Interpersonal-psychological Theory Of Suicide Research Articles

Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample

The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18–23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.

Testing Basic Assumptions of the Interpersonal Needs Questionnaire-15 in a Sample of Clinically Depressed and Suicidal Youth.

Suicide is a leading cause of death in adolescence. The mechanisms of adolescent suicidality, however, are not fully understood. Although the Interpersonal-Psychological Theory of Suicide, as assessed by the Interpersonal Needs Questionnaire-15 (INQ), may be a promising framework, systematic study of its utility during adolescence is lacking. To this end, we utilized factor analyses and hierarchical regression analyses to test the factor structure, correlates, and predictive validity of the INQ in a sample of clinically depressed and suicidal adolescents (N=120, aged 12-18). The sample was mostly female (81.9%), ethnically diverse (68.2% non-White) and with nearly a third identifying as a sexual minority (31.8%). Contrary to studies including adult samples in which a two-factor solution is identified, results within this sample indicated three factors: perceived burdensomeness, thwarted belongingness, and perceived isolation. Perceived burdensomeness and the interaction between perceived burdensomeness and perceived isolation predicted suicide ideation above and beyond depression, but thwarted belongingness and perceived isolation did not. Perceived burdensomeness appears to play a role in adolescent suicidality and may be a point of intervention, yet the notable deviation from previous findings and the relative weakness of two of the factors warrant further study.

Evaluating the Interpersonal-Psychological Theory of Suicide among Latina Adolescents using Qualitative Comparative Analysis.

The Interpersonal-Psychological Theory of Suicide (IPTS) has emerged as an empirically supported theory of suicide risk, yet few studies have utilized IPTS to examine the suicidal behaviors of Latina adolescents. In this study, we explore the cultural and developmental appropriateness, as well as the explanatory fit, of IPTS within a sample of Latina adolescents. Data for this project were drawn from qualitative interviews conducted with Latina adolescents with (n=30) and without (n=30) histories of attempted suicide. We employed a deductive qualitative approach to define and compare core constructs of IPTS (perceived burdensomeness, thwarted belongingness, and acquired capability), and then use qualitative comparative analysis to evaluate how core constructs were linked with the occurrence of a suicide attempt. Consistent with IPTS, perceived burdensomeness, thwarted belongingness, and acquired capability were present in 20 of the 30 adolescents who had attempted suicide, and absent in 22 of the 30 adolescents with no lifetime history of suicidal behaviors. Notably, alternative combinations of IPTS constructs were found in 10 cases of adolescents who attempted suicide, suggesting a need to adjust IPTS to fit the developmental and cultural contexts of Latina teens. Although our results suggest predominantly positive support for IPTS, participants varied in terms of how their experiences resonated with the conceptual definitions put forward by the theory. Ultimately, our findings point to the ways in which developmental tensions are exacerbated by broader sociocultural dynamics, contributing to a broader understanding of suicide risk among ethnic minority adolescents.

Refinement of the Role of Hopelessness in the Interpersonal Theory of Suicide: An Exploration in an Inpatient Adolescent Sample

Hopelessness is a well-established risk factor for suicidal ideation. Recent research has indicated that hopelessness can be split into two subsets: pessimism (PESS) and lack of optimism (LOO) and that LOO is more salient of the two in predicting suicide ideation (SI). The aim of this study was to examine the relationship of PESS and LOO to SI in the context of the Interpersonal Psychological Theory of Suicide (IPTS). Participants were 294 inpatient adolescents. LOO but not PESS was associated with SI. LOO interacted with the IPTS variable of perceived burdensomeness to differentiate between passive and active SI, partly consistent with the theory. These results support the value of separating the two components of hopelessness in understanding adolescent SI.

