Interpersonal-psychological Theory Research Articles

Conceptualizing Suicide Prevention in Firefighters Through the lens of the Interpersonal-Psychological Theory of Suicide: A Narrative Review

Suicide is the 10th leading cause of death in the United States and is a significant public health problem. Suicide has also become a major concern among career American firefighters with rates for suicidal ideation and attempts in firefighters two to three times higher than rates in the general population. Firefighter suicide and mental health are major issues facing fire service leaders, mental health professionals, and most recently suicide experts. Despite an increased focus on understanding suicide in the fire service, there is little empirical evidence on the effectiveness of prevention in this population. The juxtaposition of elevated suicide rates with a dearth of empirical prevention data specific to firefighters warrants new approaches and conceptualizations of suicide prevention in this population. Grounded in the framework of the interpersonal-psychological theory of suicide (IPTS), this narrative review integrates select relevant firefighter specific suicide risk/protective factors and multi-level intervention/prevention literature to provide a structured approach to identifying current suicide intervention/prevention efforts with promising transportability to firefighters. Several recommendations for future intervention research specific to firefighters are also proposed.

Suicide among Black Children: An Integrated Model of the Interpersonal-Psychological Theory of Suicide and Intersectionality Theory for Researchers and Clinicians.

Recently, research has reported that the rates of suicide among Black children between the ages of 5 to 12-years-old are increasing as they are now more likely to commit suicide than White children. Yet, there are very few, if any, frameworks being used by researchers to explain the risks of suicide among Black children. Suicide research has overwhelmingly been focused on White youth thus leaving a critical gap in suicide research. This conceptual paper provides an integrated framework using the Interpersonal-Psychological Theory of Suicide and Intersectionality theory, as a guide for researchers, clinicians, and practitioners to incorporate culturally appropriate techniques in their work as a way to prevent suicide among Black children. This framework highlights racial discrimination, mental health, socioeconomic status, and sexual/gender minority status to be the most preeminent, yet understudied factors leading to suicide risk among Black children in the United States.

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.

Key ethical questions for research during the COVID-19 pandemic

Key ethical questions for research during the COVID-19 pandemic

Pain persistence and lethality of suicide attempts.

The interpersonal-psychological theory of suicide posits that elevated pain tolerance is necessary to engage in suicidal behaviour. It is assumed that suicidal intent only leads to lethal (or near lethal) suicide attempts when an individual has the capability to persist the pain involved in dying. The aim of this study was to assess whether objective pain persistence moderates the association between suicide intent and lethality of a recent suicide attempt. Ninety-seven inpatients, who were hospitalized due to a recent suicide attempt, were interviewed regarding lifetime suicide attempts as well as their most recent suicide attempt: Method of attempt, intention to die, medical risk of death, probability of an intervention, and physical condition following the attempt were inquired. Pain persistence was examined using a pressure algometer. Contrary to the expectation, pain persistence did not moderate the association between suicide intent and lethality of a recent suicide attempt, that is, medical risk of death, probability of an intervention, or physical condition following the attempt. Future studies are needed to examine method specific pain persistence for suicidal behaviour in a longitudinal study design.

Suicide among justice-involved veterans: a brief overview of extant research, theoretical conceptualization, and recommendations for future research

ABSTRACT Both justice-involved individuals and veterans are at elevated risk for suicide. Despite this, research examining the intersection between justice involvement and veteran status has been limited. In addition, factors which drive risk for suicidal self-directed violence (i.e. suicide attempt, suicide) among justice-involved veterans remain understudied. This paper serves as a brief overview of extant literature regarding potential psychosocial factors which may drive suicide risk in this population. Additionally, the Interpersonal-Psychological Theory of Suicide is applied to posit specific factors underlying justice-involved veterans’ risk for suicidal self-directed violence. Finally, given the limited suicide-focused research specific to justice-involved veterans, we propose specific directions that are needed for subsequent research. In particular, further examination of a conceptual model of suicide risk in this population, as well as methods for intervening on identified risk factors, remain necessary to effectively prevent suicide in this understudied population of veterans.

