Simultaneous Longitudinal Examination of Hopelessness, Thwarted Belongingness, and Perceived Burdensomeness as Predictors of Suicide Ideation

Relationship of Perceived Burdensomeness and Thwarted Belongingness to Suicide Ideation Persistence and Suicide Behavior Over 12 Months in People With Serious Mental Illness

BACKGROUND AND HYPOTHESIS

People with serious mental illness (SMI) have an increased risk of suicide ideation (SI) and suicide behavior (SB). Longitudinal studies on factors contributing to SI/SB in SMI are lacking. Interpersonal biases (ie, perceived burdensomeness and thwarted belongingness) are cross-sectionally related to SI/SB, but do they relate to longitudinal suicide risk or other illness factors? Ecological momentary assessment (EMA) offers a powerful approach to a deeper understanding of these complex relationships.

STUDY DESIGN

Participants with SMI (N = 180) completed 3 in-lab visits (baseline, 6-month, and 12-month) and 10 days of EMA (3×/day) following the baseline visit. At all timepoints, participants were assessed for SI/SB and were classified as persistent, intermittent, or no SI or any reports of SB over the 12-month follow-up. Multinomial logistic regression models examined whether EMA burdensomeness, belongingness, social motivations, and psychotic symptoms predicted SI persistence or SB over 12 months. Time-series network analysis compared participants' EMA data by baseline SI.

STUDY RESULTS

Burdensomeness and belongingness related to persistent SI 12 months, as did voices, suspiciousness, and social motivations. Only burdensomeness and belongingness related to increased risk of SB over 12 months. Network analyses revealed unique lagged relationships in the baseline SI group: of suspiciousness to belongingness and social avoidance motivation to burdensomeness when compared to the baseline group without SI.

CONCLUSIONS

These findings indicate the importance of interpersonal risk factors and suspiciousness to trajectories of SI and SB over 12 months in SMI. Pending replication, these constructs may be potential suicide prevention treatment targets in SMI.

The Interaction Between Alcohol Misuse and Belongingness on Suicidal Ideation Among Military Personnel

Previous research suggests a high prevalence of suicidal ideation among military personnel. Suicidal ideation is associated with suicide attempts and death. This study focused on the association between belongingness-a component of the Interpersonal Psychological Theory of Suicide-and alcohol misuse on suicidal ideation among the different categories of military branch and military service status. Using the Military Suicide Research Consortium Common Data Elements database (N = 2516), we conducted linear regression analyses to examine the moderating effect of belongingness and alcohol misuse on the association between military branch and military service status (i.e., Active Duty) on suicidal ideation. Results showed a negative significant association between belongingness and suicidal ideation, and a positive significant association between alcohol and suicidal ideation. The results indicated that alcohol misuse moderated the association between military branch and suicidal ideation, but did not moderate the association between military service status and suicidal ideation. Additionally, the results indicated that belongingness moderated the association between military branch and suicidal ideation and the association between military service status and suicidal ideation. The results highlight the differences across military branches and military service statuses and suggest the importance of developing tailored suicide prevention programs to address the specific needs of each military subpopulation.

The "Vicious Circle of addictive Social Media Use and Mental Health" Model

Social media use (SMU) is a significant part of many people's everyday life. Research around the globe describes an increase of addictive SMU tendencies since the COVID-19 outbreak. The present work combines available findings in the "Vicious Circle of addictive Social Media Use and Mental Health" model to explain how social media (SM) activity can contribute to the development of addictive tendencies, which consequences they have for mental health, and how to prevent them. Following the model, the interplay between the risk factors negative experiences caused by daily hassles and by unexpected global and traumatic events, SMU (dimension "quality"), and SM flow can directly contribute to addictive SMU through the "vicious circle". Time spent on SMU (dimension "quantity"), symptoms of depression and anxiety, and the personality trait narcissism contribute to the circle as moderators. Symptoms of stress, insomnia, and suicide-related outcomes are described as potential consequences of addictive SMU. Based on longitudinal intervention studies, a conscious reduction of SMU time and an increase of physical activity, as well as positive mental health and mindfulness are identified as protective factors that reduce the risk of addictive tendencies. The model contributes to a better understanding of addictive SMU. Implications of the model for future research and praxis, specifically for mental health programs and therapeutic treatment are discussed.