Suicide etiology in youth: Differences and similarities by sexual and gender minority status

Sexual and gender minority (SGM) individuals are at steeply elevated risk for suicide, particularly in adolescence and young adulthood. Evidence on suicide risk factors specific to SGM youth is emerging, but an integrated understanding of the etiology of suicide that accounts for both commonalities and differences between SGM and non-SMG youth is lacking. Using 2018 data from a social media-based sample of SGM (n = 175) and non-SGM (n = 310) youth ages 14–21, we assess the role of constructs from the general-population-based interpersonal-psychological theory of suicide and the SGM-specific minority stress theory in suicide ideation and attempt. Parental support was a strong protective factor shared across the SGM and non-SGM youth samples. The role of other factors, such as racial/ethnic identity, differed by group. Implications for suicide prevention and intervention in schools and other settings that include both SGM- and non-SGM youth are discussed.

The Development and Validation of the Thwarted Belongingness Scale (TBS) for Interpersonal Suicide Risk

Thwarted belongingness (TB) has been identified as a risk factor for the development of suicide ideation. However, measures for assessing this construct are currently limited. The present study aimed to develop and validate a new self-report measure for thwarted belongingness (TBS) against the Interpersonal Needs Questionnaire Thwarted Belongingness sub-scale (INQ TB; Van Orden et al. 2012), and provide a comparative test of the Interpersonal Psychological Theory of Suicide (IPTS; Joiner 2005). A 42-item pool underwent refinement via three consecutive stages: (1) expert feedback, (2) item selection study using a sample of community-dwelling Australian adults (Study 1, N = 284), and (3) validation study and test of IPTS predictions in a larger sample of community-dwelling Australian adults (Study 2, N = 747). Exploratory and confirmatory factor analyses supported the uni-dimensionality of the TBS. Item response theory analysis indicated that the TBS captured more information over a slightly narrower range than the INQ TB. Preliminary support was provided for the IPTS ideation prediction when using the TBS and INQ TB. The TBS may provide enhanced identification of TB in individuals who display moderate to high levels of this interpersonal risk factor. However, further development of additional interpersonal measures is needed to ascertain the role of TB in relation to interpersonal suicide risk and how to best approach its conceptualisation and measurement.

Assessing Longitudinal Relationships among Thwarted Belongingness, Perceived Burdensomeness, and Eating Disorder Symptoms.

Past work has documented a cross-sectional relationship between eating disorders (ED) and suicidality, but few studies have examined the directionality of this relationship. Informed by the interpersonal-psychological theory of suicide (IPTS), this study examines the bidirectional, longitudinal relationship between ED symptoms and two determinants of suicide ideation-thwarted belongingness (TB) and perceived burdensomeness (PB). Ninety-two treatment-seeking individuals with ED (94.5% White, 95.6% female) completed baseline (T1) measures of ED symptoms along with TB and PB. Of those, 75 (81.5%) completed a follow-up assessment eight weeks later (T2). Separate linear regression models revealed that T1 ED symptoms did not predict T2 TB (b=.03, p=.42) or T2 PB (b=-.01, p=.68). Similarly, T1 TB did not predict T2 ED symptoms (b=.25, p=.37). T1 PB did significantly predict T2 ED symptoms (b=0.52, p=.04). Further, among participants with AN/sub-AN, T1 TB and PB predicted T2 ED symptoms (p's≤.03). Our results reveal the need for a nuanced understanding of the relationship between ED and suicidality. This study found that PB predicts greater ED symptoms and, among the AN/sub-AN sample, TB does as well.

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.

The interaction between personality and interpersonal needs in predicting suicide ideation

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

Self‐criticism, interpersonal conditions, and biosystemic inflammation in suicidal thoughts and behaviors within mood disorders: A bio‐cognitive‐interpersonal hypothesis

We review the theoretical and empirical literature on the role of self-concept in suicidal behavior in the context of mood disorders (i.e., unipolar depression and bipolar spectrum disorders). The main themes emanating from this review are then juxtaposed against (a) the Interpersonal-Psychological Theory of Suicide and (b) biological research on the role of inflammatory processes in suicidality. Such a juxtaposition paves the way for a bio-cognitive-interpersonal hypothesis. Pathologies of the self-concept-primarily self-criticism-propel mood disorder sufferers to generate interpersonal stress that culminates in two proximal causes of suicidality: thwarted belongingness and perceived burdensomeness. In turn, these two interpersonal conditions set in motion systemic biosystemic inflammation, serving as a proximal cause for suicidality in mood disorders. We conclude by describing a research project aimed at testing this hypothesis, and by outlining pertinent implications for assessment, treatment, and prevention.

