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.     

Childhood Abuse,the Interpersonal–Psychological Theory of Suicide,and the Mediating Role of Depression

Although childhood abuse is a well‐known risk factor for suicide, no studies have investigated the role of interpersonal–psychological (Joiner, 2005), constructs in this association. This study examined whether childhood physical, sexual, and emotional abuse were associated with IPTS constructs, and whether depressive symptoms mediated these associations. Ninety‐one participants completed self‐report measures. Emotional abuse predicted perceived burdensomeness and thwarted belongingness, and depressive symptoms mediated these associations. Physical abuse predicted the acquired capability for suicide, although depression did not mediate this association. These findings suggest that specific types of abuse differentially predict IPTS components and underscore depression as a potential mechanism.     

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.     

Understanding the Pathways from Depression to Suicidal Risk from the Perspective of the Interpersonal–Psychological Theory of Suicide

Suicide is a major public health concern, especially in adolescence. Identifying risk factors for suicide is important to effectively prevent such behavior. Depression is one of the most widely examined risk factors for suicidal risk. How depression and suicidal risk are related, however, is still not clear. This study tested a model with three key constructs of the interpersonal–psychological theory of suicidal behavior (IPTS)—perceived burdensomeness, thwarted belongingness, and nonsuicidal self‐injury (NSSI)—as mediators in the relationship between depression and suicidal risk among Chinese adolescents. Chinese high school students (N = 1,074; 54.2% male; M_age = 13.87 years, SD = 1.48) completed questionnaires assessing all study variables. Results suggested that perceived burdensomeness and NSSI partially mediated the relationship between depression and suicidal risk. Findings of this study emphasize the importance of the IPTS framework in understanding the possible mechanisms underlying the relationship between depression and suicidal risk, and suggest a possible avenue for suicide interventions.     

Perceived Burdensomeness Predicts Outcomes of Short‐Term Psychological Treatment of Young People at Risk of Suicide

The interpersonal‐psychological theory of suicide (IPTS; Joiner, 2005 ) provides a model for understanding the mechanisms underlying suicide risk, but there is limited research measuring change in the constructs over the course of treatment. This study aimed to test whether changes in perceived burdensomeness (PB) and thwarted belongingness (TB) mediated the effects of changes in depression and hopelessness on suicide risk. The sample comprised 226 Australian young people (aged 12–24; 67.7% female; 5.7% Aboriginal and Torres Strait Islander) receiving short‐term psychological treatment for suicide‐related behaviors. Change scores over the course of therapy were generated using admission and discharge measures of PB, TB, depression, hopelessness, and suicide risk. Results revealed partial support for the theory. The relationship between changes in depression and hopelessness on suicide risk was fully mediated by changes in PB. However, changes in TB did not mediate these relationships. This study offers encouragement for the potential use of the IPTS in the context of psychological treatment of young people. Assessment of the IPTS constructs may be helpful in assessing change in suicide risk and further assist in treatment.     

A Trait‐Interpersonal Analysis of Suicide Proneness Among Lesbian,Gay, and Bisexual Community Members

Suicide remains a concerning issue for lesbian, gay, and bisexual (LGB) persons. The integrated effects of five‐factor model personality traits and interpersonal‐psychological theory of suicide (IPTS) constructs on suicide proneness in a community sample of 336 LGB adults were examined. Results supported a model inclusive of all five‐factor model domains predicting IPTS constructs leading to suicide proneness. Effects of neuroticism and extraversion were both mediated by perceived burdensomeness and thwarted belongingness. Thwarted belongingness mediated the effect of agreeableness on suicide proneness. Identified mediation pathways build on existing trait‐interpersonal theory and may inform clinical services for sexual minority persons.     

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.     

A Short‐Term,Prospective Test of the Interpersonal–Psychological Theory of Suicidal Ideation in an Adolescent Clinical Sample

The present prospective study tested a portion of the interpersonal–psychological theory of suicide (IPTS) in an adolescent clinical sample. Participants were 143 adolescents consecutively admitted to a partial hospitalization program who completed assessments at intake and discharge from the program. Results partially supported the IPTS and suggest that (1) perceived burdensomeness may be an important socially based cognition for understanding concurrent risk for suicidal ideation (SI); (2) thwarted belongingness affects depression symptom severity over time, which indirectly predicts SI over a short follow‐up time frame; and (3) the IPTS constructs may function differently in a high‐risk clinical adolescent sample, compared to adults, although findings are preliminary.     

