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.     

Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options

Abstract

Substance use disorders are nearly twice as common among sexual minority youth (SMY) as among their heterosexual peers. Most applied literature about this population suggests interventions on either the individual or community level, and the benefits of family therapy for this population are often overlooked. The present literature review (a) outlines clinical knowledge related to sexual minority youth and substance use (e.g., prevalence rates, contributing factors), (b) discusses the importance of clinical self-awareness around these topics, and (c) outlines clinical behaviors and interventions from literature that may be employed when working with substance-using SMY and their families.     

Self-Injurious Thoughts and Behaviors May Be More Common and Severe Among People Identifying as a Sexual Minority

Research indicates that people who identify as a sexual minority are at higher risk of numerous negative outcomes, including self-injurious thoughts and behaviors (SITBs). The minority stress model proposes that people identifying as a sexual minority are at higher risk of these behaviors due to sexual orientation-specific stressors—however, it does not clarify whether SITBs will be more severe among these individuals. The present study tested whether SITBs are more common and more severe among people identifying as a sexual minority using several metrics, including frequency of SITB engagement, age of onset of SITB, desire to discontinue SITB engagement, and likelihood of future SITBs. Four independent research samples were used to test this model. Results were then combined and tested in an internal meta-analysis. Findings converge to indicate a longer and more severe course of SITB engagement among people identifying as a sexual minority. Future research is needed to replicate these findings and to advance the understanding of why this imbalance in risk and severity might exist, and how it can be prevented.     

The Influence of Acetaminophen and Observational Conditioning on the Acquired Capability for Suicide

The effects of acetaminophen and a reading task on physical pain tolerance and fearlessness about death were tested in 106 undergraduate students. Participants were randomized into four groups, each receiving either acetaminophen or no medication, along with either a control or experimental reading task. It was predicted that acetaminophen would increase pain tolerance and fearlessness about death, that the experimental reading task would decrease both outcomes, and that the interventions would interact (i.e., acetaminophen would dampen the effects of the reading task). Multivariate analysis of variance was used to test hypotheses. No significant interaction was found (p = .17) and there was no effect for acetaminophen (p = .56), but individuals administered the experimental reading task demonstrated significantly higher physical pain tolerance (p < .05).     

Minority stress and intimate partner aggression among male same-sex couples

Intimate partner aggression (IPA) is high among gay, bisexual, queer, and other sexual minority men (SMM), and is strongly linked to minority stress. These links might be further magnified or buffered by communication between partners (i.e., negative and positive communication, respectively). The present study investigated associations of minority stress and IPA, and the moderating role of positive/negative communication, among male couples (N = 932 individuals, 466 couples). Partners completed measures of communication skills, minority stress, and IPA, which were analyzed using moderated actor-partner interdependence models. Results suggested that microaggressions increase one's own (i.e., an actor effect) and one's partner's (i.e., a partner effect) verbal IPA victimization, verbal IPA perpetration, and physical IPA victimization. Positive communication moderated the association between microaggressions and verbal IPA victimization, suggesting that high levels of positive communication may buffer the microaggression-verbal IPA link. Thus, minority stress' detrimental impacts on relationship functioning among male same-sex couples may be reduced by the presence of positive communication (e.g., effective conflict resolution). We discuss structural and clinical innovations to prevent IPA among male couples, with particular emphasis on the absence of positive communication as an aggravating factor.     

Understanding and Responding to Victims of Interpersonal Sexual Violence and Sexual Assault within Committed Relationships

Abstract

The purpose of this article is to increase therapeutic discussion surrounding intimate partner sexual violence (IPSV) by increasing understanding in how victims of IPSV perceive and respond to the assault. Although IPSV has received little research attention, sexual violence within relationships occurs at an alarmingly high rate. Theories of sexual assault, such as sex-role socialization, are discussed to aid clinicians in better identifying assaultive behaviors and common physical and emotional responses of victims. Additionally, the authors provide a framework for the assessment of IPSV and suggestions on “best practices” for creating conversations that promote hope and healing.     

Interpersonal Trauma,Posttraumatic Stress Disorder Symptoms,and the Interpersonal Theory of Suicide in Women Seeking Shelter from Intimate Partner Violence

This study examined how trauma exposure and posttraumatic stress disorder symptoms of reexperiencing, avoidance, numbing, dysphoric arousal, and anxious arousal relate to the major components of the interpersonal theory of suicide; namely, thwarted belongingness, perceived burdensomeness, and the acquired capability for suicide. A sample of 137 women seeking shelter from intimate partner violence completed self-report assessments. Symptoms of dysphoric arousal and numbing were uniquely and positively associated with thwarted belongingness. Numbing symptoms were uniquely and positively associated with perceived burdensomeness. Reexperiencing and anxious arousal symptoms were uniquely but negatively associated with the acquired capability for suicide. Interpersonal trauma was also positively associated with acquired capability, but only when examined independently. Posttraumatic stress disorder symptoms of dysphoric arousal and numbing symptoms might complement brief screenings for acute suicide risk and can help inform in-shelter activities as well as postshelter treatment recommendations to decrease suicide risk for shelter-seeking women.     

