Thwarted Belongingness Mediates the Relationship between Fear of Negative Evaluation and Suicidal Ideation

The bidirectional longitudinal associations between fear of negative evaluation and suicidal ideation among Chinese adolescents: The mediating role of interpersonal needs factors

Based on previous theories and studies, fear of negative evaluation (FNE) may be a key predictor of suicidal ideation in adolescents. However, few studies examined the longitudinal relationships between FNE and suicidal ideation. This study aimed to explore the bidirectional longitudinal relationships between FNE and suicidal ideation. Meanwhile, based on the Interpersonal Theory of Suicide, this study would examine the longitudinal mediating role of interpersonal needs factors (thwarted belongingness and perceived burdensomeness) on the relationship between FNE and suicidal ideation. A sample of 515 adolescents (Mage = 12.309, SD = 0.807; 49.3 % girls) completed questionnaires on 4 waves, 6 months apart. The Random Intercept Cross-Lagged Panel Models (RI-CLPMs) were utilized to estimate the associations among study variables. The results showed that: (1) there was a significant bidirectional longitudinal relationship between FNE and suicidal ideation; (2) thwarted belongingness and perceived burdensomeness independently and serially mediated the relationship between FNE and suicidal ideation. This study contributed to understanding the complex relationship between FNE and suicidal ideation, emphasizing the critical roles of thwarted belongingness and perceived burdensomeness. The findings underscore the bidirectional nature of these associations and provide insights into the potential pathways involved in the development of suicidal ideation among adolescents.

Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review

The purposes of this brief integrative review are to identify and critically evaluate recent work in the area of Dialectical Behavior Therapy-Skills Group (DBT-SG) for Social Anxiety Disorder (SAD) with suicidal ideation (SI) and to suggest further how DBT-based skills may be applied to cognitive maintenance factors of SAD. Accordingly, we first evaluate the relevance of DBT in treating SI in other disorders. Second, we evaluate the relationship between SI and SAD, providing considerations for the complexity of comorbid disorders and presentations. Finally, we extend this knowledge to discuss considerations for the use of DBT-SG skills to target specific etiological and maintenance elements of SAD, with a focus on four themes (interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance). Overall, we conclude that DBT-SG may prove beneficial in reducing SI and symptoms in SAD that impact social and emotional functioning.

Social anxiety and interpersonal risk for suicidal ideation: A longitudinal daily diary analysis

INTRODUCTION

Social anxiety is associated with elevated suicidal ideation (SI). One potential explanation is that socially anxious persons experience frequent interpersonal stressors that elicit SI. Longitudinal designs with temporal ordering are needed to adequately test this hypothesis. Therefore, this study leveraged a longitudinal design combining trait and daily reports.

METHODS

Two hundred eleven community adult participants with elevated levels of depression and/or social anxiety completed social anxiety and SI measures at baseline and again at a 1.5-month follow-up. Between these assessments, participants completed a 14-day diary study that assessed three forms of interpersonal distress: unfavorable social comparisons, perceived barriers to seeking social support, and loneliness.

RESULTS

As predicted, simple mediation models revealed that baseline social anxiety had a significant indirect effect on SI severity at 1.5 months postbaseline via unfavorable social comparisons (indirect effect: β = 0.07, p < 0.05) and barriers to seeking support (indirect effect: β = 0.08, p < 0.05); however, social anxiety did not have a significant indirect effect on SI severity through loneliness.

CONCLUSION

Study results are consistent with the proposition that increases in interpersonal distress may explain socially anxious persons' vulnerability to SI. Implications of these findings for the research, assessment, and treatment of suicidality in social anxiety are discussed.

Perceived stress from interpersonal relations predicts suicidal ideation in Chinese university students: Roles of meaning in life and coping humor

Existing studies emphasize that interpersonal relationships are closely associated with the increased risk of suicidal ideation (SI). However, the mechanism underlying this association remains poorly understood. In this study, we investigated how and under what conditions the perceived stress from interpersonal relations links to SI. Also we explored the possible important roles of meaning in life and coping humor. A total of 1472 Chinese freshmen completed self-reported questionnaires of thwarted belongingness (TB), fear of negative evaluation (FNE), meaning in life, coping humor, and SI. Our results showed that SI was associated with more TB and FNE, and it was linked to less meaning in life and coping humor. Importantly, two dimensions of meaning in life mediated the associations between TB, FNE, and SI. Specifically, TB increased SI by destroying both presence of meaning and search for meaning while FNE increased SI by destroying presence of meaning, but not by search for meaning. Additionally, coping humor attenuated the effect of FNE on SI. Our findings highlight the protective roles of meaning in life and coping humor in the link between perceived stress from interpersonal relations and SI among Chinese university students. These results provide feasible advices for practitioners to carry out suicide prevention and intervention.

