The impact of the nature of relationships on perceived burdensomeness and suicide ideation in a community sample of older adults

Older adults die by suicide at very high rates, and previous research indicates that perceived burdensomeness may contribute to deaths by suicide. In this study, the impact of the nature of relationships on perceived burdensomeness and suicide ideation was examined. Results indicated that older adults' perceptions of burden on younger generations were associated with greater overall perceived burdensomeness and suicide ideation when compared to the older adults' own or older generations. Thus, clinicians should examine general perceived burdensomeness as well as the types of relationships the older adult perceives himself or herself to be a burden on.     

PTSD symptoms and suicide ideation: Testing the conditional indirect effects of thwarted interpersonal needs and using substances to cope

Posttraumatic stress disorder (PTSD) symptoms and substance use have been associated with increased suicide ideation, but have rarely been examined within a larger theoretical context of suicide risk. The interpersonal theory of suicide posits that feeling disconnected from others (i.e., thwarted belongingness) and feeling like a burden on others (i.e., perceived burdensomeness) are associated with increased suicide ideation. We hypothesized that perceived burdensomeness and thwarted belongingness would mediate the relation between PTSD symptoms and suicide ideation, and that using substances to cope would moderate these relations. Participants were 254 college students reporting exposure to potentially traumatic experiences. Findings from a moderated mediation analysis indicated that perceived burdensomeness, but not thwarted belongingness, mediated the relation between PTSD symptoms and suicide ideation, and using substances to cope moderated this relation. Therapeutic interventions aimed at reducing suicide ideation might benefit from decreasing perceived burdensomeness and the use of substances to cope.     

Race,Offense Type,and Suicide Ideation: Tests of the Interpersonal‐Psychological Theory in Juvenile Offenders

This study evaluated the synergy hypothesis of the Interpersonal‐Psychological Theory of Suicide (IPTS ), which argues thwarted belongingness and perceived burdensomeness are positively interactive in their association with suicide ideation, in a group of juvenile offenders. It also examined whether this prediction is differentially applicable across race/ethnicity or offense type. Participants included 590 adjudicated and confined male juveniles. Regression was used to test the association between suicide ideation and thwarted belongingness, perceived burdensomeness, and their interaction term. Subsequent analyses included tests of group interactions related to race/ethnicity and offense type. No interaction between thwarted belongingness and perceived burdensomeness was observed, despite adequate power. No significant group interactions were observed for race/ethnicity or offense type. However, results did show significant linear relationships between thwarted belongingness, perceived burdensomeness, and ideation, highlighting their potential utility as intervention targets in this at‐risk population. Thus, although the current results are the first to show the basic IPTS risk factors generalize across race/ethnicity and offense type, they also failed to support that those factors were interactive, a primary IPTS claim. The absence of an interaction between thwarted belongingness and perceived burdensomeness suggests their role in suicide ideation for juvenile offenders may be more parsimonious than the IPTS proposes.     

Mindfulness Moderates the Association Between Perceived Burdensomeness and Suicide Ideation in Adults With Elevated Depressive Symptoms

A conceptual model in which the associations between perceived burdensomeness and suicide ideation, and between thwarted belongingness and suicide ideation, are moderated by mindfulness was examined. Participants were 218 undergraduates (mean age = 20.81) with moderate‐to‐severe depressive symptoms. Mindfulness significantly moderated the association between perceived burdensomeness and suicide ideation; participants with thoughts of burdensomeness experienced lower levels of suicide ideation if they were high, as opposed to low, in mindfulness. Mindfulness did not significantly moderate the association between thwarted belongingness and suicide ideation. Implications for intervention and elaboration of the interpersonal psychological theory of suicide are discussed.     

The Role of Hope and Optimism in Suicide Risk for American Indians/Alaska Natives

There are some American Indian/Alaska Native communities that exhibit high rates of suicide. The interpersonal theory of suicide (Joiner, 2005) posits that lethal suicidal behavior is likely preceded by the simultaneous presence of thwarted belongingness, perceived burdensomeness, and acquired capability. Past research has shown that hope and optimism are negatively related to suicidal ideation, some of the constructs in the interpersonal theory of suicide, and suicide risk for the general population. This is the first study to investigate hope and optimism in relation to suicidal ideation, thwarted belongingness, perceived burdensomeness, and acquired capability for American Indians/Alaska Natives. Results showed that hope and optimism negatively predicted thwarted belongingness, perceived burdensomeness, and suicidal ideation. However, these results were not found for acquired capability. Overall, this study suggests that higher levels of hope and optimism are associated with lower levels of suicidal ideation, thwarted belongingness, and perceived burdensomeness in this American Indian/Alaska Native sample.     