Suicide and Suicide-related Behavior among Bhutanese Refugees Resettled in the United States.

Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper identification of risk factors for suicide saves lives; however, if risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to occur. In this review, we examine specific cultural factors related to psychopathology and suicide among Bhutanese refugees. To contextualize the current suicide crisis among Bhutanese refugees, we propose an integration of the interpersonal psychological theory of suicide (Joiner, 2005) and the cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010). We provide recommendations for preventing suicide from a systems framework and discuss practical lessons from a preliminary study designed to test a culturally-responsive model of suicide in Bhutanese refugees.

Measuring Thwarted Belongingness and Perceived Burdensomeness in Clinically Depressed and Suicidal Youth: Refinement and Reduction of the Interpersonal Needs Questionnaire.

The Interpersonal-Psychological Theory of Suicide (IPTS) posits two constructs (thwarted belongingness (TB) and perceived burdensomeness (PB)) contribute to suicide ideation. These constructs are typically measured by the Interpersonal Needs Questionnaire (INQ); however, available INQ versions have demonstrated poor psychometric properties with youth. This study examined the INQ using Item Response Theory (IRT) to refine and reduce the scale for clinically depressed and suicidal youth. Participants were 378 youth (Age M (SD)=14.78 (1.41), 82.54% female) who completed the INQ. The INQ contains 25 items across two subscales (i.e., TB and PB) rated on a 7-point Likert-type scale. Rating scale performance, dimensionality, model fit, and instrument-level statistics were examined using IRT methodology. Post hoc analyses were performed to further reduce the scale. The INQ was reduced from 25 to 10 items (five per subscale), and response options were refined to four choices. Correlations between original and IRT-refined items were large (r=.97 for PB; r=.98 for TB). Additional item-level (e.g., fit, difficulty) and instrument-level (e.g., dimensionality) characteristics were examined. The newly refined INQ resulted in improved scale reliability and validity. The psychometrically improved INQ can assist clinicians and researchers identify adolescents at risk of experiencing suicide ideation.

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

BackgroundThe “self” has been implicated in the development of a range of psychological disorders. While a growing body of literature has emerged exploring the Interpersonal Psychological Theory of Suicide (IPTS), little research has been conducted on the construct of self-hate and its relationship with suicidal ideation. The aims of this study were to: 1) develop and validate a brief self-report instrument of self-hate; and, 2) explore the relationship between self-hate, suicidal ideation, and the two main factors of the IPTS, perceived burdensomeness and thwarted belongingness. MethodsInitial development of the item pool involved an expert panel and the development of the Self-Hate Scale included exploratory and confirmatory factor analyses using a large community sample. ResultsA 7-item Self-Hate Scale was developed, which exhibited a reliable unidimensional factor structure. High self-hate was found to predict suicidal ideation, while the relationship between low/moderate self-hate and suicidal ideation was partially moderated by the level of thwarted belongingness. The study provided limited evidence for the IPTS’ main predictions. LimitationsWhile the current study provided support for the psychometric properties of the Self-Hate Scale, the scale will need to be replicated and validated using clinical populations. ConclusionsThe Self-Hate Scale is a brief, psychometrically valid measure of self-hate that has the potential to be useful in suicide risk assessment.

The role of childhood abuse for suicidality in the context of the interpersonal theory of suicide: An investigation in German psychiatric inpatients with depression