Fear of negative evaluation and suicidal ideation among college students: the moderating role of impulsivity-like traits

Objective: Fear of negative evaluation (FNE) is a key trait of social anxiety and has been linked to isolation and low self-esteem. Impulsivity has been shown to amplify the risk of socially anxious individuals engaging in risky behaviors such as suicidal behaviors; yet little research has examined associations between FNE and suicidality or the relationship between FNE and impulsivity. Participants/Methods: This study tested whether FNE was associated with suicidal ideation in a sample of 1,816 college students from 10 universities. Analyses also examined whether impulsivity-like traits moderated the relationship between FNE and suicidal ideation. Results: Results showed that FNE was significantly associated with suicidal ideation and the positive association between FNE and suicidal ideation was strongest among individuals with higher negative urgency and lower perseverance. Conclusions: These findings highlight FNE as an important risk factor of suicidal ideation in college students and illuminates potential influence of impulsivity on this relationship.

Depression, anxiety, stress, and satisfaction with life: Moderating role of interpersonal needs among university students

Depression, anxiety, and stress are ranked among the top mental health concerns faced by university students in recent times perpetuated by the proliferation of digitalization. Thus, this study was performed to assess the relationship between depression, anxiety, stress, and satisfaction with life, with interpersonal needs (perceived burdensomeness and thwarted belongingness) as moderators. A cross-sectional study using a convenient sampling method was conducted among 430 Malaysian private university students (Mean aged= 20.73 years; SD = 1.26 years). A self-administered questionnaire comprising the Depression, Anxiety and Stress Scale (DASS-21), Satisfaction with Life Scale, and Interpersonal Needs Questionnaire were used. Students who experienced lower depression and anxiety reported higher satisfaction with life under the influence of low perceived burdensomeness. Perceived burdensomeness, when coupled with depression (β = 0.76, p < 0.01) and anxiety (β = 0.79, p < 0.01), contributed 15.8% of variance in satisfaction with life. Students who experienced stress reported higher satisfaction with life under the influence of high thwarted belongingness (β = 0.73, p < 0.01), contributing 17.3% of the variance in satisfaction with life. For university students who experienced depression and anxiety symptoms, mental health practitioners may need to be cognizant of how to support students' education and management of their perceived burdensomeness perceptions.

Social-cognitive risk for suicide and new relationship formation: False perception, self-fulfilling prophecy, or both?

OBJECTIVE

This study examined the impact of social-cognitive constructs associated with increased suicide risk (i.e., perceived burdensomeness and thwarted belongingness) on relationship formation during real-time interactions of older adolescents with strangers in a dyadic context.

METHOD

Two hundred and seventy-four older adolescents (61.9% female, M age = 18.96 years) were paired with same-gender strangers and completed a laboratory-based interaction task. Both target participants and their partners answered questions about their interaction at three time points during the 45-min session. Structural equation modeling was used to test hypothesized models.

RESULTS

Perceived burdensomeness and thwarted belongingness predicted interpersonal consequences during the interaction. In the first model, thwarted belongingness led targets to inaccurately perceive their partners' assessments of the interaction. This misperception negatively impacted the participants' own desires for friendship. In the second model, thwarted belongingness predicted decreases in targets' desire to continue the conversation, whereas perceived burdensomeness predicted higher levels of desire to continue the conversation. For females, thwarted belongingness in particular was related to new relationship formation in these models. Overall, those who desired to continue talking were more likely to like their partner at the end of the conversation.

CONCLUSIONS

Results add to our understanding of how perceived burdensomeness and thwarted belongingness contribute to increased social alienation, which could serve to increase suicide risk.