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.     

The Relationship Between Non-Suicidal Self-Injury and Both Perceived Burdensomeness and Thwarted Belongingness

Prior research has established a connection between non-suicidal self-injury (NSSI) and suicidal behavior. The interpersonal-psychological theory of suicidal behavior (IPTS) posits that an individual must possess both a desire and capability for suicide in order to engage in a lethal suicide attempt. The IPTS conceptualizes the role of NSSI in suicidal behavior as contributing to an individual’s acquired capability. The primary aim of this study was to investigate the relationship between frequency of engagement in NSSI and suicidal desire (thwarted belongingness and perceived burdensomeness). In this study, undergraduate students (n = 999) completed various questionnaires online. Results revealed a significant, positive association between NSSI frequency and thwarted belongingness and a non-significant association between NSSI frequency and perceived burdensomeness. Additionally, results indicated a significant indirect effect of NSSI frequency on burdensomeness and belongingness through depression and borderline personality disorder symptoms. The direct effect of NSSI frequency on belongingness remained significant; however, the direct effect of NSSI frequency on burdensomeness did not. These findings suggest that the relationship between NSSI and suicide is not strictly limited to acquired capability, but rather includes a component of suicidal desire.     

A Prospective Examination of the Interpersonal‐Psychological Theory of Suicidal Behavior Among Psychiatric Adolescent Inpatients

The challenge of identifying suicide risk in adolescents, and particularly among high‐risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal‐Psychological Theory of Suicidal Behavior (IPTS)—with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self‐injury—predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three‐way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2‐way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12‐month attempts. Results suggest gender‐specific associations between theory components and attempts. The time‐limited effects of these associations point to TB and PB being dynamic and modifiable in high‐risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively.     

An Examination of the Interpersonal Psychological Theory of Suicidal Behavior in Physicians

Physicians are commonly reported to die by suicide more frequently than individuals in the general population. Thus far, few reasons for this elevated suicide risk have been empirically investigated. Although the interpersonal psychological theory of suicidal behavior (IPTS) has been suggested as a fruitful means of explaining physician suicidality, it has yet to be examined quantitatively. Four hundred nineteen Pennsylvania physicians were assessed on a number of demographics, as well as all components of the IPTS. Findings indicated that physician scores on IPTS components are comparable to other groups displaying increased suicidality (e.g., military populations, prior attempters). Perceived burdensomeness was a significant predictor of suicidal ideation, while thwarted belongingness predicted prior suicide attempts. Acquired capability did not distinguish between prior attempters and nonattempters. Preliminary findings indicate the IPTS may be a useful framework for understanding and predicting physician suicidality.     

The Specificity of the Interpersonal‐Psychological Theory of Suicidal Behavior for Identifying Suicidal Ideation in an Online Sample

The interpersonal‐psychological theory of suicidal behavior suggests that the combination of perceived burdensomeness and thwarted belongingness predicts suicidal ideation. However, the specificity of this prediction to suicidal ideation has not been tested. This study examined whether these constructs were consistently associated with different characteristics of suicidal ideation, and whether they were associated with mental health problems more broadly, in an online sample of 1,352 Australian adults. Findings indicated that the interaction between perceived burdensomeness and thwarted belongingness was associated only with suicidal ideation and consistent across multiple characteristics of ideation. The study broadly supported the specificity of the IPTS.     

Anxiety Sensitivity Differentially Predicts Factors of Interpersonal–Psychological Suicide Risk: A Consideration of Specificity

Recent studies have identified anxiety sensitivity (AS) as a risk factor for suicidality; however, limited work has been performed to understand this risk within the context of the interpersonal–psychological theory of suicide (IPTS; Joiner, 2005). The current study examined the relationship between overall AS, each AS subfactor (cognitive, social, and physical), and the three IPTS domains (perceived burdensomeness, thwarted belongingness, and acquired capability). While each AS subfactor uniquely predicted one IPTS domain, greater overall AS only predicted greater acquired capability, suggesting that assessment of AS at the subfactor level may offer us more information about an individual's interpersonal suicide risk.     

