Interpersonal-psychological Theory Research Articles

Family Relationships and Suicide Ideation: The Mediating Roles of Anxiety, Hopelessness, and Depression in Adolescents

Background: Several studies have shown that the suicide trend in Iran is rising. Although there is a growing number of studies that identify a number of the risk and protective factors associated with suicidal behaviors in adolescents, only a few studies have integrated this knowledge for the purpose of validating more complex models of adolescent suicidal behaviors in the Middle East. Objectives: The purpose of this study was to explore a theoretically derived model positing that anxiety, depression, and hopelessness mediate between family relationships as indicators of burdensomeness and belongingness in interpersonal-psychological theory and suicide ideation among adolescent suicidal attempters. Patients and Methods: This study develops and tests a model of suicide ideation with family relationships as antecedents, and latent variables as depression, hopelessness, and anxiety. In particular, we investigated 120 consecutive adolescent suicidal attempters who were assessed in terms of their Family Environment Scale (FES) and Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), Beck Anxiety Inventory (BAI), and Beck Suicide Ideation Scale (BSSI). The final structural models have shown to be fitted to the considered data. Results: The results showed that family cohesion and expressiveness were stronger predictors of suicide ideation than family conflict. Indeed, family cohesion exerted direct and indirect effects through depression, hopelessness, and anxiety on suicide ideation, and family expressiveness was also directly related to suicide ideation. It was shown that latent variables (depression, hopelessness, and anxiety) were positively correlated with suicide ideation. Conclusions: The results of the study imply that family cohesion and family expressiveness act as predictive factors against depression, hopelessness, anxiety, and suicide ideation.

Psychological Interpersonal Needs and Suicidal Ideation among College Students:The Moderating Role of Social Support

Suicideis a growing cause of deaths and is considered a widespread problem throughout the country. There are a number of cases where in students not scoring expected or perceived competitive marks in exams are taking course to suicide. A number of studies worldwide have brought out that it is not only restricted to geographical boundaries but it is arising global problem. However in India it is one of the major cause of deaths and the number of suicide cases per year is increasing at an alarming rate. More than one lakh lives are lost every year due to suicides in our country. In the last two decades the suicidal rate has increased from 7.9 to 10.3 per 10000. According to National Crime Records Bureau, India (2015), the southern states of Kerala; Andhra Pradesh and Tamil Nadu have a suicide rate of 3%. As per Wilcox et al. (2010) the transition of youth in to adulthood makes them more vulnerable to an increased risk of suicide, as they experience new stressful events such as leaving home, being away from family, pressures of going to college and adjusting with unfamiliar situations of varied complexity. In addition, they are exposed to other risk factors for suicide (e.g., alcohol, drug use, risky behaviors) and are in the age range where psychological disorders begin to develop (Wilcox et al., 2010). The continuous changes in social factors and exposure to the dynamic factors of peer pressure, personal achievements and competition may emerge as an important factor for suicide ideation amongst college students. Thus it makes this study of impact of social support, thwarted belongingness and perceived burdensomeness even more important.Social supportEmotional support on family and friends plays a vital role especially in the transitional period of a young person to adulthood. Social support can be defined as a interpersonal process in which one person emotionally comforts another, helps to discuss problems, gives advice, provides material goods and services and makes other feel part of social network (Cohen & Wills, 1985). It is considered major psychosocial protective factor that reduces individual vulnerability to the deleterious effect of stress on health (Cassel, 1976). Social support works as buffering model or moderate the effect of stress on mental and physical health, social support helps a person to remain healthy in adverse circumstances. Lack of social support has been related to suicidal behavior (Thompson, Mazza, Herting, Rendell, & Eggert, 2005). Durkheim's (1857) Concept of Egotistic Suicide is particularly relevant to this study. Durkheim stresses that suicide is associated with the integration of social groups that an individual is a member of. When the individual's society is strongly integrated it can serve as buffer of suicide. Belonging to a group, creates a bond between individuals that unite and attaches them and prevents negative feelings from occurring. This bond creates a consistent distribution of ideas and feelings that are mutually shared between individuals of the group.The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) states that anindividual will not die by suicide unless s/he has both the desire to die by suicide as well as the ability to do so. The theory asserts that when people hold two specific psychological states in their minds simultaneously, and when they do so for long enough, they develop the desire fordeath. The two psychological states are perceived burdensomeness and a sense of low belongingness or social alienationPerceived burdensomenessPerceived burdensomeness can be defined as the cognition that an individual is a burden to others, including family and friends (Joiner, 2005). Joiner emphasizes the term perceived, in that people who are suicidal perceive they are a burden, even if that perception is false. Perceived burdensomeness includes feelings of worthlessness and thoughts that often people will benefit from one's death. …