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.     

Social Problem-Solving and Suicidal Ideation Among Homeless Youth Receiving a Cognitive Therapy Intervention: A Moderated Mediation Analysis

Despite the high prevalence of suicidal ideation and attempts among homeless youth, little research has examined how suicide prevention interventions influence suicide-related risk and protective factors, and ultimately produce positive outcome in suicidality in this population. Drawing on the Diathesis-Stress Model and the Interpersonal Theory of Suicide, the current study examined whether participation in Cognitive Therapy for Suicide Prevention (CTSP) moderated the mediation link between social problem-solving, perceived burdensomeness and thwarted belongingness, and suicidal ideation among a sample of homeless youth experiencing suicidal ideation. Social problem-solving refers to a set of cognitive, emotional, and behavioral coping responses in the face of stressful situations, and it is identified as a potent protective factor in alleviating perceived burdensomeness and thwarted belongingness, and reducing suicidal ideation. Participants included 150 homeless youth (M age = 20.99, range = 18-24; 41% female) who were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) (n = 75) or Treatment as Usual alone (n = 75). Participants were assessed at baseline, 3, 6, and 9 months post-baseline. Findings showed that perceived burdensomeness mediated the association of social problem-solving with suicidal ideation only among youth participating in the CTSP condition. These findings provide evidence to support the promising effects of CTSP in enhancing the protective effects of social problem-solving on suicidal ideation through the mediating effects of perceived burdensomeness. Findings also have implications for improving intervention effectiveness with a community-based population at high risk of suicide.     

Posttraumatic Stress Disorder Symptom Clusters and the Interpersonal Theory of Suicide in a Large Military Sample

Prior studies examining posttraumatic stress disorder (PTSD) symptom clusters and the components of the interpersonal theory of suicide (ITS) have yielded mixed results, likely stemming in part from the use of divergent samples and measurement techniques. This study aimed to expand on these findings by utilizing a large military sample, gold standard ITS measures, and multiple PTSD factor structures. Utilizing a sample of 935 military personnel, hierarchical multiple regression analyses were used to test the association between PTSD symptom clusters and the ITS variables. Additionally, we tested for indirect effects of PTSD symptom clusters on suicidal ideation through thwarted belongingness, conditional on levels of perceived burdensomeness. Results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms (dysphoric arousal in the 5‐factor model) are positively associated with thwarted belongingness. Results also indicated that hyperarousal symptoms (anxious arousal in the 5‐factor model) were positively associated with fearlessness about death. The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model. Overall, these results provide further clarity regarding the association between specific PTSD symptom clusters and suicide risk factors.     

The moderating role of pessimism in the association between retrospective relational peer victimization,interpersonal risk factors,and suicide ideation

Peer victimization (PV) is a serious concern for youth and is associated with subsequent suicide ideation in young adulthood. The interpersonal theory of suicide may provide a framework for understanding suicide ideation in this population. Specifically, thwarted belongingness (TB) and perceived burdensomeness (PB) have been significantly associated with suicide ideation among young adults with a history of peer victimization. Additionally, the personality trait of pessimism is associated with elevated suicide ideation. Thus, this study tested the association between self-reported frequency of retrospective relational (i.e., verbal and indirect) PV in primary and secondary school, thwarted interpersonal needs (TB and PB), and current suicide ideation, as well as how these relations may vary based on current pessimism. Participants were 330 undergraduate students. Nonparametric bootstrap moderated mediation procedures were used to test hypotheses. Results indicated significant indirect effects of frequency of retrospective relational PV and suicide ideation through PB and TB. Contrary to predictions, results did not indicate significant moderated mediation; however, the association between PB and suicide ideation was stronger at lower pessimism levels. We also provide supplemental analysis with optimism as the moderator. These findings suggest that clinicians may consider targeting TB, PB, as well as pessimism and optimism among those with a history of relational PV when assessing and intervening on current suicide ideation. Implications, limitations, and future directions are further discussed.     