ПСИХОЛОГІЧНІ АСПЕКТИ СКОЄННЯ СУЇЦИДІВ ВІЙСЬКОВОСЛУЖБОВЦЯМИ: СИСТЕМАТИЗАЦІЯ ДОСЛІДЖЕНЬ

The article is devoted to the systematization of modern scientific research related to the problem of the psychological aspects of suicide by military personnel of armed formations. The main results of the study of the interpersonal psychological theory of suicide proposed by T.E. Joiner are analyzed. The most common were studies of the suicide capacity of servicemen, taking into account the peculiarities of the influence of military experience, the experience of physical pain and the loss of loved ones; identifying risk groups; studies aimed at counteracting the desire to hide their suicidal thoughts and intentions (the use and requirements for the psychodiagnostics tools) and identifying predictors of suicidal risk. The search for the latter further complicated the plans for empirical research (increasing variables, increasing and differentiating groups of subjects, using longitudinal research, searching for mediators of suicide, using multistage and cross-cultural research, taking into account content and military specifics, etc.). All available methods of mathematical statistics were used to determine reliable markers of suicidal risk in servicemen. Trying not to lose control over the problem of suicide among the military, researchers resort to measures to control the situation of committing suicide in terms of accessibility and attitude to weapons, as well as analyze preventive measures that would be effective for objectively reducing the number of suicide attempts among risk groups (cognitive behavioral approaches in psychotherapy). Despite these efforts, the problem of identifying predictors of suicide risk among military personnel has not yet been finally resolved. Modern suicidology needs, seeks and appreciates new approaches to the study of self-destructive behavior in military personnel.

The desire to be dead among Bhutanese refugees resettled in the United States: Assessing risk.

Bhutanese refugees are at elevated risk for suicide, but culturally inflexible suicide risk models may hinder accurate risk detection in this population. This cross-sectional study aimed to use a theoretical model based on the interpersonal psychological theory of suicide and the cultural model of suicide to improve suicide risk-assessment among Bhutanese refugees. Participants included 60 Bhutanese refugees (31 males and 29 females), aged 18 to 65, resettled in Vermont. Suicidal ideation (n = 4, 6.7%) was low, but a substantial minority (n = 29, 48.3%) endorsed some desire to be dead. Perceived burdensomeness, but not thwarted belongingness, was significantly associated with both suicidal ideation and the desire to be dead. Neither desire to be dead nor suicidal ideation was significantly related to suicide attempt history. Results highlight that including assessments of desire to be dead in addition to assessments of suicidal ideation may address the problem of underidentification of Bhutanese refugees at risk for suicidal behavior, particularly those who do not present with suicidal ideation. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The association of trait impulsivity and suicidal ideation and its fluctuation in the context of the Interpersonal Theory of Suicide

