Interpersonal-psychological Theory Of Suicidal Behavior Research Articles

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.

Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior.

Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understanding suicide in the resettled Bhutanese community.

The Specificity of the Interpersonal-Psychological Theory of Suicidal Behavior for Identifying Suicidal Ideation in an Online Sample.

The interpersonal-psychological theory of suicidal behavior suggests that the combination of perceived burdensomeness and thwarted belongingness predicts suicidal ideation. However, the specificity of this prediction to suicidal ideation has not been tested. This study examined whether these constructs were consistently associated with different characteristics of suicidal ideation, and whether they were associated with mental health problems more broadly, in an online sample of 1,352 Australian adults. Findings indicated that the interaction between perceived burdensomeness and thwarted belongingness was associated only with suicidal ideation and consistent across multiple characteristics of ideation. The study broadly supported the specificity of the IPTS.

Does the experience of interpersonal predictors of suicidal desire predict positive attitudes toward Physician Assisted Suicide?

The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample. Results suggest that attitudes toward PAS may be influenced by the experience of thwarted belongingness and perceived burdensomeness and provide a clear rationale for the study of these variables in populations more apt to consider hastened death. Future work regarding the application of the interpersonal-psychological theory of suicidal behavior in hastened death research is discussed.

A prospective examination of the interpersonal-psychological theory of suicidal behavior among psychiatric adolescent inpatients.

The challenge of identifying suicide risk in adolescents, and particularly among high-risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS)--with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self-injury--predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three-way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2-way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12-month attempts. Results suggest gender-specific associations between theory components and attempts. The time-limited effects of these associations point to TB and PB being dynamic and modifiable in high-risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively.

Gender-differences in risk factors for suicidal behaviour identified by perceived burdensomeness, thwarted belongingness and acquired capability: cross-sectional analysis from a longitudinal cohort study.

BackgroundThe Interpersonal-Psychological Theory of Suicidal Behavior (IPT) is supported by recent epidemiological data. Unique risk factors for the IPT constructs have been identified in community epidemiological studies. Gender differences in these risk factors may contribute substantially to our understanding of suicidal risk, and require further investigation. The present study explores gender differences in the predictors and correlates of perceived burdensomeness, thwarted belongingness and acquired capability for suicide.MethodsParticipants (547 males, 739 females) aged 32–38 from the PATH through Life study, an Australian population-based longitudinal cohort study (n=1,177) were assessed on perceived burdensomeness, thwarted belongingness and acquired capability for suicide using the Interpersonal Needs Questionnaire and Acquired Capability for Suicide Survey, and on a range of demographic, social support, psychological, mental health and physical health measures. Gender differences in the predictors of the IPT constructs were assessed using linear regression analyses.ResultsHigher perceived burdensomeness increased suicide ideation in both genders, while higher thwarted belongingness increased suicide ideation only in females. In females, thwarted belongingness was uniquely related to perceived burdensomeness, while greater physical health was significantly associated with greater thwarted belongingness in males but not in females. There were trends suggesting greater effects of being single and greater perceived burdensomeness for men, and stronger effects of less positive friendship support for women associated with greater thwarted belongingness.ConclusionsMen and women differ in the pattern of psychological characteristics that predict suicide ideation, and in the factors predicting vulnerability. Suicide prevention strategies need to take account of gender differences.

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.

Predictors of the risk factors for suicide identified by the interpersonal-psychological theory of suicidal behaviour

The Interpersonal-Psychological Theory of Suicide (IPTS) has been supported by recent research. However, the nature of the models׳ three major constructs – perceived burdensomeness, thwarted belongingness and acquired capability – requires further investigation. In this paper, we test a number of hypotheses about the predictors and correlates of the IPTS constructs. Participants aged 32–38 from an Australian population-based longitudinal cohort study (n=1167) were assessed. IPTS constructs were measured by items from the Interpersonal Needs Questionnaire (INQ) and Acquired Capability for Suicide Scale (ACSS), alongside demographic and additional measures, measured concurrently or approximately 8 years earlier. Cross-sectional analyses evaluating the IPTS supported earlier work. Mental health was significantly related to all three IPTS constructs, but depression and anxiety caseness were associated only with perceived burdensomeness. Various social support measures were differentially associated with the three constructs. Stressful events and lifetime traumas had robust independent associations with acquired capability for suicide only. The IPTS model provides a useful framework for conceptualising suicide risk. The findings highlight the importance of perceived social support in suicide risk, identify the importance of personality and other factors as new avenues of research, and provide some validation for the independence of the constructs.