Pilot Randomized Controlled Trial of LEAP: A Selective Preventive Intervention to Reduce Adolescents’ Perceived Burdensomeness

This research draws upon the interpersonal-psychological theory of suicide in the development of the LEAP intervention, a web-based selective preventive suicide intervention targeting cognitions of perceived burdensomeness toward others. The pilot randomized controlled trial consisted of 80 adolescents (68.8% female, 65.8% Hispanic) 13–19 of age years who were randomly assigned to either the LEAP intervention or a psychoeducational control condition. Participants completed baseline, posttreatment, and 6-week follow-up assessments. All participants reported high levels of satisfaction with the program. Findings on outcome variables differed across intent-to-treat analyses and treatment completer analyses. Intent-to-treat analysis yielded no significant between-condition differences in perceived burdensomeness at posttreatment or follow-up. Treatment completer analyses revealed significant between-condition differences on outcome variables such that participants who completed the LEAP intervention showed significantly lower perceived burdensomeness scores at postintervention and significantly lower perceived burdensomeness, thwarted belongingness, and depressive symptom scores at follow-up as compared to participants in the control condition. No significant differences in suicidal ideation were found between conditions. These findings support the promise of the LEAP intervention as a brief, web-based selective preventive intervention for reducing perceived burdensomeness among adolescents who complete the intervention. This study provides evidence that perceived burdensomeness can be modified via a psychosocial intervention. Future research is needed to identify ways to enhance adolescent engagement with and completion of the intervention.

Does the interpersonal–Psychological theory of suicide provide a useful framework for understanding suicide risk among eating disorder patients? A test of the validity of the IPTS

The current study tested whether the Interpersonal-Psychological Theory of Suicide (IPTS) provides a useful framework for understanding elevated suicide rates among individuals with eating disorders (EDs). Based on predictions of the IPTS, we tested whether the combination of thwarted belongingness and perceived burdensomeness was associated with suicidal desire, and whether the combination of thwarted belongingness, perceived burdensomeness, and fearlessness about death was associated with past suicide attempts in an ED sample (n = 100). We also compared these IPTS constructs in an ED sample versus general psychiatric inpatients (n = 85) and college students (i.e., non-clinical comparison group; n = 93). Within the ED sample, no hypothesized interactions were found, but perceived burdensomeness was associated with suicidal desire, and perceived burdensomeness and fearlessness about death were associated with past suicide attempts. The ED and psychiatric samples had greater thwarted belongingness, perceived burdensomeness, and suicidal desire than the non-clinical comparison group. The IPTS constructs of perceived burdensomeness and fearlessness about death appear to explain some facets of suicidality among people with EDs, but overall, support for the IPTS was limited. Future research on EDs and suicidality should look beyond the IPTS and consider other biological and sociocultural factors for suicide. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1082-1086).

A Neural Basis for the Acquired Capability for Suicide.