Perceived burdensomeness, thwarted belongingness, and hopelessness as predictors of future suicidal ideation in Spanish university students

The Interpersonal Theory of Suicide (IPTS) has received support for its role in understanding suicidal thoughts and behaviors. However, few longitudinal studies have focused on testing this theory in university students. The present study aimed to confirm the theoretical model of the IPTS in a sample of 225 Spanish university students, using path analysis in a longitudinal study. We assessed thwarted belongingness and perceived burdensomeness at T1 and hopelessness and suicidal ideation at T2, 12-14 weeks later. Moreover, we assessed suicidal ideation weekly for 14 weeks. Path analyses confirmed the Interpersonal Theory of Suicide model, with thwarted belongingness and perceived burdensomeness as direct and indirect predictors of suicidal ideation through hopelessness. Providers of guidance and clinical services in university settings should be trained to identify perceived burdensomeness, social belongingness, hopelessness, and suicidal ideation when screening for suicide prevention.

A unidimensional short form of the Beck Hopelessness Scale (BHS-7) derived using item response theory

The Beck Hopelessness Scale (BHS) is the most widely used measure of hopelessness, a key psychological construct linked with various mental health outcomes. In clinical settings, the BHS has proven a reliable tool for assessing hopelessness; however, there has been debate regarding the tool's internal consistency among non-clinical populations. Most studies assessing the dimensionality of the BHS have relied on the use of classical test theory (CTT). The length of the BHS has also prompted concerns over its practicality. The BHS-9 was developed to address these critiques and formulated based on psychiatrically hospitalized adult patients. The current study investigates the dimensionality of the BHS-9 among a non-clinical sample using item response theory (Mokken scale analysis and Rasch) and CTT. The results confirm that the BHS-9 is essentially unidimensional. However, a salient finding was that Item 6 violated invariant item ordering. An exploratory factor analysis of the remaining eight items found that the items accounted for 48.05% of the variance. Further exploratory factor analyses, removing one item at a time, showed that the removal of item 18 would increase variance explained > 50%. The revised BHS-7 was found to be unidimensional and maintained strong internal consistency and criterion-related validity. This revised tool effectively captures the essence of hopelessness among a non-clinical population and presents a more refined option for the assessment of this construct.

A Psychometric Evaluation of the Interpersonal Hopelessness Scale Among Individuals With Elevated Suicide Risk

The interpersonal theory of suicide hypothesizes that suicide ideation (SI) emerges specifically in the context of hopelessness about the immutability of thwarted belongingness (TB) and perceived burdensomeness (PB; i.e., interpersonal hopelessness). The psychometrics of the Interpersonal Hopelessness Scale (IHS), which could be used to test this hypothesis directly, have not been rigorously evaluated. Participants (U.S. adults reporting past-year SI) completed online self-report assessments at Waves 1 (W1; N = 595) and 2 (W2; N = 215), 1 week apart. Confirmatory factor analyses supported a two-factor structure, IHS-TB and IHS-PB. Correlations indicated strong concurrent validity. Hurdle negative binomial regressions indicated that W1 IHS-TB and IHS-PB scores were associated with SI presence and severity at both waves, but this was inconsistent when adjusting for other W1 variables. IHS-TB and IHS-PB demonstrated excellent internal consistency and moderate to good test-retest reliability. The IHS could improve theory testing and suicide risk assessment and management.

Interpersonal Needs, Mental Pain, and Hopelessness in Psychiatric Inpatients with Suicidal Ideation

INTRODUCTION

Suicide is a leading cause of death worldwide and models may help the understanding of the phenomenon and ultimately reduce its burden through effective suicide prevention strategies. The Interpersonal Theory of Suicide and Shneidman's Model have tried to describe different unmet needs related to suicidal ideation. The study aims to assess the association between thwarted belongingness, perceived burdensomeness, and suicidal ideation in a sample of psychiatric inpatients and the mediating role of hopelessness and mental pain in this association.

