Adolescents (PIL-A) were used.ResultsThe INQ-15 showed good internal consistency for TB ( = 0.88) and PB ( = 0.78) subscales and construct and concurrent/discriminant validity in the whole sample. Both the PB and TB subscales showed a good fit { = 6.448, p = 0.694, CFI = 1.000, RMSEA = 0.000 [90% CI (0.000, 0.022)] and = 248.973, p = 0.000, CFI = 0.922, RMSEA = 0.073 [90% CI (0.065, 0.082)]}, respectively. Regarding the invariance analyses, we found (1) non-invariance in the PB subscale across sex groups and metric, scalar, and stric invariance across age groups, and (2) that it was not possible to perform the invariance analysis for the TB subscale across both sex and age because the fit was not adequate for both boys and 12–15 years old groups. Positive and significant relationships were found between the INQ-15 subscales and hopelessness and NSSI frequency, and negative and significant correlations with meaning in life.ConclusionsThe INQ-15 is a valid instrument for assessing TB and PB in Spanish adolescents. Future studies should analyze the invariance of this instrument in adolescents across sex and age.

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.

To evaluate the Caring Connections intervention compared to an attention control condition on loneliness, perceived burdensomeness (PB), and thwarted belongingness (TB). In a two-arm parallel randomized controlled trial (RCT), 58 individuals with spinal cord injuries and disorders were randomized 1:1 to the intervention or the attention control condition. Block randomization with random block sizes of 2, 4, or 6 and allocation concealment were used to assign individuals to arms. Both groups showed within-group improvements in loneliness from baseline to post-RCT, but no statistically significant differences in change scores between the conditions over time. The treatment group showed within-group improvement in PB from baseline to post (p = .0008), but not in TB. The control group showed within-group improvement in TB from baseline to post (p = .04), but not in PB. No significant differences over time were found for either PB or TB between conditions. A greater proportion of the treatment versus control group found the program to be beneficial (76% vs. 45%, p = .02) and satisfactory (79% vs. 52%, p = .03). We did not demonstrate that the Caring Connections intervention reduced feelings of loneliness compared to the control condition. We found significant within-group improvements in loneliness from baseline to post-RCT for both groups. Within-group improvements in PB were seen in the treatment group and TB in the control group, but no significant differences in change scores over time between conditions. Communication over a 6-month period (from personalized peer letters or informational material on quality of life) had some impact on loneliness, PB, and TB. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The objective of this study was to explore the role of personality and self-esteem in later life within two established risk factors for suicidal ideation (SI)-Thwarted Belongingness (TB) and Perceived Burdensomeness (PB). The data about personality (i.e., Five Factor Model [FFM] and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Personality Disorders [PD]), self-esteem, TB, PB, and SI were collected from 102 community-dwelling older adults and analyzed using bivariate and multivariate techniques. All FFM domains and most PD traits were significantly correlated with SI, TB, and PB. Furthermore, FFM and PD traits explained a significant and meaningful amount of variance of SI, TB, and PB. Self-esteem demonstrated strong negative relationships with SI, TB, and PB. Personality features and self-esteem are important associated features for SI, TB, and PB. Clinicians should consider this information when assessing and evaluating for suicidal risk among older adults. The findings also highlight the need to consider personality traits in developing prevention strategies.

Background Suicidal thoughts and behaviors are an acute public health issue, particularly among US Veterans. The interpersonal-psychological theory of suicide posits that unmet interpersonal needs, specifically thwarted belongingness (TB) and perceived burdensomeness (PB) contribute to desire for death by suicide and increased suicidal ideation (SI). However, little is known about the neurochemical correlates of TB and PB. Prior research using proton magnetic resonance spectroscopy (1H-MRS) has implicated glutamate (Glu) and glutamine (Gln), as well as gamma-aminobutyric acid (GABA), in SI and related psychiatric disorders. The current study sought to examine the relationship between thwarted belongingness and perceived burdensomeness and concentrations of Gln, Glu, and GABA in US Veterans with and without a history of SI. Methods In this preliminary exploratory study, 25 US Veterans underwent a two-dimensional J-resolved 1H-MRS exam to measure in vivo concentrations of Gln, Glu, and GABA in the anterior cingulate cortex. Veterans also completed the Columbia Suicide Severity Rating Scale to characterize lifetime history of suicidal thoughts and behaviors and the Interpersonal Needs Questionnaire to measure TB and PB. Results Reduced Gln/water was associated with increased TB and PB scores. Reduced Gln/Glu was associated with increased TB scores. Veterans with a lifetime history of SI also exhibited reduced Gln/water and Gln/Glu. Follow-up regression models showed that neither TB, PB, nor SI history were uniquely associated with Gln, but TB was uniquely associated with Gln/Glu. Conclusion Results provide preliminary evidence that TB and PB may be linked to abnormalities in Gln. This work further integrates biological and psychosocial perspectives on SI.