BackgroundSeveral studies provide evidence for a relationship between childhood abuse and suicidality across the lifespan. To examine this association in the context of the Interpersonal Psychological Theory of Suicide (IPTS), we investigated whether its constructs thwarted belongingness, perceived burdensomeness and capability for suicide are potential mediators. MethodsEighty-four German psychiatric inpatients with unipolar depression (M = 37.6 years, 69% female) and current or lifetime suicidal ideation were included. For the assessment we used the Childhood Trauma Screener (CTS), the Rasch-based Screening for Depression (DESC-I), the Interpersonal Needs Questionnaire (INQ), the German Capability for Suicide Questionnaire (GCSQ), the Beck Scale for Suicide Ideation (BSS) and the Suicide Behaviors Questionnaire-Revised (SBQ-R). Simple and multiple mediator analyses were applied. ResultsMost patients (70%) had experienced childhood abuse. Emotional abuse showed an indirect association with suicidal ideation via thwarted belongingness and perceived burdensomeness, whereas physical and sexual abuse were indirectly related to suicide risk via capability for suicide. LimitationsThe small sample size and the cross-sectional design are limiting factors of the present study. ConclusionsChildhood abuse is a common experience of inpatients with unipolar depression. This study showed its indirect effects on suicidal ideation and risk for suicide, mediated by the constructs of the IPTS. Further research should investigate this issue in other populations and clinicians should be aware of the devastating effects of childhood abuse.

Mother-Daughter Interpersonal Processes Underlying the Association Between Child Maltreatment and Adolescent Suicide Ideation.

The aim of the present study was to investigate whether mother-daughter relationship quality and mother-daughter conflict represent mechanisms underlying the association between child maltreatment and adolescent passive or active suicide ideation. The sample included 164 socioeconomically disadvantaged depressed adolescent girls and their mothers (adolescents: mean age=14.00 years; 66.3% African-American, 21.3% white, 14.0% Latina). Structural equationmodeling was used to test three simultaneous and distinct mediating pathways linking child maltreatment to adolescent suicide ideation: (1) mother-daughter relationship quality, (2) mother-daughter conflict, and 3) adolescent depressive symptoms. Consistent with the interpersonal-psychological theory of suicide (Joiner, Why people die by suicide, 2005, Harvard University Press, Cambridge, MA), both mother-daughter relationship quality and mother-daughter conflict mediated the effect of child maltreatment on adolescent suicide ideation, over and above the significant depressive symptoms mediational pathway. These findings advance our understanding of why individuals who experienced child maltreatment are at risk for suicide ideation and highlight the importance of relationship-based interventions for these vulnerable youths.

A Matter of Life and Death: Integrating Mattering into the Interpersonal-Psychological Theory of Suicide.

This paper advocates for a more robust sense of mattering into the interpersonal-psychological theory of suicide (IPTS) constructs of perceived burdensomeness and thwarted belongingness. According to IPTS, suicide is precipitated in part by the presence of these twin constructs. IPTS theorists rely on mattering, or feeling significant to others, to undergird theoretical constructs. This is not surprising, as mattering theorists herald "significance to others" as essential to one's will to live. However, IPTS theorists solely leverage mattering to explain perceived burdensomeness. This paper summarizes the existing suicide literature on IPTS and mattering. Further, this paper extensively reviews how mattering has been incorporated into IPTS to date, and possibilities for how mattering could be more fully integrated into the theory. IPTS theorists rely on select mattering elements to define perceived burdensomeness. Strong theoretical overlap exists between mattering and thwarted belongingness. Mattering can play central role in understanding both perceived burdensomeness and thwarted belongingness. Implications for future research and use of mattering-enriched IPTS are discussed.

Double trouble: Nonsuicidal self-injury and its relationship to suicidal ideation and number of past suicide attempts in clinical adolescents

BackgroundDeath by suicide is one of the leading causes of mortality among adolescents, and nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicide attempts (SAs). The underlying bases for this relationship are unknown. We derived two hypotheses from the Interpersonal Psychological Theory of Suicide (IPTS): unmet interpersonal needs would explain NSSI's association with suicidal ideation (SI) and increased capability for suicide would explain NSSI's relationship with SA. MethodsAdolescents hospitalized on a psychiatric inpatient unit (N = 289) provided measures of current SI, number of past SAs, unmet interpersonal needs (perceived burdensomeness and thwarted belongingness), capability for suicide (fearlessness about death [FAD] and pain tolerance), depressive symptoms, and number of NSSI methods utilized. ResultsDepressive symptoms, but not unmet interpersonal needs, explained NSSI's association with SI. FAD and SI, but not depressive symptoms or pain tolerance, accounted for NSSI's relationship with SA. FAD was associated with SA, but it did not fully account for NSSI's relationship with SA. LimitationsThis study utilized a cross-sectional design and retrospective, self-report measures. ConclusionsOur study provides partial support for the role of the IPTS variables in NSSI's relationship with SA in adolescents. The finding that depressive symptoms and not unmet interpersonal needs explained NSSI's relationship with SI contradicts the IPTS. However, in those with SI, FAD was linearly associated with SA, which is consistent with the IPTS. Future studies are needed to clarify the persistent basis for NSSI's relationship with SA beyond FAD and SI.