An Examination of the Connections Between Eating Disorder Symptoms,Perceived Burdensomeness,Thwarted Belongingness,and Suicide Risk Among Undergraduate Students

Suicide attempts and premature mortality due to suicide are elevated in people with eating disorders. Informed by the interpersonal theory of suicide, two studies examined the role of perceived burdensomeness and thwarted belongingness in explaining the association between eating disorder symptoms and suicide risk. Results indicated that various eating disorder symptoms had an indirect effect on suicide risk through perceived burdensomeness and thwarted belongingness. Targeting perceived burdensomeness and thwarted belongingness may be useful for decreasing suicide risk among undergraduates with eating disorder symptoms.     

Shame,Guilt, and Suicide Ideation among Bondage and Discipline,Dominance and Submission,and Sadomasochism Practitioners: Examining the Role of the Interpersonal Theory of Suicide

To date, no study has examined rates of suicide ideation or theory‐based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty‐seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma‐related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.     

The Interpersonal Theory of Suicide Applied to Male Prisoners

The interpersonal theory of suicide proposes that severe suicide ideation is caused by the combination of thwarted belongingness (TB) and perceived burdensomeness (PB), yet few studies have actually examined their interaction. Further, no studies have examined this proposal in male prisoners, a particularly at‐risk group. To address this gap, the current study surveyed 399 male prisoners. TB and PB interacted to predict suicide ideation while controlling for depression and hopelessness. High levels of both TB and PB were associated with more severe suicide ideation. The interpersonal theory may aid in the detection, prevention, and treatment of suicide risk in prisoners.     

Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire

The present study examined the psychometric properties and construct validity of scores derived from the Interpersonal Needs Questionnaire (INQ) using latent variable modeling with 5 independent samples varying in age and level of psychopathology. The INQ was derived from the interpersonal theory of suicide and was developed to measure thwarted belongingness and perceived burdensomeness-both proximal causes of desire for suicide. Results support that thwarted belongingness and perceived burdensomeness are distinct but related constructs and that they can be reliably measured. Further, multiple-group analyses were consistent with invariance for young versus older adults and nonclinical versus clinical populations, thereby supporting the relevance of these constructs to diverse populations. Finally, both constructs demonstrated convergent associations with related interpersonal constructs-including loneliness and social support for belongingness and social worth and death ideation for burdensomeness--as well as prospective associations with suicidal ideation.     

Examining Proximal Risk Factors for Suicide in a Sample of Mexican Adults in Rehabilitation Centers

The cross‐cultural generalizability of the interpersonal theory of suicide was examined in this study. One hundred ninety‐nine adults in an inpatient setting in Mexico completed the Personal Resources Questionnaire, Beck Hopelessness Scale, Interpersonal Needs Questionnaire, Acquired Capability for Suicide Scale, and Suicide Behaviors Questionnaire‐Revised. Analyses revealed the interaction between perceived burdensomeness and thwarted belongingness did not predict suicide ideation. The interactions between perceived burdensomeness and thwarted belongingness and between perceived burdensomeness and acquired capacity significantly predicted suicidal behaviors, whereas the hypothesized three‐way interaction did not. These findings highlight the importance of perceived burdensomeness in the development of suicidal behaviors among Mexican‐origin adults.     

Low Parental Warmth and High Youth Impairment: A Recipe for Perceived Burdensomeness?

Theory and research document the role of perceived burdensomeness in the development of suicide ideation, including in youth. There is a critical need to identify and evaluate variables that foster perceived burdensomeness in youth, with an eye toward advancing etiological models and informing prevention approaches for at-risk youth who are not yet actively suicidal. The current study examined and replicated a conceptual model wherein the association between low parental warmth and burdensomeness is moderated by youth impairment. Participants were 75 and 150 clinic referred youths in Study 1 and Study 2, respectively, with anxiety-related difficulties. Youth impairment significantly moderated the association between low parental warmth and youth perceived burdensomeness such that the association was negative and statistically significant at high levels of impairment, but not at low levels of impairment. The moderation effect was statistically significant in both studies while controlling for anxiety and depressive symptoms. These findings provide insight into variables that are associated with a sense of burdensomeness toward others in youth, and identify potential targets for preventing or intervening to reduce perceived burdensomeness in clinic-referred youth.     