The high rate of fatal suicidal behavior (SB) in men is an urgent issue as highlighted in the public eye via news sources and media outlets. In this study, we have attempted to address this issue and understand the neural substrates underlying the gender differences in the rate of fatal SB. The Interpersonal–Psychological Theory of Suicide has proposed an explanation for the seemingly paradoxical relationship between gender and SB, i.e., greater non-fatal suicide attempts by women but higher number of deaths by suicide in men. This theory states that possessing suicidal desire (due to conditions such as depression) alone is not sufficient for a lethal suicide attempt. It is imperative for an individual to have the acquired capability for suicide (ACS) along with suicidal desire in order to die by suicide. Therefore, higher levels of ACS in men may explain why men are more likely to die by suicide than women, despite being less likely to experience suicidal ideation or depression. In this study, we used activation likelihood estimation meta-analysis to investigate a potential ACS network that involves neural substrates underlying emotional stoicism, sensation-seeking, pain tolerance, and fearlessness of death, along with a potential depression network that involves neural substrates that underlie clinical depression. Brain regions commonly found in ACS and depression networks for males and females were further used as seeds to obtain regions functionally and structurally connected to them. We found that the male-specific networks were more widespread and diverse than the female-specific ones. Also, while the former involved motor regions, such as the premotor cortex and cerebellum, the latter was dominated by limbic regions. This may support the fact that suicidal desire generally leads to fatal/decisive action in males, while, in females, it manifests as depression, ideation, and generally non-fatal actions. The proposed model is a first attempt to characterize the neural networks underlying gender differences in SB. Future studies should examine the proposed network to better characterize and refine this network using tasks specifically targeted toward constructs underlying ACS.

A Preliminary Test of the Interpersonal-Psychological Theory of Suicide in Women Seeking Shelter From Intimate Partner Violence.

Women seeking shelter from intimate partner violence (IPV) are at greater risk of suicide ideation and attempts compared with women in the general population. A theoretically grounded understanding of suicide risk in shelter-seeking women is critical to improve assessment and management of suicide risk in this population. The interpersonal-psychological theory of suicide (IPTS) proposes that suicide ideation results from hopelessness about thwarted belongingness and perceived burdensomeness. However, suicide ideation does not progress to death by suicide unless one has acquired the capability for suicide (i.e., pain tolerance and fearlessness about death) via repeated exposure to painful and fearsome events. The present study provides a preliminary test of the IPTS in a sample of 134 women seeking shelter from IPV. First, we examined factors theoretically related to suicide ideation, demonstrating that only at high levels of hopelessness was perceived burdensomeness associated with suicide ideation. The study also examined factors theoretically related to the acquired capability for suicide (ACS), indicating that physical partner violence perpetration was associated with ACS. These findings suggest that perceived burdensomeness, particularly in the context of increased hopelessness, is important in the assessment and treatment of suicide ideation. Furthermore, violence perpetration may indicate greater risk of the capability to die by suicide among women seeking shelter from IPV.

A test of the trait-interpersonal model of suicide proneness in emerging adults

The present study tests the trait-interpersonal model of suicide, an approach integrating both the Five-Factor Model (FFM) of personality and Interpersonal-Psychological Theory of Suicide (IPTS). Survey data in an emerging adult sample (n=572) yielded the following prominent predictors of elevated suicide proneness: (1) neuroticism (positively) and openness (positively) predicted suicide proneness (accounting for the IPTS and trait-interpersonal pathways), (2) neuroticism-perceived burdensomeness/thwarted belonging/acquired capability mediation pathways were observed, (3) an extraversion-thwarted belonging pathway emerged, (4) an openness-acquired capability emerged, (5) agreeableness-perceived burdensomeness/thwarted belonging/acquired capability pathways emerged, and (6) conscientiousness-thwarted belonging/perceived burdensomeness pathways were observed. Findings are discussed with regard to trait-interpersonal literature, and public health and clinical suicide prevention strategies.