METHODS

112 consecutive adult psychiatric inpatients were administered the Columbia Suicide Severity Rating Scale (C-SSRS), the Italian version of the Interpersonal Needs Questionnaire-15-I (INQ-15-I), the Physical and Psychological Pain Scale, and the Beck Hopelessness Scale (BHS).

RESULTS

Mediation models indicated a significant indirect effect of perceived burdensomeness (with thwarted belongingness as covariates) on suicidal ideation intensity with hopelessness as a mediator. When thwarted belongingness (controlling for perceived burdensomeness as a covariate) was included in a model as an independent variable, direct and indirect effects on suicidal ideation intensity were not significant.

CONCLUSIONS

Psychosocial interventions focusing on identifying and decreasing the perception of being a burden for others and the feeling hopeless could represent a powerful pathway for reducing suicidal ideation. Moreover, the attention toward unmet interpersonal needs may help increase and focus clinical discussions on risk factors, which may help engagement toward psychiatric care and downsize the stigma related to suicide. Raising awareness toward mental health topics is a goal of healthcare services globally.

Self-burdensomeness, other-burdensomeness, and suicidal ideation

Perceiving oneself as a burden to others (other-burdensomeness), as well as perceiving one's selfhood as a burden (self-burdensomeness), have been proposed as risk factors for suicidal ideation. Yet, it is unclear whether the altruistic motive of being a burden to others or the self-oriented motive of being a burden on oneself is more relevant to suicidal ideation. Given this background, two rival mediation models were tested. Data from N = 228 outpatients (64% female; age: M(SD) = 38.69 (12.27), range:17-65) undergoing psychotherapy were collected at two measurement time points over a three-month period (first measurement = T1, second measurement = T2). The significant positive association between other-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by self-burdensomeness (T1). Furthermore, the significant positive association between self-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by other-burdensomeness (T1). Results suggest that suicidal ideation can develop from both an altruistic, self-sacrificial perception of being a burden to others, as well as from a more self-oriented perception of being a burden to oneself. There is no indication that either self-burdensomeness or other-burdensomeness is a stronger indicator in the development of suicidal ideation.

The Roles of Minority Stress and Thwarted Belongingness in Suicidal Ideation among Cisgender and Transgender/Nonbinary LGBTQ+ Individuals

Rates of suicidal ideation (SI), attempts, and death by suicide are consistently elevated among persons from sexual and gender minority groups relative to the general population. Experiences of minority stress and thwarted belongingness may contribute to elevated risk, and be most pernicious among persons with multiple marginalized identities.

AIM

The present study sought to examine the relation between gender identity (cisgender vs. transgender and nonbinary individuals [TNB]) and recent SI among a convenience sample of lesbian, gay, bisexual, questioning, and queer adults.

METHODS

Participants (N = 807) completed an online survey with measures of minority stress, SI, and thwarted belongingness.

RESULTS

We tested a mediation model in which TNB identity was indirectly associated with SI via minority stress (β = 1.94, SE = 0.30, Bootstrap 95% CI = [1.39, 2.58]). We also investigated thwarted belongingness as a moderator between minority stress and SI, and found evidence of a two-way interaction (β = 0.01, SE = 0.001, p < .001). The conditional indirect effect of gender identity on SI through minority stress was higher for individuals with higher levels of thwarted belongingness (β = 0.07, SE = 0.02, Bootstrap 95% CI = [0.04, 0.11]).

CONCLUSION

Gender identity was indirectly associated with SI through minority stress and elevations in minority stress were associated with more frequent SI. The minority stress and SI association was strongest for participants reporting higher thwarted belongingness. Building and maintaining strong social support networks may be especially important for persons with intersecting gender and sexual minority identities who face minority stress.

HIGHLIGHTSTNB gender identity was indirectly associated with SI via minority stressThwarted belongingness moderated the relation between minority stress and SIThe minority stress SI relation was strongest at higher thwarted belongingness.