The mediating role of non-suicidal self-injury in the relationship between impulsivity and suicidal behavior among inpatients receiving treatment for substance use disorders

Several theories posit a direct role of impulsivity in suicidal behavior. The interpersonal-psychological theory of suicidal behavior (IPTS) argues that the relationship between impulsivity and suicidal behavior is explained by the painful and/or provocative experiences (PPEs) often encountered by impulsive individuals. It thus seems plausible that nonsuicidal self-injury (NSSI), itself associated with impulsivity, might account for the relationship between impulsivity and suicidal behavior. We examined data from 93 adult inpatients (54.8% male) seeking treatment for substance use disorders. Patients completed a structured interview assessing prior suicidal behavior and a series of self-report questionnaires examining impulsivity, NSSI, and psychopathology. Four impulsivity dimensions (negative urgency, positive urgency, lack of premeditation, lack of perseverance) were associated with lifetime number of suicide attempts and/or suicide potential. Furthermore, results supported our hypotheses, as all but one relation was better accounted for by NSSI and, in the one exception, the direct effect was non-significant. Findings are consistent with the IPTS and suggest that suicidal behavior may not be a direct manifestation of impulsivity, but facilitated through exposure to PPEs capable of altering an individual׳s relationship to pain and fear of death.

Suicidal Behavior and HIV/AIDS: A Partial Test of Joiner's Theory of Why People Die by Suicide

Suicidal behavior occurs among people living with HIV/AIDS. Thomas Joiner has postulated that in order to complete suicide three variables must be present—perceived burdensomeness and thwarted belongingness, and acquired capacity. We examined these three concepts in a partial test of Thomas Joiner's interpersonal-psychological theory of suicidal behavior. Our sample consisted of 52 individuals that were receiving services at HIV/AIDS clinics. These individuals were divided into two groups—one with suicidal behaviors, the other with no suicidal behaviors. Acquired capacity was limited to medication adherence and both groups reported good adherence with their medications. Results show those in the suicidal behavior group experience slightly more perceived burdensomeness and feelings of thwarted belongingness than those in the no suicidal behaviors group. These findings and suggestions for future research are presented.

Hope and the Interpersonal‐Psychological Theory of Suicidal Behavior: Replication and Extension of Prior Findings

The interpersonal-psychological theory of suicidal behavior (IPTS; Joiner, 2005) posits that suicidal behavior occurs when an individual has a desire for death (due to the combination of perceived burdensomeness and thwarted belongingness) in addition to an acquired capacity for suicide, which is present when the individual has a low fear of death and high pain tolerance. Previous research has demonstrated an expected negative relation between trait hope and perceived burdensomeness and thwarted belongingness, as well as a more perplexing finding that hope is positively associated with the acquired capability. In a sample of 230 college students, measures of the three components of the IPTS were administered, along with measures of hope, depression, and painful and/or provocative events. Hierarchical regression analyses replicated the previously found associations between hope and burdensomeness and belongingness while controlling for depression and demographic variables. The positive association between hope and acquired capacity was also replicated, but a mediation analysis demonstrated that the effect was statistically accounted for by distress tolerance. The results further support the incremental validity of hope as a consideration in suicide risk assessments and suggest that hope may serve as a protective factor with respect to suicidal desire.

The interactive role of distress tolerance and borderline personality disorder in suicide attempts among substance users in residential treatment

The primary purpose of this study was to examine the interactive effect of borderline personality disorder (BPD) and distress tolerance (DT) on suicidal behavior across levels of intent to die (clear vs ambiguous) and medical severity. One hundred seventy-six adult patients in residential substance use disorder treatment were administered a series of structured interviews, behavioral assessments, and self-report questionnaires. A series of analyses of covariance and multiple regression analyses were conducted to test hypotheses using both categorical and dimensional measures of BPD and DT. Analyses supported hypotheses, indicating that patients with BPD who exhibit high DT are at the greatest risk for engaging in chronic and medically serious suicidal behavior. Although high DT is unlikely to be inherently problematic, results suggest that within the context of severe psychopathology (eg, co-occurring BPD–substance use disorder), the ability to withstand aversive internal states in pursuit of a goal (eg, one's own death) may enable individuals to persist in otherwise unsustainable behavior. In this sense, DT may function in a manner consistent with the acquired capability for suicide (a component of the interpersonal-psychological theory of suicidal behavior defined by a diminished fear of death and enhanced tolerance for pain that, in the presence of suicidal desire, enables individuals to enact lethal self-injury).