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

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

Transgender youth and suicidal behaviors: Applying the interpersonal psychological theory of suicide

ABSTRACTThe interpersonal psychological theory of suicide (IPTS) was used to examine suicidal thoughts and behaviors among 129 transgender and gender nonconforming (TGNC) youth. Youth were categorized according to their gender identities: female to male (FTM), male to female (MTF), female to different gender (FTDG), and male to different gender (MTDG). Higher percentages of suicidal ideation were reported by FTDG and FTM youth; higher percentages of suicide attempts were reported by FTDG and MTDG youth. Perceived burdensomeness and thwarted belongingness were significantly related to suicidal ideation and/or suicide attempts. Experiences of painful, provocative, and harmful events and acquired capability significantly predicted suicide attempts. The findings support IPTS in explaining suicidal behaviors among TGNC youth. Implications for prevention and intervention efforts are discussed.

Burdensomeness, Belongingness, and Capability: Assessing the Interpersonal-Psychological Theory of Suicide With MMPI-2-RF Scales.

Given the emerging body of literature demonstrating the validity of the interpersonal-psychological theory of suicide (IPTS), and the importance of increasing our understanding of the development of risk factors associated with suicidal behavior, it seems worthwhile both to expand IPTS research via Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) correlates and to expand the availability of methods by which to assess the constructs of the IPTS. The present study attempted to do so in a large adult outpatient mental health sample by (a) inspecting associations between the IPTS constructs and the substantive scales of the MMPI-2-RF and (b) exploring the utility of MMPI-2-RF scale-based algorithms of the IPTS constructs. Correlates between the IPTS constructs and the MMPI-2-RF scales scores largely followed a pattern consistent with theory-based predictions, and we provide preliminary evidence that the IPTS constructs can be reasonably approximated using theoretically based MMPI-2-RF substantive scales. Implications of these findings are discussed.

Integrating Two Theoretical Models to Understand and Prevent Military and Veteran Suicide

Despite increasing prevention efforts, military suicide rates have surpassed those of the general population. This trend may reflect a deficit in our understanding of suicide, historically atheoretical and based on decreasing risk factors of suicide. The interpersonal–psychological theory of suicide (IPTS) provides a theoretical foundation to understand suicide but only assesses three risk factors of suicide and is primarily aimed at explaining who may die by suicide, but not when. The fluid vulnerability theory (FVT) provides a broad theoretical framework to understand and organize risk and protective factors of suicide in order to understand the process of suicide risk over time. Overlaying the IPTS’s constructs of thwarted belongingness, perceived burdensomeness, and the acquired capability for suicide within the FVT framework provides a robust model to understand not only who is at risk for suicide but also when suicide risk is likely to emerge.

Predicting Risk for Suicide: A Preliminary Examination of Non-Suicidal Self-Injury and the Acquired Capability Construct in a College Sample

The interpersonal psychological theory of suicide provides a useful framework for considering the relationship between non-suicidal self-injury and suicide. Researchers propose that NSSI increases acquired capability for suicide. We predicted that both NSSI frequency and the IPTS acquired capability construct (decreased fear of death and increased pain tolerance) would separately interact with suicidal ideation to predict suicide attempts. Undergraduate students (N = 113) completed self-report questionnaires, and a subsample (n = 66) also completed a pain sensitivity task. NSSI frequency significantly moderated the association between suicidal ideation and suicide attempts. However, in a separate model, acquired capability did not moderate this relationship. Our understanding of the relationship between suicidal ideation and suicidal behavior can be enhanced by factors associated with NSSI that are distinct from the acquired capability construct.

Understanding the Relationship Between Suicidality and Psychopathy: An Examination of the Interpersonal-Psychological Theory of Suicidal Behavior

A number of studies have reported a bifurcated relationship between psychopathy and suicidality, such that suicidality is positively related to Factor 2 (impulsive-antisocial lifestyle) of psychopathy but negatively related or unrelated to Factor 1 (affective-interpersonal deficits). The present study aims to expand these findings by investigating this relationship through the lens of the interpersonal-psychological theory of suicidal behavior across both undergraduate and forensic samples. We hypothesized that, although both Factors 1 and 2 would be associated with the acquired capability for suicide, Factor 2 would exhibit a unique relationship with suicidal desire (perceived burdensomeness and thwarted belongingness). Results were largely supportive of these hypotheses, although differences were noted across samples and measures. Findings highlight the importance of precision in the assessment of antisociality and suggest potential differences in the construct of psychopathy between non-criminal and criminal samples.