Psychotherapy for the Spectrum of Sexual Minority Stress: Application and Technique of the ESTEEM Treatment Model

Converging evidence points to minority stress as a risk factor that predisposes sexual minority individuals to a variety of negative psychosocial health outcomes, particularly depression and anxiety, substance use, and sexual risk-taking. This paper outlines the techniques and theoretical underpinnings for implementing an emerging empirically supported psychotherapy designed to target the transdiagnostic mechanisms linking sexual minority stress with these outcomes. We outline the essential therapeutic principles, psychoeducation content, as well as session- and homework-based activities that can be adapted for a variety of presenting problems that originate from, and are exacerbated by, minority stress via transdiagnostic minority stress processes. As the development and dissemination of this therapeutic model is still within its early stages, we review the intervention’s empirical support thus far and outline potential directions for future development and dissemination via individual, clinic-based, and societal channels.     

The Use of Relational‐Cultural Theory in Counseling Clients Who Have Traumatic Stress Disorders

Counseling scholarship has increasingly demonstrated the utility of relational‐cultural theory (RCT) in promoting the relationship‐building and growth‐fostering connections many clients require to manage problems in living. The authors applied RCT to counseling clients with traumatic stress disorders rooted in traumas of an interpersonal nature (e.g., child abuse, interpersonal partner violence, sexual assault). An overview of traumatic stress disorders and RCT, as well as the ways in which RCT can inform trauma conceptualization and treatment approaches with victims, is provided.     

An Examination of Posttraumatic Stress Symptoms among Maltreated Multiracial Youth

Symptoms of posttraumatic stress disorder (PTSD) are common among maltreated youth removed from their homes. These symptoms might be particularly evident in multiracial youth, although little research exists on this vulnerable population. A model whereby depression, dissociation, and posttraumatic cognition symptoms contributed to symptoms of PTSD met goodness-of-fit criteria in 160 maltreated multiracial adolescents. Enhanced model fit was found for females and for adolescents 11 to 13 years old. Analyses further revealed that the best predictors of PTSD symptoms were negative cognitions about the world and anhedonia. The findings are discussed within the context of existing theoretical models of PTSD. The results further highlight the importance of ethnically and racially sensitive approaches to assessment and treatment of youth with PTSD symptoms.     

The Burden of Not Belonging: A Qualitative Study of the Applicability of the Interpersonal Theory of Suicide Constructs of Belongingness and Burdensomeness to Ethnocultural Minoritized Youth

Guided by the Interpersonal Theory of Suicide (IPTS), this study aims to understand the applicability of the constructs of belongingness and burdensomeness and their relevance to suicide risk and mental health among ethnocultural minoritized youth. A qualitative exploratory study was conducted using five focus groups with 29 self-identified Latinx and Black adolescents aged 13–17 years to explore the meaning they ascribed to belongingness and burdensomeness. Views of social media related to these constructs were also explored. Template analysis was used to analyze the data. Themes highlighted dimensions such as caring, self-worth, and liability, congruent with the IPTS dimensions of belongingness and burdensomeness. Notably, new themes emerged reflecting the distinctive experiences of these populations, such as the importance of being true to themselves, the burden of not belonging to families, and cultural aspects of liability, highlighting dimensions not found in the existing IPTS theoretical constructs. Consideration of the diverse experiences of ethnocultural minoritized youth can strengthen theoretical constructs, clinical practice, and aid in developing intervention strategies to increase protective factors and decrease risk factors for suicide behaviors relevant to such youth.     

The Roles of Family,Friends, and Romantic/Sexual Partners in the Body Image of Sexual Minority Men

The purpose of this study was to explore the roles of family, friends, and romantic/sexual partners in the body image development of sexual minority men. Data were analyzed using consensual qualitative research methodology. Romantic/sexual partners, family, and friends were all found to play influential roles in body development, with romantic/sexual partners being the most significant and friends being the least significant. Implications for counselors and counselor educators, as well as suggestions for future research, are provided.     