Hope and the Interpersonal‐Psychological Theory of Suicidal Behavior: Replication and Extension of Prior Findings

The interpersonal‐psychological theory of suicidal behavior (IPTS; Joiner, 2005) posits that suicidal behavior occurs when an individual has a desire for death (due to the combination of perceived burdensomeness and thwarted belongingness) in addition to an acquired capacity for suicide, which is present when the individual has a low fear of death and high pain tolerance. Previous research has demonstrated an expected negative relation between trait hope and perceived burdensomeness and thwarted belongingness, as well as a more perplexing finding that hope is positively associated with the acquired capability. In a sample of 230 college students, measures of the three components of the IPTS were administered, along with measures of hope, depression, and painful and/or provocative events. Hierarchical regression analyses replicated the previously found associations between hope and burdensomeness and belongingness while controlling for depression and demographic variables. The positive association between hope and acquired capacity was also replicated, but a mediation analysis demonstrated that the effect was statistically accounted for by distress tolerance. The results further support the incremental validity of hope as a consideration in suicide risk assessments and suggest that hope may serve as a protective factor with respect to suicidal desire.     

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.     

Alcohol-related problems and risk of suicide among college students: the mediating roles of belongingness and burdensomeness

The relationship among alcohol-related problems, perceived burdensomeness, thwarted belongingness, and suicide proneness in undergraduate college students (N=996) was examined. As hypothesized, alcohol-related problems, perceived burdensomeness, and thwarted belongingness were all significantly and positively correlated with suicide proneness. The relation between experiencing alcohol-related problems and suicide proneness was, in part, accounted for by perceived burdensomeness and thwarted belongingness. Additionally, the mediation via perceived burdensomeness was significantly stronger than the mediation via thwarted belongingness. Results suggest that it would be advisable for clinicians to be aware of students' experiences with alcohol-related problems in conjunction with their levels of burdensomeness and belongingness when assessing for suicide risk.     

Child Abuse—Suicide Resilience Link in African American Women: Interpersonal Psychological Mediators

The interpersonal-psychological theory of suicidal behavior (IPTS) is an exemplary model for understanding the desire for suicidal behavior. As such, it is important to explore its applicability in ethnoracial minority groups at increasing risk for suicidal behavior, such as low-income, African American women. Guided by the IPTS, the current study used 5 parallel mediation models to examine if there are links between individual types of childhood abuse (physical, sexual, emotional) and suicide resilience, and between cumulative abuse (higher levels of abuse inclusive of all three types, more types of severe levels of abuse) and suicide resilience, and whether the three components of the model (thwarted belongingness, perceived burdensomeness, acquired capability for suicide) mediate these associations. In a sample of low-income, African American women (n = 179), higher levels of each of the 3 types of childhood abuse and cumulative abuse correlated with lower levels of suicide resilience. Parallel mediation analyses using bootstrapping techniques revealed that increased acquired capability for suicide mediated all 5 associations and perceived burdensomeness mediated 3 of the links (emotional abuse, cumulative abuse, and cumulative abuse–severe with suicide resilience). Attention is paid to the clinical implications of the findings in terms of attending to the acquired capability for suicide and suicide resilience in the assessment and treatment of low-income, suicidal, African American women.     

Intervening on Thwarted Belongingness and Perceived Burdensomeness to Reduce Suicidality Among Veterans: Subanalyses From a Randomized Controlled Trial

Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensomeness and thwarted belongingness, or participate in a repeated contact control condition. Results indicated a direct effect of the intervention on both perceived burdensomeness and thwarted belongingness. Temporal mediation analyses also revealed an indirect effect of condition on suicidality at Month 1 follow-up via reductions in perceived burdensomeness. The current results are the first to indicate that factors from the interpersonal theory of suicide can be reduced among veterans, and to demonstrate that these reductions in perceived burdensomeness lead to reductions in suicidality. Because of the brevity and computer delivery system, this intervention could be widely and rapidly disseminated among military veterans to reduce the public health burden of suicide in this population.     

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.