Examination of real-time variation in interpersonal hopelessness and suicidal desire in a college student sample reporting past-2-week suicidal ideation

INTRODUCTION

Interpersonal hopelessness (IH), as outlined in the Interpersonal Theory of Suicide, is theorized to include two correlated, distinct constructs: hopelessness about one's thwarted belongingness (IH-TB) and about perceived burdensomeness on others (IH-PB). Few studies have explored IH, and none have explored its temporal stability or prospective prediction of suicidal desire.

METHODS

Undergraduates (N = 43) selectively recruited for past-2-week suicidal ideation completed five ecological momentary assessment surveys per day for 10-days. Intraclass correlations, root mean square of successive differences, and multilevel models were used to examine the data and test relationships among predictor variables.

RESULTS

IH-TB and IH-PB demonstrated greater temporal stability than general hopelessness. IH-TB, IH-PB, and their interaction were significant predictors of suicidal desire concurrently and prospectively. IH-PB was no longer significantly predictive of suicidal desire when adjusting for general hopelessness. Post-hoc models showed that suicidal desire was not predictive of IH-TB, IH-PB, or their interaction suggesting the relationship is not recursive.

CONCLUSION

Results showed that interventions aimed at decreasing one's hopelessness specific to TB and PB may be beneficial for decreasing suicidal desire. Future research should seek to replicate these results in larger and more diverse samples and consider the use of shorter ambulatory assessment intervals.

Development and initial validation of a parent report measure of youth belongingness and burdensomeness

OBJECTIVE

The Interpersonal Theory of Suicide (ITS) implicates thwarted belongingness and perceived burdensomeness as casually related to suicide desire. The self-report Interpersonal Needs Questionnaire (INQ) is the most commonly used measure to assess belongingness and burdensomeness, including in youth. No parent-report version of the INQ exists. The current study adapted the ten-item version of the INQ (INQ-10) for parent report of youth belongingness and burdensomeness, thereby moving ITS research in youth to a multi-informant measurement approach, and examined its factor structure and convergent and concurrent validity.

METHODS

Participants were 168 clinic-referred youths ages 9-17 years (58.9% female; M_age  = 11.91) and their parents.

RESULTS

Findings supported a two-factor structure of the parent INQ. In support of convergent and concurrent validity, parent-reported belongingness and burdensomeness were significantly associated with youth-reported belongingness and burdensomeness, suicide ideation, anxiety symptoms, depressive symptoms, and impairment.

CONCLUSIONS

The current study provides initial support the INQ-parent version as a valid measure to complement youth self-reports of belongingness and burdensomeness.

An experimental investigation of the influence of loneliness on changes in belongingness and desire to escape

OBJECTIVE

Loneliness is a well-established risk factor for suicide in young adults, but the mechanisms involved are still unclear. Drawing on the Interpersonal Theory of Suicide, the Evolutionary Model of Loneliness, and Prospect Theory, we examined if high and low levels of loneliness are associated with different patterns of response to losses or gains of belongingness.

METHODS

A sample of 188 students completed the UCLA-Loneliness scale (version 3) and measures of suicide risk. Participants in the top and bottom tertiles of loneliness scores completed a computerized task designed to induce changes (gains, losses) or consistency in risk factors for suicide (belongingness, burdensomeness) over time, and examined the effect on desire to quit the task.

RESULTS

The results showed that the high loneliness group exhibited a larger magnitude of effect on desire to quit from gaining belongingness than for losing belongingness. In contrast, the low loneliness group showed a larger change in desire to quit from losing belongingness than gaining belongingness.

CONCLUSION

The findings provide preliminary experimental support for distinct profiles of suicide risk based on prevailing levels of loneliness. The findings are discussed in relation to a need for increased precision in theoretical models of suicide and loneliness.

Dynamic Regulatory Processes in the Transition From Suicidal Ideation to Action in Adults Leaving Inpatient Psychiatric Care: Protocol for an Intensive Longitudinal Study

BACKGROUND

US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life.

OBJECTIVE

This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, which are featured in most major suicide theories, will comprise a latent factor indicative of psychache (emotional pain), which will predict increases in suicidal thinking over time. Second, we hypothesize that poor inhibitory control in the context of negative affective stimuli, as well as emotion-related impulsivity, will predict the transition from suicidal thinking to suicidal behavior over time. Third, we hypothesize that short sleep duration will precede within-person increases in suicidal ideation as well as increased odds of suicidal behavior among those reporting suicidal thoughts.