Interpersonal-psychological theory and parental bonding predict suicidal ideation among soldiers in Taiwan.

Suicide is an important issue among military personnel, who have higher suicide rates compared with the general population. The interpersonal-psychological theory of suicide (IPTS) might provide an empirical explanation of this phenomenon, and parental bonding influences social adjustment and suicide. To investigate the relevance of IPTS and parental bonding for suicide among Taiwanese soldiers, a case-control study was conducted. Using a suicide-reporting system in a teaching general hospital in Southern Taiwan, 226 at-risk maladjusted soldiers and 229 well-adjusted controls were enrolled. We collected basic information, and participants answered four IPTS-based questions. Suicide risk was assessed using the Brief Symptom Rating Scale item 6. A four-factor model of the Parental Bonding Instrument assessed parental bonding. All participants were interviewed using the Mini International Neuropsychiatric Interview for primary screening and to recheck the accuracy of the Brief Symptom Rating Scale item 6 score. A parsimonious model obtained by regression analysis of risk factors indicated that poor academic performance, conduct-related issues in childhood, and exposure to life-threatening situations are risk factors for suicide intention. Maladjusted suicidal soldiers showed a sense of thwarted belongingness (β = 0.145; P < 0.001), higher perceived burdensomeness (β = 0.311; P < 0.001), less fear of death (β = 0.124; P < 0.05), lower paternal autonomy (β = -0.122; P < 0.05), and higher maternal indifference (β = 0.162; P < 0.0001). Interpersonal-psychological theory of suicide, accompanied by an assessment of parental bonding, could be used for assessing suicide risk and preventing suicide attempts.

Suicidality among immigrants: Application of the interpersonal-psychological theory

ABSTRACTImmigrants constitute a significant percentage of the total population living in the United States; however, there is a paucity of research unique to suicidality among immigrants. The present article examines the applicability of the three variables of the interpersonal-psychological theory of suicidal behavior—acquired capability for suicide, sense of thwarted belongingness, and perceived burdensomeness—to conceptualize, assess, and treat suicidality among immigrants. Risk and protective factors and mechanisms are discussed in the context of 2 case studies and immigrant paradox. Clinical implications include assessment and treatment of immigrant-specific experiences. Obstacles to treatment and future research directions are presented.

Associations between eating disorder symptoms and suicidal ideation through thwarted belongingness and perceived burdensomeness among eating disorder patients

BackgroundSuicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal–Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations. MethodWe tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome. ResultsThe first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. LimitationsThe sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation. ConclusionsResults underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.

PTSD symptoms, suicidality and non-suicidal risk to life behavior in a mixed sample of pre- and post-9/11 veterans

ABSTRACTThis study investigated relationships between symptom clusters of posttraumatic stress disorder (PTSD), suicidal ideation, suicide plan, and non-suicidal risk to life behavior (NSRB) behavior in a sample of 1,356 pre- and post-9/11-era military veterans. After controlling for a positive PTSD screen, results indicated that suicidal ideation was significantly associated with re-experiencing symptoms (OR = 1.12), White race (OR = 1.82) and use of pain medication (COR = 1.62). Suicide plan was associated with avoidance symptoms (OR = 1.08), and NSRB with hyperarousal symptoms (OR = 1.11) and severe alcohol use (OR = 2.10). Standardized coefficients indicated that re-experiencing symptoms (b = .38) were a stronger predictor of suicidal ideation than White race (b = .16) or pain medication (b = .12) and that hyperarousal symptoms (b = .36) were a stronger predictor of NSRB than severe alcohol use (b = .15). The interpersonal–psychological theory of suicide was used to frame a discussion of military specific suicide risk as well as the risk of premature death among veterans who endorse NSRB but not suicidality. We suggest that this subset of veterans may be overlooked by traditional screening methods while nonetheless presenting with great risk for premature death.