Sexual Self‐Concept Ambiguity and the Interpersonal Theory of Suicide Risk

Mechanisms (i.e., thwarted belongingness, perceived burdensomeness, hopelessness) derived from the interpersonal theory of suicide which are hypothesized to account for the relation between sexual orientation self‐concept ambiguity and active suicide ideation were examined. Participants included 349 women, among whom 42% currently self‐ascribed a non‐exclusively heterosexual sexual identity. Among women reporting higher levels of sexual self‐concept ambiguity, greater risk for active suicide ideation is found when perceptions of burden and feelings of thwarted belonging co‐occur with feelings of hopelessness. Results support relevant theory useful for understanding suicide risk among sexual minority women who acknowledge ambiguity with regard to their sexual orientation.     

The Role of Life Stress and Social Support in the Adjustment of Sexually Victimized Pregnant and Parenting Minority Adolescents

Associations among sexual victimization and the psychosocial functioning of African American and Latina pregnant and parenting adolescents were examined. Forty-seven (17.7%) of the 265 participants reported histories of sexual victimization, most of which was unwanted sexual intercourse. The victimized adolescents reported higher levels of depression, anxiety, and life stress and, although the two groups reported no differences in their levels of social support, support was found to be differentially related to depression and anxiety in the two groups. In particular, victims derived benefits from social support at low levels of stress, but social support provided no protection against depression and anxiety at average or high levels of stress. For nonvictims, social support provided no benefits at low levels of stress, but protected against depression and anxiety at moderate levels of stress and against depression at high levels of stress. Implications of these findings for research, theory, and intervention are discussed.     

The Impact of Cumulative Minority Stress on Cognitive Behavioral Treatment With Gender Minority Individuals: Case Study and Clinical Recommendations

For sexual minority individuals (i.e., lesbian, gay, and bisexual [LGB] persons), minority stress includes experiences of discrimination, expectations of rejection, internalized negativity, and concealment of identity. Sexual minority stress has been linked to various negative mental health outcomes (e.g., depression, anxiety), and levels of psychiatric comorbidity are high among LGB people. However, little is known about the extension of minority stress models to gender minority individuals (i.e., transgender and gender nonconforming persons) and its impact on mental health in this particular group. Further, the influence of gender minority stress on the delivery and outcome of traditional cognitive behavioral therapy (CBT) approaches is unclear. A case study of CBT for chronic depression with a young, transgender individual is presented. This case study highlights potential barriers that may arise with gender minority clients when implementing evidence-based clinical interventions in the context of an individual’s minority stress history. Implications for cognitive-behavioral treatments with gender minority individuals and recommendations for clinicians and researchers are discussed.     

Depressive Symptoms Among Delinquent Youth: Testing Models of Association with Stress and Support

The high prevalence of depression among incarcerated youth indicates a need to better understand factors that contribute to depression within this vulnerable subgroup. Previous research in general community samples has suggested that high levels of stress and low levels of parental support are associated with depression in young people, but it is unclear whether or how they might be associated with depression among incarcerated youth who are already vulnerable. Using a sample of 228 adolescents (aged 13–18 years) who were detained in the juvenile justice system, stress and support were modeled as independent main effects and as interactive risk factors in relation to depressive symptoms. More stressful life events and less caregiver support were each independently associated with depressive symptoms, but no evidence was found for the buffering hypothesis in this sample. Stressful life events were more strongly associated with depressive symptoms among boys compared to girls.     

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.     

Closing the Gap in Aboriginal and Torres Strait Islander Youth Suicide: A Social–Emotional Wellbeing Service Innovation Project

Objective

The suicide rate for Queensland's Aboriginal and Torres Strait Islander young people is over four times that of their non‐Indigenous counterparts, with Aboriginal and Torres Strait Islander children (under 15) dying by suicide at 12 times the non‐Indigenous rate. There is a need for interventions that are culturally validated and community‐endorsed. The aim of this article is to describe the design and implementation of a group‐based intervention, as well to report the results of the various qualitative and quantitative measures.

Method

Sixty‐one Aboriginal and Torres Strait Islander persons aged 11–21 years completed a social–emotional wellbeing (SEWB) program at headspace Inala. Data were available through to 2‐month follow‐up for 49 participants. The program was designed and delivered in collaboration with the local Aboriginal and Torres Strait Islander community.

Results

There was a statistically significant decrease in suicidal ideation experienced by the participants after completing the program. Qualitative measures indicated that participants experienced improved understanding of holistic health and an increased number of coping skills.

Conclusions

Not only was this the first evaluated intervention in Aboriginal and Torres Strait Islander youth to ever report a decrease in individual suicidality, the program was carefully designed and implemented in consultation with community in a culturally sensitive manner and thus provides an invaluable framework for future SEWB work.