How Is the Presence of Company Related to Thwarted Belongingness in Real Time? Taking a Closer Look at the Conceptualization of the Construct of the Interpersonal Theory of Suicide

(1) Background: The role of thwarted belongingness (TB) in predicting suicidal ideation, as originally assumed by the Interpersonal Theory of Suicide, is repeatedly challenged by empirical findings. This could be due to an inadequate conceptualization of the construct of TB that is assumed to be influenced by intrapersonal and interpersonal factors. (2) Methods: We examined the associations of TB with intrapersonal variables related to depression, and with interpersonal variables related to an individual’s actual social environment. We analyzed data from an ecological momentary assessment study in psychiatric inpatients with depressive disorders. N = 73 participants rated momentary TB, depressive affect and status of company up to 10 times per day, over a period of six days, on smartphones. (3) Results: TB was lower when assessed while participants were in company compared to when they were alone, and the more desired the company was, the less TB was experienced. Individuals who had a partnership experienced less momentary TB. Furthermore, higher levels of momentary depressive affect, as well as more stable levels of depression, were related to higher levels of TB, and the relation between the presence of company and TB was weaker for more depressed persons. (4) Conclusions: Our findings can be seen as evidence that both intrapersonal and interpersonal factors relate to TB, and thus support the conceptualization of TB as proposed by the Interpersonal Theory of Suicide.

Perceived burdensomeness uniquely accounts for suicidal ideation severity in social anxiety disorder

BACKGROUND

High rates of suicidal ideation in those with social anxiety disorder (SAD) have been attributed to feelings of thwarted belongingness and perceived burdensomeness, but most work has been in non-clinical samples. We assessed the contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation severity, over clinical covariates, in individuals diagnosed with SAD.

METHODS

Participants were 58 adult outpatients (mean age 25.62 years, 69% female) with SAD. Hierarchical linear regression assessed contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation, before and after covarying other potential explanatory variables (depression, agitation, brooding rumination).

RESULTS

Perceived burdensomeness was significantly positively related to suicidal ideation severity (p < .001) above thwarted belongingness, which was not incremental (p = .791). The same pattern was found after inclusion of additional covariates (perceived burdensomeness p = .006; thwarted belongingness p = .757). Greater agitation also uniquely accounted for more severe suicidal ideation (p = .001).

LIMITATIONS

This study was cross-sectional, did not assess all potential confounding variables, and utilized a treatment-seeking sample.

CONCLUSIONS

Results suggest perceived burdensomeness is independently related to suicidal ideation severity in SAD, over thwarted belongingness and other clinical features. Future work should seek to replicate these findings and evaluate causal, longitudinal relationships among perceived burdensomeness, agitation, and severity of suicidal ideation in those with SAD in order to determine whether these may be clinically-relevant mechanisms.

Shame and Suicidal Ideation among Undergraduates in China: The Mediating Effect of Thwarted Belongingness and Perceived Burdensomeness

Undergraduate students with shame are more likely to experience suicidal ideation, but there remains a lack of research investigating the factors underlying this relationship. The interpersonal theory of suicide posits that suicidal ideation is influenced by the simultaneous presence of thwarted belongingness and perceived burdensomeness. We examined the prevalence of suicidal ideation among undergraduate students in China and examined the association between shame and suicidal ideation mediated by perceived burdensomeness and thwarted belongingness. A survey was conducted in July 2018 involving 2320 undergraduate students, and the twelve-month prevalence of suicidal ideation was 8.95%. Shame played a crucial role in predicting suicidal ideation, and the mediating effects of perceived burdensomeness and thwarted belongingness between shame and suicidal ideation were significant. Suicidal ideation is common among undergraduate students in China and merits greater attention. Shame, perceived burdensomeness, and thwarted belongingness may be important factors to assess among undergraduate students in suicide risk assessment and psychological intervention.

Social anxiety and interpersonal stress generation: the moderating role of interpersonal distress

BACKGROUND AND OBJECTIVES

Existing models of social anxiety scarcely account for interpersonal stress generation. These models also seldom include interpersonal factors that compound the effects of social anxiety. Given recent findings that two forms of interpersonal distress, perceived burdensomeness and thwarted belongingness, intensify social anxiety and cause interpersonal stress generation, these two constructs may be especially relevant to examining social anxiety and interpersonal stress generation together.

DESIGN

The current study extended prior research by examining the role of social anxiety in the occurrence of negative and positive interpersonal events and evaluated whether interpersonal distress moderated these associations.

METHODS

Undergraduate students (N = 243; M = 20.46 years; 83% female) completed self-report measures of social anxiety, perceived burdensomeness, and thwarted belongingness, as well as a self-report measure and clinician-rated interview assessing negative and positive interpersonal events that occurred over the past six weeks.

RESULTS

Higher levels of social anxiety were associated only with a higher occurrence of negative interpersonal dependent events, after controlling for depressive symptoms. This relationship was stronger among individuals who also reported higher levels of perceived burdensomeness, but not thwarted belongingness.