Evaluation of a Functional Model of Acquired Capability for Suicide in a Nationwide Sample of Korean Adults.

ObjectiveWe examined a functional model of acquired capability for suicide, which was elaborated from the “Interpersonal-Psychological Theory of Suicide”.MethodsA total of 6,027 Korean community subjects were recruited from The Korean Epidemiologic Catchment Area study conducted in 2011. The subjects were assessed systematically using the Korean version of the Composite International Diagnostic Interview version 2.1, the Korean version of the Barratt Impulsiveness Scale, and the Korean version of the Mood Disorder Questionnaire. We used structural equation modeling to identify potential factors contributing to a suicide attempt.ResultsMost aspects of the model were supported by the data and “the short-term enhancer for the acquired capability for suicide” had direct effects on suicide attempts. However, the suicidal planning effects of “the short-term enhancer for the acquired capability for suicide” were eliminated by the rule of parsimony.ConclusionThe main finding was that “the short-term enhancer for the acquired capability for suicide” is relevant to suicide attempts when it's direct, indirect, and reciprocal effects are tested within a more complete system of relationships than found in existing studies. The implications of these findings are discussed with regard to future conceptual work and empirical research.

Unpacking Sleep and Suicide in Older Adults in a Combined Online Sample.

Duration of insomnia symptoms and nightmares are related to suicidal risk in young adults independent of current symptoms of insomnia, nightmares, anxiety, depression, and PTSD. However, this relation has yet to be examined among older adults, despite older adults being at higher risk of suicidal behavior. Further, the current study aims to replicate previous research among younger adults showing that insomnia symptoms and nightmares are associated with suicide risk independent of the interpersonal psychological theory of suicide (IPTS). The present study utilized 167 participants age 55 and older obtained by combining two independent mTurk data collections of adults in the United States. In the current sample, duration of nightmares was associated with suicide risk in older adults independent of symptoms of current insomnia and nightmares, duration of insomnia, and symptoms of PTSD, anhedonia, and the IPTS. Our findings suggest that the duration of nightmares (i.e., how long someone has been experiencing nightmares) predict substantial variance in suicide risk among older adults in addition to the risk factors typically examined. Thus, assessment of sleep dysfunction is important when assessing suicide risk among older adults.

Preliminary Examination of the Interpersonal Psychological Theory of Suicide in an Adolescent Clinical Sample.

This study offers a preliminary examination of the Interpersonal-Psychological Theory of Suicide (IPTS; Joiner 2005) in an adolescent clinical sample. The IPTS offers a nuanced framework that has many conceptual and practical merits. Although this theory has a growing base of evidence among adults, it has yet to be tested in adolescents using direct measures of its central constructs. Participants were 147 adolescents (76.2% girls) on an inpatient psychiatric unit, who completed measures of key IPTS constructs of thwarted belongingness, perceived burdensomeness, acquired capability for suicide, as well as depression severity, hopelessness, and severity of suicidal symptoms. Our findings were largely consistent with hypotheses derived from the IPTS: perceived burdensomeness, and at a marginal level, thwarted belongingness, were independently associated with current suicidal ideation. The thwarted belongingness by perceived burdensomeness interaction marginally distinguished between adolescents with passive and active suicidal ideation. Acquired capability for suicide was associated with recent suicidal intent. Examination of all three IPTS constructs simultaneously revealed main effects of each construct (with a marginal effect of thwarted belongingness), and interaction effects for thwarted belongingness by perceived burdensomeness, and thwarted belongingness by perceived burdensomeness by acquired capability for suicide in association with suicidal symptom severity. Sex, age, depression severity, and hopelessness were controlled in all analyses. This study offers strong, albeit preliminary, support of the IPTS in a clinical adolescent sample. Assessment of IPTS constructs may be useful in determining persistent risk for suicide attempt. Prospective tests of the theory, and extensions to intervention and prevention should be considered in future IPTS research.