METHODS

The desired sample size is 130 adults with past-week suicidal thoughts or behaviors who are receiving inpatient psychiatric treatment. Participants will complete a battery of measures while on the inpatient unit to assess negative affective experiences, emotion-related impulsivity, inhibitory control, typical sleep patterns, and relevant covariates. After discharge from inpatient care, participants will complete 4 weeks of signal-contingent ecological momentary assessment surveys, as well as mobile behavioral measures of inhibitory control, while wearing an actigraphy device that will gather objective data on sleep. Participants will complete interviews regarding suicidal thoughts and behaviors at 4 and 8 weeks after discharge.

RESULTS

The study was funded by the National Institutes of Health in November 2020. Recruitment began in April 2021. Data analysis will begin after completion of data collection.

CONCLUSIONS

This study will elucidate how affective, cognitive, and physiological risk factors contribute (or do not contribute) to within-person fluctuations in suicide risk in daily life, with important implications for extant theories of suicide. Of import, the examined risk factors are all modifiable; thus, the results will inform identification of key targets for just-in-time, flexible, personalized, digital interventions that can be used to decrease emotional distress and prevent suicide among those at highest risk.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/38582.

Adolescent Connectedness: A Scoping Review of Available Measures and Their Psychometric Properties

Introduction

Adolescent connectedness, a key component of positive youth development, is associated with various positive health outcomes. Several measures have been developed to assess this construct. However, no study has summarized data on the existing measures of adolescent connectedness. We conducted this scoping review to fill this gap. We specifically aimed to: (i) identify the existing measures of adolescent connectedness, (ii) determine the most frequently used measures among the identified measures, and (iii) summarize the psychometric properties of these measures with a keen interest in highlighting their cross-cultural utility and validity.

Methods

We searched CINAHL, Embase, PsycInfo, PubMed, and Web of Science databases for relevant articles published since database inception to 7th February 2021. Our search structure contained the key words "Adolescents", "Connectedness", and "Measures". We also searched Open Gray for potentially relevant gray literature.

Results

We identified 335 measures from 960 eligible studies assessing various domains of adolescent connectedness, including school, family, community, peer, ethnic, racial, cultural, religious/spiritual, and self-connectedness. Most of the included studies (72.1%) were from North America and Europe. Most of the measures (n = 132, 39.4%) were measures of school connectedness among adolescents. Of the identified measures, 60 of them met our criteria of frequently used measures (i.e., the top five most used measures per domain of connectedness). These frequently used measures were used across 481 of the included studies with 400 of them reporting their psychometric properties. The reported reliability of these measures was adequate (Cronbach's alpha ≥ 0.70) in 89.8% of these studies. These measures also appeared to be valid in terms of their face, content, construct, criterion, convergent, discriminant, concurrent, predictive, measurement invariance, and cross-cultural validity.

Conclusions

There exists a wide array of measures of adolescent connectedness. Sixty of these measures have been frequently used across studies and appear to be reliable and/or valid. However, this evidence is mostly from North America and Europe. This is a reflection of the limitation of this review where only studies published in English were considered. It might also reflect the paucity of research in other regions of the world. More research is needed for clearer insights.

Social isolation and suicide risk: Literature review and perspectives

Background

Suicide is a major public health problem and a cause of premature mortality. With a view to prevention, a great deal of research has been devoted to the determinants of suicide, focusing mostly on individual risk factors, particularly depression. In addition to causes intrinsic to the individual, the social environment has also been widely studied, particularly social isolation. This paper examines the social dimension of suicide etiology through a review of the literature on the relationship between suicide and social isolation.

Methods

Medline searches via PubMed and PsycINFO were conducted. The keywords were “suicid*” AND “isolation.”

Results

Of the 2,684 articles initially retrieved, 46 were included in the review.

Conclusions

Supported by proven theoretical foundations, mainly those developed by E. Durkheim and T. Joiner, a large majority of the articles included endorse the idea of a causal relationship between social isolation and suicide, and conversely, a protective effect of social support against suicide. Moreover, the association between suicide and social isolation is subject to variations related to age, gender, psychopathology, and specific circumstances. The social etiology of suicide has implications for intervention and future research.