BackgroundAlthough the relationship of trait impulsivity and suicidal behavior is well established, its relationship with suicidal ideation and its fluctuation still remains unclear. Our aim is to examine (1) the relationship of trait impulsivity and suicidal ideation and behavior in the context of the Interpersonal Psychological Theory of Suicide (IPTS) and (2) the association of trait impulsivity with the fluctuation of suicidal ideation in an inpatient sample with unipolar depression. MethodEighty-four inpatients with unipolar depression and current and/or lifetime suicidal ideation were assessed with a baseline assessment including trait impulsivity, suicidal ideation, suicidal behavior and the constructs of the IPTS. Seventy-four of these patients underwent a 6-day ecological momentary assessment (EMA) with 10 assessments per day across six days assessing passive and active suicidal ideation. Mean squared successive differences (MSSD) across EMA assessments of suicidal ideation were calculated to test fluctuation as an indicator of temporal variability. Correlation analyses were conducted to test the associations. ResultsThere were no associations of trait impulsivity with suicidal ideation, thwarted belongingness and perceived burdensomeness, except the rather low but significant association between thwarted belongingness and the attention subdomain of trait impulsivity (r = 0.23*, p ≤ 0.05). Moreover, trait impulsivity showed a significant positive correlation with capability for suicide but not with the two subdomains of capability for suicide. The only significant but rather low correlation was identified between the motor aspect of trait impulsivity and fearlessness about death (r = 0.26, p ≤ 0.01). Suicidal behavior showed a positive correlation with trait impulsivity, but not with the different subdomains of trait impulsivity. Trait impulsivity showed a significant correlation with the MSSD of passive suicidal ideation (r = 0.26, p ≤ 0.05), but not with active suicidal ideation. Furthermore, the motor aspect of trait impulsivity (BIS motor) showed a significant correlation (r = 0.32, p ≤ 0.01) with the MSSD of passive suicidal ideation, but not with active suicidal ideation or the MSSD total score. ConclusionOverall the findings are in line with our assumptions and the IPTS and underline that trait impulsivity is related to suicidal behavior and the fluctuation of suicidal ideation, but not to suicidal ideation itself. Thus, trait impulsivity seems to act as a distal risk factor via capability for suicide and it seems to play a role for the dynamics of suicidal ideation. The results have to be investigated in larger samples, with a higher risk of suicide and in prospective studies. Moreover, the role of the fluctuation of suicidal ideation for the prediction of suicide risk should be investigated in future studies.

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.

Aggressive Worriers: How Aggression Moderates the Association between Intolerance of Uncertainty and Suicidal Desire Constructs

Suicide is a public health concern and has been the tenth leading cause of death in the United States since 2008. The Interpersonal-Psychological Theory of Suicidal Behavior is an empirically supported model of suicide. The theory posits that thwarted belongingness and perceived burdensomeness examine the individual’s perceived connectedness to others around them and together create suicidal desire. Anxiety is another widespread public health concern, associated with suicidal ideation and suicide attempts above and beyond the effects of socio-demographic factors and other mental disorders. A key factor in anxiety disorders is intolerance of uncertainty, or the individual’s tendency to perceive ambiguous situations and events as being aversive to emotional and behavioral well-being. Additionally, different facets of aggression have been associated with both intolerance of uncertainty and suicidal desire. The current study sought to examine how facets of aggression moderated the associations between intolerance of uncertainty (both prospective and inhibitory) and thwarted belongingness/perceived burdensomeness. Participants were 440 adults recruited online. The hypotheses of aggression facets moderating the association between intolerance of uncertainty and perceived burdensomeness were largely supported with statistical significance for six out of eight models. Similarly, the hypotheses of aggression facets moderating thwarted belongingness were largely supported with significant moderations for seven out of eight models. The results were upheld when using Benjamini-Hochberg test of significance to account for Type I error. Overall, results indicate that aggressive facets can amplify the associations between intolerance of uncertainty and thwarted belongingness/perceived burdensomeness; however, results differed based on the intolerance of uncertainty dimensions.

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.

Ethnic Identity and Suicide Risk among Hispanic/Latinx Young Adults: The Impact of Perceived Burdensomeness and Thwarted Belongingness

Hispanic/Latinx college students experience SI/behaviors at high rates, yet there is a dearth of research on suicide risk and sociocultural correlates of suicide risk among Hispanic/Latinx individuals. This study examined the impact of ethnic identity on suicide risk among 63 Hispanic/Latinx young adults. Further, we tested a model in which ethnic identity is integrated into the Interpersonal Psychological Theory of Suicide Behavior (IPTS). Lower levels of ethnic identity attachment were related to greater suicide risk. Further, moderated mediation analyses indicated that perceived burdensomeness mediated the relation between ethnic identity and suicide risk at higher levels of thwarted belongingness. Findings highlight the importance of sociocultural factors in understanding the utility of the IPTS model among Hispanic/Latinx individuals.

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.