CONCLUSIONS

It may be important to more strongly consider interpersonal stress generation in models of social anxiety.

Social-Cognitive and Social-Behavioral Correlates of Suicide Risk in College Students: Contributions from Interpersonal Theories of Suicide and Depression

Joiner's interpersonal-psychological theory of suicide (IPTS) is predated by literature examining maladaptive interpersonal behaviors associated with depression; however, research has not examined the potential relevance of such behaviors for the IPTS. The current study aimed to expand understanding of suicide risk by examining two maladaptive interpersonal behaviors in the context of Joiner's IPTS model. Structural equation modeling examined associations between depressive symptoms, social-cognitive predictors of suicide, maladaptive interpersonal behaviors, and suicide risk in 228 college students (53.9% female; M = 19.5 years, SD = 1.8). Social-cognitive IPTS variables mediated the relation between depressive symptoms and maladaptive interpersonal behavior. Both social-cognition and maladaptive interpersonal behavior mediated the effect of depressive symptoms on suicide risk. Findings have the potential to add to our understanding of the interplay of social-cognitive factors and interpersonal behaviors associated with suicide risk. Directions for future research are discussed.

The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research

Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum. (PsycINFO Database Record

Validation of the Korean Depressive Symptom Inventory-Suicidality Subscale

OBJECTIVE

The present study aimed to validate a Korean version of the self-report Depressive Symptom Inventory-Suicidality Subscale (DSI-SS).

METHODS

553 South Korean undergraduate students (aged 18-34 years, 74.8% females) completed questionnaires. Participants completed Korean versions of the self-report Depressive Symptom Inventory-Suicidality Subscale (DSI-SS), Beck Depression Inventory-II (BDI-II), Insomnia Severity Index (ISI), Beck Scale for Suicide Ideation (BSS), and a measure of suicide-related symptom history.

RESULTS

Results indicated that the DSI-SS demonstrated excellent internal consistency (α=0.93) and strong convergent validity with the BDI (r=0.57, p<0.01), ISI (r=0.27, p<0.01), and BSS (r=0.70, p<0.01). DSI-SS scores also significantly differentiated between those reporting a history of suicide attempts compared to non-suicide attempters [t (38.80)=-3.28, p<0.05].

CONCLUSION

Given the brevity of this measure, and evidence for its validity, the Korean version of the DSI-SS may be particularly promising for clinical and empirical use as a screening tool among South Korean undergraduates.

Cannabis use and suicidal ideation: Test of the utility of the interpersonal-psychological theory of suicide

Despite a documented relationship between cannabis use and suicidality, little is known about psychological vulnerability factors that may increase suicidality among this high-risk group. The Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005) proposes that people are vulnerable to wanting to die by suicide if they experience both perceived burdensomeness and thwarted belongingness. Daily cannabis users may be especially vulnerable to these factors. The current study used moderated mediation to test whether the relation between daily cannabis use status and suicidal ideation (SI) occurred indirectly via higher levels of both perceived burdensomeness and thwarted belongingness among 209 (76.1% female) current cannabis using undergraduates who used cannabis daily (n=39) or less frequently (n=160). The direct effect of cannabis use status on SI was no longer significant after controlling for thwarted belongingness, perceived burdensomeness, and the thwarted belongingness X perceived burdensomeness interaction. Cannabis use status was predictive of greater SI indirectly through perceived burdensomeness only at higher levels of thwarted belongingness. Findings support the utility of the IPTS in regard to SI among daily cannabis users, indicating that difficulties in interpersonal functioning may serve as potential pathways through which daily cannabis use may lead to greater suicide risk.

Perceived problem-solving deficits and suicidal ideation: Evidence for the explanatory roles of thwarted belongingness and perceived burdensomeness in five samples