Association of chronic diseases and lifestyle factors with suicidal ideation among adults aged 18-69 years in Eswatini: evidence from a population-based survey

Background

How chronic diseases and lifestyle affect suicidal ideation in the sub-Saharan region remains unclear. We investigated the association of chronic diseases and lifestyle with suicidal ideation in the past year and the potential modifying role of sociodemographic status on this association. The findings can guide suicide prevention interventions.

Methods

We analyzed 3026 respondents from the World Health Organization STEPwise approach to noncommunicable disease risk factor surveillance conducted in Eswatini in 2014. The outcome was past-year suicidal ideation, and the main predictors were chronic diseases and lifestyle. Multiple logistic regression was used to estimate predictors, and subgroup analysis was performed to assess effect modification.

Results

The prevalence of past-year suicidal ideation was 9.9%. After adjustment for covariates, including sex, marital status, employment status, and education level, individuals aged 18–30 years (adjusted odds ratio [aOR]: 2.27, 95% confidence interval [CI]: 1.22–4.22) were more likely to have had past-year suicidal ideation than those aged 45–69 years. After adjustment for covariates among employed individuals, having high blood pressure (aOR: 3.38, 95% CI: 1.54–7.40), not exercising (aOR: 2.65, 95% CI: 1.09–6.39), drinking alcohol (aOR: 2.40, 95% CI: 1.14–5.05), being aged 18–30 years (aOR: 3.50, 95% CI: 1.01–12.1), and being exposed to threats (aOR: 2.37, 95% CI: 1.01–5.53) were significantly associated with past-year suicidal ideation.

Conclusions

Among currently employed individuals, having high blood pressure, not exercising, and drinking alcohol were associated with past-year suicidal ideation. The findings highlight the importance of developing and strengthening systems for early identification of suicidal ideation risk.

Dynamic associations between interpersonal needs and suicidal ideation in a sample of individuals with eating disorders

BACKGROUND

Over half of individuals with eating disorders experience suicidal ideation at some point in their lives, yet few longitudinal studies have examined predictors of ideation in this at-risk group. Moreover, prospective research has focused on relatively distal or trait-level factors that are informative for distinguishing who is most at risk but not when. Little is known about more proximal or state-level risk factors that fluctuate within an individual, which is critical for determining when a person is most likely to engage in suicidal behaviors.

METHODS

Women (N = 97) receiving treatment for their eating disorder completed questionnaires weekly to assess suicidal ideation and interpersonal constructs (i.e. perceived burdensomeness, thwarted belongingness) theorized to be proximal predictors of suicidal desire. Longitudinal multilevel models were conducted to examine both within- and between-person predictors of suicidal ideation across 12 weeks of treatment.

RESULTS

Statistically significant within-person effects for burdensomeness (β = 0.06; p < 0.001) indicate that when individuals have greater feelings of burdensomeness compared to their own average, they also experience higher suicidal ideation. We did not find any significant influence of thwarted belongingness or the interaction between burdensomeness and belongingness on suicidal ideation.

CONCLUSIONS

This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results are only partially consistent with the Interpersonal Theory of Suicide and suggest that short-term changes in burdensomeness may impact suicidal behavior in individuals with eating disorders.

Predicting suicidal ideation in a longitudinal high-risk sample: Multilevel analyses and 12-month trajectories

BACKGROUND

The Interpersonal Theory of Suicide states that suicidal ideation (SI) results from perceived burdensomeness (PB) and thwarted belongingness (TB). Cross-sectional studies found associations with SI. This study examined the prospective prediction of SI.

METHODS

Three hundred and eight inpatients reporting severe SI or a recent suicide attempt were assessed four times within 12 months. The prediction of SI was examined using multilevel analyses, group comparisons, and logistic regression analyses.

RESULTS

Cross-sectionally, PB and TB were associated with SI. Prospectively, neither PB nor TB predicted SI. We found no autocorrelation of SI over time. Patients with persistent and fluctuating SI reported higher PB at T0. PB predicted the persistence of SI over 12 months.