Proximal Correlates of Suicidal Ideation and Behaviors: A Test of the Interpersonal-Psychological Theory of Suicide.

The interpersonal-psychological theory of suicide hypothesizes proximal causes of suicidal ideation and behaviors; however, past studies have generally tested distal relations. The present study tested the proximal nature of the theory's hypotheses. A repeated-measures design collected daily survey data on the theory constructs over 90days from 206 (150 women) college students with previous histories of suicidal ideation. Participants completed 7,342 (39.6%) of the 18,540 surveys sent. Thwarted belongingness and perceived burdensomeness both positively associated with passive suicidal ideation at the daily level. A statistical trend revealed that perceived burdensomeness was associated with daily active suicidal ideation only at high levels of thwarted belongingness and hopelessness. Active suicidal ideation, but not capability for suicide, was positively associated with suicidal behavior at the daily level. These results support the theory's predictions regarding passive and active suicidal ideation, with limited support regarding suicidal behaviors. The proximal associations of the IPTS constructs with daily suicidal ideation suggest areas for potential intervention with suicidal clients.

Infancy onset maltreatment and the development of suicide ideation: An investigation of moderation by oxytocin-related gene polymorphisms

BackgroundSuicide ideation and behavior remains a significant public policy concern. The interpersonal-psychological theory of suicide posits that thwarted belongingness potentiates risk for suicide. Early disruptions in caregiving have documented effects on lifespan social and interpersonal development, and therefore warrants further investigation in suicide research. This novel study investigates risk for suicide ideation conferred by infant-onset child maltreatment and oxytocin genotypes (OXTR and CD38) and tests interactive effects of genetics and early maltreatment experiences. MethodsParticipants (N = 251) were from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children (wave 1). Childhood maltreatment was coded from child protective service records and buccal cells were obtained from children and genotyped. At wave 2, self-reported suicide ideation and internalizing symptomatology were obtained. ResultsMaltreatment onset in infancy was significantly related to lifetime suicide ideation. The CD38 gene variation moderated this association such that early onset maltreatment was related to suicide ideation among C-carriers only. The OXTR gene did not relate to lifetime suicide ideation, nor did it moderate early onset maltreatment risk. LimitationsThis study was conducted with a relatively small sample, necessitating the combination of genotypes into binary groups. Replication is necessary. ConclusionsChild maltreatment experienced early in development confers significant risk for lifetime suicide ideation. Furthermore, greater risk for suicide ideation was present for those with specific oxytocin genotypes. These findings further emphasize the importance of preventive interventions aimed at decreasing the incidence of maltreatment and increasing support for high risk families.

Exploring the psychology of suicidal ideation: A theory driven network analysis

Two leading theories within the field of suicide prevention are the interpersonal psychological theory of suicidal behaviour (IPT) and the integrated motivational-volitional (IMV) model. The IPT posits that suicidal thoughts emerge from high levels of perceived burdensomeness and thwarted belongingness. The IMV model is a multivariate framework that conceptualizes defeat and entrapment as key drivers of suicide ideation. We applied network analysis to cross-sectional data collected as part of the Scottish Wellbeing Study, in which a nationally representative sample of 3508 young adults (18–34 years) completed a battery of psychological measures. Network analysis can help us to understand how the different theoretical components interact and how they relate to suicide ideation. Within a network that included only the core factors from both models, internal entrapment and perceived burdensomeness were most strongly related to suicide ideation. The core constructs defeat, external entrapment and thwarted belonginess were mainly related to other factors than suicide ideation. Within the network of all available psychological factors, 12 of the 20 factors were uniquely related to suicide ideation, with perceived burdensomeness, internal entrapment, depressive symptoms and history of suicide ideation explaining the most variance. None of the factors was isolated, and we identified four larger clusters: mental wellbeing, interpersonal needs, personality, and suicide-related factors. Overall, the results suggest that relationships between suicide ideation and psychological risk factors are complex, with some factors contributing direct risk, and others having indirect impact.

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.