Validation of the Korean Version Interpersonal Needs Questionnaire.

The Interpersonal Psychological Theory of Suicide posits thwarted belongingness and perceived burdensomeness as the constructs of suicidal desire. This study examined the psychometric properties of the Interpersonal Needs Questionnaire (INQ), which measures thwarted belongingness and perceived burdensomeness, in Korean university students. A series of exploratory and confirmatory factor analyses were conducted to identify the latent structure of the 15-item INQ. Then, its psychometric properties were examined through a correlation analysis and a hierarchical regression analysis. The study included 313 Korean students of which 113 were male and 200 were female. The mean age was 21.51years. The factor analyses supported a two-factor model. However, item 12 cross-loaded on both thwarted belongingness and perceived burdensomeness. While the correlation analysis supported convergent validity, discriminant validity was observed only through a more elaborative measure. Furthermore, the hierarchical regression analysis revealed perceived burdensomeness and the interaction between the two constructs as significant predictors of current suicide ideation. The difference in the structure of the INQ may be due to cultural influences. Nevertheless, the high predictability of suicide ideation that it produces even when controlling for depression implies its clinical usefulness when assessing suicidal risk in Koreans.

A Theory-Driven Investigation of the Association Between Emotion Dysregulation and Suicide Risk in a Clinical Adolescent Sample.

Emotion dysregulation has been consistently linked to suicide ideation and attempt, but an explanatory model for this relationship has not been adequately investigated in adolescents. This study examined the concurrent relationship among emotion dysregulation, variables from the Interpersonal-Psychological Theory of Suicide (IPTS), and suicide risk (operationalized as a continuous variable that increases in intensity from nonspecific to active suicide ideation to suicide ideation with a plan) in a clinical adolescent sample. A total of 151 adolescents (aged 12-17) were recruited from an inpatient psychiatry unit. Cross-sectional analyses were conducted to determine whether the relationship between emotion dysregulation and suicide risk was explained by the variables of perceived burdensomeness (PB), thwarted belongingness, and capability for suicide, as proposed by the IPTS. As hypothesized, the relationship between emotion dysregulation and suicide risk was explained by PB and capability for suicide. Depressive symptoms had an independent relationship with suicide risk after controlling for IPTS variables. The results from this study suggest that effective treatment strategies that reduce negative cognition tied to PB and depressive symptoms would address the most proximal variables related to suicide risk in adolescents. Enhancing emotion management would serve to maintain low levels of proximal influences on risk.

Number and violence of suicide attempt methods: A preliminary investigation of the associations with fearlessness of suicide and fearlessness about death

The Interpersonal Psychological Theory of Suicide (IPTS) proposes that to attempt suicide one must not only desire death, but must also have acquired the capability to act on that desire. The IPTS states capability for suicide can be acquired through exposure to painful and provocative events, with events most closely related to suicide (e.g., non-fatal attempt) having the strongest effects on capability. We tested the effects of two aspects of suicide attempt history—number and violence of methods—on acquired capability, operationalized as both fearlessness about death and fearlessness of suicide, in a sample of psychiatric inpatients with a history of multiple suicide attempts. Results from three separate models suggest that number of methods and number of violent methods, but not history of ever using a violent method, are associated with increased fearlessness of suicide, even after accounting for hopelessness, general painful and provocative events, NSSI, and number of attempts. Few variables were associated with fearlessness about death. Our results raise the possibility that fearlessness of death and suicide may not be synonymous constructs. They also indicate that number of methods, and/or number of violent methods, may be important markers of fearlessness of suicide among those at high risk.