CONCLUSION

Results emphasize cross-sectional associations between PB, TB, and SI. PB and TB could not predict the intensity of SI over time. SI did not predict itself over time. PB was associated with a persistent trajectory of SI over 12 months.

A direct comparison of theory-driven and machine learning prediction of suicide: A meta-analysis

Theoretically-driven models of suicide have long guided suicidology; however, an approach employing machine learning models has recently emerged in the field. Some have suggested that machine learning models yield improved prediction as compared to theoretical approaches, but to date, this has not been investigated in a systematic manner. The present work directly compares widely researched theories of suicide (i.e., BioSocial, Biological, Ideation-to-Action, and Hopelessness Theories) to machine learning models, comparing the accuracy between the two differing approaches. We conducted literature searches using PubMed, PsycINFO, and Google Scholar, gathering effect sizes from theoretically-relevant constructs and machine learning models. Eligible studies were longitudinal research articles that predicted suicide ideation, attempts, or death published prior to May 1, 2020. 124 studies met inclusion criteria, corresponding to 330 effect sizes. Theoretically-driven models demonstrated suboptimal prediction of ideation (wOR = 2.87; 95% CI, 2.65-3.09; k = 87), attempts (wOR = 1.43; 95% CI, 1.34-1.51; k = 98), and death (wOR = 1.08; 95% CI, 1.01-1.15; k = 78). Generally, Ideation-to-Action (wOR = 2.41, 95% CI = 2.21-2.64, k = 60) outperformed Hopelessness (wOR = 1.83, 95% CI 1.71-1.96, k = 98), Biological (wOR = 1.04; 95% CI .97-1.11, k = 100), and BioSocial (wOR = 1.32, 95% CI 1.11-1.58, k = 6) theories. Machine learning provided superior prediction of ideation (wOR = 13.84; 95% CI, 11.95-16.03; k = 33), attempts (wOR = 99.01; 95% CI, 68.10-142.54; k = 27), and death (wOR = 17.29; 95% CI, 12.85-23.27; k = 7). Findings from our study indicated that across all theoretically-driven models, prediction of suicide-related outcomes was suboptimal. Notably, among theories of suicide, theories within the Ideation-to-Action framework provided the most accurate prediction of suicide-related outcomes. When compared to theoretically-driven models, machine learning models provided superior prediction of suicide ideation, attempts, and death.

Perceived burdensomeness is a curvilinear, short-term predictor of suicide ideation in a community sample of adults

OBJECTIVE

Our primary aim was to test the Interpersonal Theory of Suicide's synergy hypothesis (i.e., the interaction between perceived burdensomeness and thwarted belongingness) in the proximal prediction of suicide ideation, while accounting for quadratic effects.

METHOD

We used MTurk to recruit participants (N = 478) with a lifetime history of suicidal thoughts and behaviors; they completed two batteries of self-report questionnaires three days apart.

RESULTS

Contrary to the synergy hypothesis, only suicide ideation and the quadratic effect of perceived burdensomeness at Time 1 were significant predictors of suicide ideation at Time 2. The quadratic effect of perceived burdensomeness indicated a u-shaped function, whereby scores at or above the 80^th percentile on perceived burdensomeness at Time 1 had increasingly strong, positive associations with suicide ideation at Time 2, while scores under the 80^th percentile were not predictive of suicide ideation at Time 2. Also, thwarted belongingness and suicide ideation at Time 1 were significant predictors of perceived burdensomeness at Time 2.

CONCLUSIONS

These findings add to a growing literature that does not support the synergy hypothesis and suggests the importance of including nonlinear terms when examining the Interpersonal Theory of Suicide's constructs.

Perceived burdensomeness and thwarted belongingness influence the childhood polyvictimization and suicide ideation association among Hispanic undergraduates

The present study examined the mediating effect of perceived burdensomeness (PB) and thwarted belongingness (TB) in the association between childhood polyvictimization and suicide ideation (past week) among 528 Hispanic college students. Nearly 10% reported polyvictimization, 19.8% had suicide ideation, and polyvictimization was a risk factor of suicide ideation through PB and TB. The indirect effect through PB was stronger than the indirect effect through TB. Interventions should focus on PB and TB to alleviate suicide ideation among Hispanic undergraduate students.