Exploring application of the Interpersonal-Psychological Theory of Suicidal Behaviour to self-injurious behaviour among women prisoners: Proposing a new model of understanding

The current study examines the application of capacity, psychological distress, coping and personality to an understanding of self-injurious behaviour, with a specific focus on testing the Interpersonal-Psychological Theory of Suicidal Behaviour (IPTSB). One hundred and ninety women prisoners took part, completing a history questionnaire and measures of personality, coping styles and psychological distress. It was expected that self-injurious behaviour would be predicted by higher levels of emotional functioning difficulties, by an increased capacity to engage in such behaviours, by previous self-injurious behaviour, decreased levels of emotional stability and increased levels of emotional coping behaviour. Results supported the capacity component of the IPTSB, indicating that an increased history of self-injurious behaviour and of engagement in reckless behaviour were particular predictors. Increased psychological distress in some domains was also a predictor although the exact domain varied across the type of self-injurious engagement Increased levels of extraversion and decreased emotional coping predicted increased self-injurious engagement, although emotional coping only related to threats and cognition. The results point to the applicability of Interpersonal-Psychological Theory to understanding self-injurious behaviour and the importance of developing a revised model. The paper presents this in the form of the Integrated Model of Self-Injurious Activity.

The Role of Optimism in the Interpersonal‐Psychological Theory of Suicidal Behavior

A possible relationship between Joiner's (2005) interpersonal-psychological theory of suicidal behavior and optimism was investigated by examining the ability of optimism to act as a moderator of perceived burdensomeness, thwarted belongingness, and acquired capability to engage in self-injury in the prediction of suicidal ideation. Results supported hypotheses that optimism would serve as a moderator of the effects of thwarted belongingness and perceived burdensomeness in the prediction of suicidal ideation; however, similar results were not found regarding the acquired capability to engage in self-injury. How optimism might play a role in alleviating suicidal ideation and clinical implications of the findings are discussed.

The Impact of the 2009 Red River Flood on Interpersonal Risk Factors for Suicide

Natural disasters are frequently associated with increases in risk factors for suicide, yet research indicates that suicide rates tend to stay the same or decrease in the wake of disasters (e.g., Krug et al., 1999). The present research sought to shed light on this counterintuitive phenomenon by testing hypotheses derived from Joiner's (2005) interpersonal-psychological theory of suicidal behavior, which proposes that the desire to die by suicide is the result of feeling like one does not belong and feeling like one is a burden on others. During natural disasters, community members often pull together in volunteering efforts, and it was predicted that such behaviors would boost feelings of belonging and reduce feelings that one is a burden. The present study tested these predictions in a sample of 210 undergraduate students in Fargo, North Dakota, following the 2009 Red River Flood. Consistent with prediction, greater amounts of time spent volunteering in flood efforts were associated with increased feelings of belongingness and decreased feelings of burdensomeness. The findings in the current study are consistent with the notion that communities pulling together during a natural disaster can reduce interpersonal risk factors associated with the desire for suicide.

Asian American college students' suicide ideation: A mixed-methods study.

The purpose of this mixed-methods study was to explore the phenomenon of suicide ideation among 293 Asian American college students. Guided by T. Joiner's (2005) interpersonal-psychological theory of suicidal behavior, the authors examined the relationships among perceived burdensomeness, thwarted belongingness, self-construals, and suicide ideation. Compared with thwarted belongingness, perceived burdensomeness was a more robust predictor of suicide ideation. However, thwarted belongingness moderated the positive association between perceived burdensomeness and suicide ideation. Furthermore, interdependent self-construal and independent self-construal both weakened the link between perceived burdensomeness and suicide ideation and between thwarted belongingness and suicide ideation. The authors also conducted a qualitative analysis of participants' open-ended responses about their perceptions of why Asian American college students might consider suicide. The authors identified a core phenomenon of unfulfilled expectations as well as 2 broad themes related to this core phenomenon: unfulfilled intrapersonal expectations and unfulfilled interpersonal expectations, comprising the subthemes of (a) family, (b) relationship, (c) cultural differences, and (d) racism. These findings are discussed in terms of implications for suicide-related clinical interventions and primary prevention efforts among Asian American college students.

Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample

The interpersonal-psychological theory of suicidal behavior (IPTS; Joiner, 2005) has been subjected to a number of rigorous investigations and has shown to be a promising lens through which to understand suicide. One area thus far left unstudied with respect to the IPTS is emotion dysregulation. The bulk of the work examining the role of emotion dysregulation in suicidality has focused on suicidal ideation rather than behavior, with a number of studies reporting that emotion dysregulation is predictive of suicidal ideation (e.g., Lynch et al., 2004; Orbach et al., 2007). Studies examining suicide attempts have produced more ambiguous results. One way to clarify the nature of this relationship is to consider the construct of emotion dysregulation through an examination of specific subcomponents. In this study, we examined two specific components of emotion dysregulation – negative urgency and distress tolerance – and their relationships to all three components of the IPTS, thereby providing clarity for an otherwise poorly understood relationship. Results indicated that emotionally dysregulated individuals – those with low distress tolerance and high negative urgency – exhibited higher levels of suicidal desire, as indexed by perceived burdensomeness and thwarted belongingness. In contrast, emotionally dysregulated individuals exhibited lower levels of the acquired capability for suicide and physiological pain tolerance. As such, a complicated but theoretically cogent picture emerged indicating that, although emotion dysregulation may drastically increase the likelihood of suicidal desire, it simultaneously serves as a form protection against lethal self-harm.

A preliminary test of the interpersonal-psychological theory of suicidal behavior in a military sample

Suicide in the military is a growing concern. The interpersonal-psychological theory of suicidal behavior proposes that an individual will not die by suicide unless he or she experiences a combined disconnection from others, feelings that one is a burden on others, and the ability to do so, but this theory has not yet been rigorously tested with military samples. The current study tested the theory’s hypotheses in predicting history of suicide in a sample of 88 active duty US Air Force personnel, which was compared to a non-military undergraduate sample ( n = 309) and a non-military clinical sample ( n = 228). Active duty personnel demonstrated higher acquired capability when compared to a clinical non-military sample. As compared to non-military undergraduates, active duty personnel demonstrated less perceived burdensomeness, but did not differ in terms of thwarted belongingness. The interaction of burdensomeness and acquired capability significantly predicted suicidal history, but the three-way interaction between burdensomeness, belongingness, and acquired capability did not, providing partial support for the theory in a military sample.

The interpersonal‐psychological theory of suicidal behavior: current status and future directions

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) holds that an individual will die by suicide if he or she has both the desire for suicide and capability to act on that desire. According to the theory, suicidal desire results from the convergence of two interpersonal states: perceived burdensomeness and thwarted belongingness. However, desire alone is not sufficient to result in death by suicide--a third component must be present: the acquired capability for suicide, which develops from repeated exposure and habituation to painful and provocative events. The purpose of this article is to discuss four viable and timely directions for future research, given the current status of the theory.

Main predictions of the interpersonal–psychological theory of suicidal behavior: Empirical tests in two samples of young adults.

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) makes 2 overarching predictions: (a) that perceptions of burdening others and of social alienation combine to instill the desire for death and (b) that individuals will not act on the desire for death unless they have developed the capability to do so. This capability develops through exposure and thus habituation to painful and/or fearsome experiences and is posited by the theory to be necessary for overcoming powerful self-preservation pressures. Two studies tested these predictions. In Study 1, the interaction of (low) family social support (cf. social alienation or low belonging) and feeling that one does not matter (cf. perceived burdensomeness) predicted current suicidal ideation, beyond depression indices. In Study 2, the 3-way interaction among a measure of low belonging, a measure of perceived burdensomeness, and lifetime number of suicide attempts (viewed as a strong predictor of the level of acquired capability for suicide) predicted current suicide attempt (vs. ideation) among a clinical sample of suicidal young adults, again beyond depression indices and other key covariates. Implications for the understanding, treatment, and prevention of suicidal behavior are discussed.