Perceived social problem-solving deficits are associated with suicide risk; however, little research has examined the mechanisms underlying this relationship. The interpersonal theory of suicide proposes 2 mechanisms in the pathogenesis of suicidal desire: intractable feelings of thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested whether TB and PB serve as explanatory links in the relationship between perceived social problem-solving (SPS) deficits and suicidal thoughts and behaviors cross-sectionally and longitudinally. The specificity of TB and PB was evaluated by testing depression as a rival mediator. Self-report measures of perceived SPS deficits, TB, PB, suicidal ideation, and depression were administered in 5 adult samples: 336 and 105 undergraduates from 2 universities, 53 homeless individuals, 222 primary care patients, and 329 military members. Bias-corrected bootstrap mediation and meta-analyses were conducted to examine the magnitude of the direct and indirect effects, and the proposed mediation paths were tested using zero-inflated negative binomial regressions. Cross-sectionally, TB and PB were significant parallel mediators of the relationship between perceived SPS deficits and ideation, beyond depression. Longitudinally and beyond depression, in 1 study, both TB and PB emerged as significant explanatory factors, and in the other, only PB was a significant mediator. Findings supported the specificity of TB and PB: Depression and SPS deficits were not significant mediators. The relationship between perceived SPS deficits and ideation was explained by interpersonal theory variables, particularly PB. Findings support a novel application of the interpersonal theory, and bolster a growing compendium of literature implicating perceived SPS deficits in suicide risk. (PsycINFO Database Record

Insomnia and suicide-related behaviors: A multi-study investigation of thwarted belongingness as a distinct explanatory factor

BACKGROUND

Insomnia is a robust correlate of suicidal ideation and behavior. Preliminary research has identified thwarted belongingness (c.f. social disconnection) as an explanatory link between insomnia and suicidal ideation.

OBJECTIVES

This study replicates and extends previous findings using both cross-sectional and longitudinal designs in four demographically diverse samples. Additionally, the specificity of thwarted belongingness was evaluated by testing anxiety as a rival mediator.

METHOD

Self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation and behavior, and anxiety were administered in four adult samples: 469 undergraduate students, 352 psychiatric outpatients, 858 firefighters, and 217 primary care patients.

RESULTS

More severe insomnia was associated with more severe thwarted belongingness and suicidality. Thwarted belongingness significantly accounted for the association between insomnia and suicidality, cross-sectionally and longitudinally, beyond anxiety. Notably, findings supported the specificity of thwarted belongingness: anxiety did not significantly mediate the association between insomnia and suicidality, and insomnia did not mediate the relation between thwarted belongingness and suicidality.

LIMITATIONS

This study relied solely on self-report measures. Future studies incorporating objective sleep measurements are needed.

CONCLUSION

Findings underscore the utility of assessing and addressing sleep disturbances and social disconnection to reduce suicide risk.

Social anxiety and suicidal ideation: Test of the utility of the interpersonal-psychological theory of suicide

Social anxiety is related to greater suicidality, even after controlling for depression and other psychopathology. The Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005) proposes that people are vulnerable to wanting to die by suicide if they experience both perceived burdensomeness (sense that one is a burden to others) and thwarted belongingness (a greater sense of alienation from others). Socially anxious persons may be especially vulnerable to these interpersonal factors. The current study tested whether interpersonal IPTS components independently and additively mediate the social anxiety-suicidal ideation (SI) relation among 780 (80.5% female) undergraduates. Social anxiety was significantly, robustly related to SI and to thwarted belongingness and perceived burdensomeness. Social anxiety was indirectly related to SI via thwarted belongingness and perceived burdensomeness. The sum of these indirect effects was significant. Moderated mediation analyses indicated that perceived burdensomeness only mediated the relation between social anxiety and SI at higher levels of thwarted belongingness. Findings highlight that difficulties in interpersonal functioning may serve as potential pathways through which social anxiety may lead to greater suicidality. Findings highlight that difficulties in interpersonal functioning may serve as potential pathways through which social anxiety may lead to greater suicidality.

Cross-sectional and temporal association between non-suicidal self-injury and suicidal ideation in young adults: The explanatory roles of thwarted belongingness and perceived burdensomeness

Non-suicidal self-injury (NSSI) is a strong predictor of suicidal ideation and attempts. Consistent with the interpersonal theory of suicide, preliminary evidence suggests that NSSI is associated with higher levels of perceived burdensomeness (PB) and thwarted belongingness (TB). However, no study to date has examined the cross-sectional and prospective relationships between NSSI, TB, PB, and suicidal ideation (SI). To fill this gap, this study examined the mediating role of TB and PB in the relationship between NSSI and SI at baseline and follow-up. Young adults (N=49) with and without histories of NSSI completed self-report measures of TB, PB, and SI at three time points over two months. NSSI history was associated with higher levels of PB, TB, and SI at all time points. TB and PB significantly accounted for the relationship between NSSI history and SI at baseline. However, the relationship between NSSI history and SI at follow-up was mediated by PB, not TB. Findings provide evidence for the roles of TB and PB in the relationship between NSSI and SI, and partial support for the interpersonal theory of suicide. Future research and clinical implications are discussed.