Interpersonal theory of suicide: prospective examination

BACKGROUND

The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies.

AIMS

To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design.

METHOD

Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18-81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted.

RESULTS

The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59-3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01).

CONCLUSIONS

The results challenge the theoretical validity of the IPTS and its clinical utility - at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.

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.

Suicide-related interpersonal needs of young Iranian people: A preliminary validation of thwarted belongingness and perceived burdensomeness constructs

The aim of the current study was to validate the Interpersonal Needs Questionnaire (INQ-15) and to test its reliability in Persian-speaking Iranian undergraduate students. In this cross-sectional study, 485 undergraduate students (age: 20.66 ± 1.42, 60% female) were assessed on the two subscales of perceived burdensomeness (PB) and thwarted belongingness (TB) and the Suicide Behavior Questionnaire-Revised (SBQ-R). Exploratory structural equation modelling (ESEM) confirmed the construct validity of INQ-14, excluding INQ#9. In addition, INQ#8, articulated in an equivalent Persian phrasing, loaded well on TB. The measurement model tested by confirmatory factor analysis (CFA) suggested INQ#11 to be eliminated, resulting in INQ-13-P to consist of PB and TB-7. The internal consistency and convergent/discriminant validity were established. The concurrent validity of PB was solidly established in terms of past year suicidal ideation (PY-SI) above and beyond anxiety, depression, prior suicidality, and TB-7. The effect of PB on PY-SI was stronger, where prior suicidality had already occurred or the perceived likelihood of future suicide (PLFS) was high. Moreover, TB-7 could only indicate PY-SI, where prior suicidality had already occurred or PLFS was high, albeit when PB was omitted. The interaction term was significant; however, beyond anxiety and depression, the effect of TB-7 on PY-SI was significant where PB was very high (n = 40, 8.25%). Therefore, future studies can utilize INQ-13-P as a valid and reliable instrument in Persian-speaking populations. However, further studies should examine the construct validity of TB and its relationship with suicide ideation in different populations.

Emotion Regulation as a Risk Factor for Suicide Ideation among Adolescents and Young Adults: The Mediating Role of Belongingness

Thwarted belongingness is an established predictor of suicide ideation. Emerging theory suggests belongingness may be a crucial pathway through which risk factors such as dysfunctional emotion regulation influence suicide ideation. This study examined whether belongingness mediated the relationship between emotion regulation and suicide ideation in young people (16-25 years). Participants (n = 1699; 63.6% females, M = 20.24 years, SD = 2.45 years) completed measures of these constructs, including the emotion regulation domains of internal-functional, internal-dysfunctional, external-functional, and external-dysfunctional. Belongingness mediated over half of the association between three emotion regulation domains and suicide ideation (internal-functional: 55.6%, internal-dysfunctional: 54.1%, and external-functional: 64.8%). Consistent with current etiological suicidality models, results suggest low belongingness is an important precursor to suicide ideation in young people, and that there is an inter-relationship between emotional regulation styles and belongingness.

Exposure to Suicide in the Family: Suicidal Ideation and Unmet Interpersonal Needs in Young Adults Who Have Lost a Family Member by Suicide

The aims of the present study were to compare a sample of individuals exposed to suicide in their families with a control group, on suicidal ideation, and to test possible potentiating effects for unmet interpersonal needs. Three hundred eighty-six young Portuguese adults participated. Two groups were defined: a group exposed to suicide in the family (n = 38) and a control group (n = 335). Groups differed significantly on suicidal ideation, on depressive symptoms, and on perceived burdensomeness and tended to differ on thwarted belongingness. Results from a hierarchical multiple regression analysis demonstrated that having lost a family member by suicide and perceived burdensomeness each provided a significant unique contribution to explaining variance in suicidal ideation when controlling for levels of depressive symptoms and having had a psychiatric diagnosis. The interaction between group membership and perceived burdensomeness provided a further enhancement to the statistical prediction of suicidal ideation.