Perceived burdensomeness, familism, and suicidal ideation among Mexican women: enhancing understanding of risk and protective factors

The interpersonal-psychological theory of suicide and a culturally-relevant construct, familism, was used to examine predictors of suicidal ideation among Mexican and Mexican American women in the United States. A sense of perceived burdensomeness toward others was expected to significantly predict suicidal ideation, especially among women who endorsed high levels of familism. Mexican and Mexican American outpatient women (N = 73) completed self-report measures and an interview measure of suicidal ideation. Main and interactive effects of perceived burdensomeness and familism were examined. Perceived burdensomeness, but not familism, significantly predicted suicidal ideation. The interaction hypothesis was not supported. These findings highlight perceived burdensomeness as a risk factor for suicidal behavior in Mexican and Mexican American women.     

Integrating the Interpersonal Psychological Theory of Suicide Into the Depression/Suicidal Ideation Relationship: A Short-Term Prospective Study

We examined the hypothesis that depressive symptoms are associated with increased beliefs about perceived burdensomeness and thwarted belongingness identified in the interpersonal psychological theory of suicide and that these beliefs are associated with changes in suicidal ideation. Participants with clinical levels of depressive symptoms (n = 299) were selected from a larger group (n = 508) and completed measures of depressive symptoms, perceived burdensomeness and thwarted belongingness, and suicidal ideation twice over a period of 2 months. Results of a structural equation model found that depressive symptoms were associated with increases in burdensomeness and lack of belonging, which were associated with suicidal ideation. Moreover, this hypothesized integrated model demonstrated a significantly better fit than an alternative model that assumed burdensomeness and lack of belonging were associated with changes in depressive symptoms, which were associated with suicidal ideation. Our findings suggest that the well-established relationship between depressive symptoms and suicidal ideation is associated with changes in beliefs that one is a burden on others and lacks belonging. More generally, these results suggest that it may be fruitful to integrate theories of suicide risk to form a comprehensive model that can inform future research and clinical interventions.     

Hope as a Predictor of Interpersonal Suicide Risk

The current study hypothesized that (1) hope would negatively predict burdensomeness, thwarted belongingness, and acquired capability to enact lethal injury; (2) hope would negatively predict suicidal ideation; and (3) the interpersonal suicide risk factors would predict suicidal ideation. Results indicated that hope negatively predicted burdensomeness and thwarted belongingness, but positively predicted acquired capability to enact suicide. Contrary to our second hypothesis, hope did not predict suicidal ideation, but interpersonal risk factors for suicide predicted suicidal ideation. Results are discussed in terms of implications for hope theory and Joiner's (2005) interpersonal risk factors for suicide, and for clinical practice.     

Comparisons of the Interpersonal–Psychological Theory of Suicide Constructs Among Individuals Without Suicidality,Ideators, Planners,and Attempters

The Interpersonal–Psychological Theory of Suicide (IPTS) proposes that combinations of thwarted belongingness, perceived burdensomeness, and acquired capability lead to suicide ideation, planning, and attempting. We compared individuals with and without suicidality on thwarted belongingness and perceived burdensomeness, and compared a combined group of planners and attempters to ideators on fearlessness about death (one component of acquired capability). Individuals with suicidality had higher thwarted belongingness and perceived burdensomeness than individuals without suicidality. Planners and attempters did not have higher fearlessness about death than ideators. These findings partially support IPTS hypotheses. Assessing thwarted belongingness and perceived burdensomeness may improve suicide risk determination.     

Suicide Risk across Latent Class Subgroups: A Test of the Generalizability of the Interpersonal Psychological Theory of Suicide

It remains unclear whether the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, 2005 ) is generalizable to the population or holds more explanatory power for certain subgroups compared to others. The aim of this study was to (1) identify subgroups of individuals who endorsed suicide ideation in the past month based on a range of mental health and demographic variables, (2) compare levels of the IPTS constructs within these subgroups, and (3) test the IPTS predictions for suicide ideation and suicide attempt for each group. Latent class, negative binomial, linear, and logistic regression analyses were conducted on population‐based data obtained from 1,321 adults recruited from Facebook. Among participants reporting suicide ideation, four distinct patterns of risk factors emerged based on age and severity of mental health symptoms. Groups with highly elevated mental health symptoms reported the highest levels of thwarted belongingness and perceived burdensomeness. Tests of the IPTS interactions provided partial support for the theory, primarily in young adults with elevated mental health symptoms. Lack of support found for the IPTS predictions across the subgroups and full sample in this study raise some questions around the broad applicability of the theory.