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• The full Interpersonal Theory of Suicide (ITPS) has yet to be empirically tested. • However, the ITPS provides explanation, clinical utility, and predictive validity. • The IPTS may be intensified by non-humanness, lack of agency, and discrimination. • Minoritized people may benefit by integrating the IPTS and Minority Stress Theory. In this state-of-the-science review, we summarize the key constructs and concepts within the interpersonal theory of suicide. The state of the scientific evidence regarding the theory is equivocal, and we explore the reasons for and some consequences of that equivocal state. Our particular philosophy of science includes criteria such as explanatory reach and pragmatic utility, among others, in addition to the important criterion of predictive validity. Across criteria, the interpersonal theory fares reasonably well, but it is also true that it struggles somewhat—as does every other theory of suicidality—with stringent versions of predictive validity. We explore in some depth the implications of the theory and its status regarding people who are minoritized. Some implications and future directions for research are also presented. [ABSTRACT FROM AUTHOR]

Within the framework of the interpersonal theory of suicide, parent-child conflict in adolescence may be associated with suicidal ideation through increases in thwarted interpersonal needs (i.e., perceived burdensomeness and thwarted belongingness). Familism, a cultural value that emphasizes prioritizing familial interconnectedness and honor, may moderate the association between parent-child conflict and thwarted interpersonal needs. This study examined the relationship between parent-child conflict, familism, and suicidal ideation through the interpersonal theory of suicide. Participants were N = 250 psychiatrically hospitalized adolescents aged 12–17 years (Mage = 14.84, 60.8% female; 41.9% Hispanic, 21.5% African American/Black, 26.0% Caucasian). Participants completed survey and interview measures prior to discharge from psychiatric hospitalization. There was a significant conditional indirect effect of parent-child conflict on suicidal ideation through thwarted interpersonal needs [F (3, 246) = 54.41, p <.01], such that the strength of the indirect effects family conflict on suicidal ideation via thwarted interpersonal needs increased as familism increased. Findings indicate that the relationship between parent-child conflict and thwarted interpersonal needs may be exacerbated when levels of familism are also high. For youth who endorse high levels of familism, parent-child conflict may be particularly pernicious. Interventions targeting the family environment are needed to potentially improve adolescents' interpersonal functioning and protect against suicidal ideation. Plain language summary: Child and adolescent suicide is a growing and pressing problem, and it is currently the second leading cause of death among people aged 10–34. One theory of suicide, called the interpersonal theory of suicide, proposes that suicide ideation is related to two main risk factors: feeling that one's life is a burden on others (called perceived burdensomeness) and feeling like one is disconnected from others (called thwarted belongingness). In this theory, risk factors like parent-child conflict may be related to suicide ideation through increases in perceived burdensomeness and thwarted belongingness. It is possible that cultural values that prioritize family connectedness and honor (called familism) may also impact these relationships. The current study looked at how parent-child conflict, familism, and adolescent suicide ideation were related to one another in the context of the interpersonal theory of suicide. Participants in the study were 250 adolescents in a psychiatric hospital who completed survey and interview measures before being discharged. Results found parent-child conflict was related to suicide ideation through increases in one's perceived burdensomeness and thwarted belongingness (higher parent-child conflict was related to higher ratings of perceived burdensomeness and thwarted belongingness, which was related to higher ratings of suicide ideation), and the strength of the relationship between parent-child conflict, perceived burdensomeness, and thwarted belongingness increased as ratings of familism increased. These results indicate that parent-child conflict may have an especially strong relationship with thoughts of suicide in adolescents who also report a high level of familism. Therefore, suicide-related interventions that target the family environment may help prevent and treat adolescent suicide ideation. [ABSTRACT FROM AUTHOR]

The present study tested a model of suicidal thoughts among bisexual women focusing on sexual violence, bisexual minority stress, and risk factors for suicide identified within the interpersonal theory of suicide (i.e., perceived burdensomeness and thwarted belongingness). The model was tested using cross-sectional, baseline data and longitudinally using 3- and 6-month follow-up assessments in a sample of bisexual women (N = 393, 98.3% cisgender, ages 18–35). Using structural equation modeling, we tested a serial mediation model predicting recent suicidal thoughts related to sexual violence and antibisexual stigma via internalized binegativity and expectations of rejection and subsequent perceived burdensomeness and thwarted belongingness. Findings suggest that bisexual minority stress and child/adolescent sexual abuse relate to suicidal thoughts among bisexual women. In the cross-sectional model, the hypothesized serial links between antibisexual stigma and concurrent suicidal thoughts via expectations of rejection and internalized binegativity and subsequent perceived burdensomeness were significant. These paths were not significant in prospective analyses. Child/adolescent sexual abuse (but not adult sexual assault) related to suicidal thoughts via perceived burdensomeness; these paths were not significant in prospective analyses. It appears important to address both universal (i.e., perceived burdensomeness) and group-specific (i.e., expectations of rejection and internalized binegativity) mechanisms of risk in suicide prevention efforts with young bisexual women. Public Significance Statement: Bisexual women who experience greater antibisexual stigma (e.g., negative stereotypes, rejection) may have higher concurrent suicidal thoughts due to internalized bisexual stigma and related feelings of perceived burdensomeness (e.g., self-hatred, feeling like a liability to others). Bisexual women with histories of child/adolescent sexual abuse may also be at risk for suicidal thoughts due to burdensomeness. Results highlight the need for interventions that address unmet interpersonal needs as well as programming and social policy aimed at preventing sexual violence and eliminating antibisexual stigma within the broader society. [ABSTRACT FROM AUTHOR]

Understanding the mechanisms of suicidal behavior is a prerequisite for suicide prevention and intervention. The current study aims to propose and verify the utility of pre-suicidal attempt as an intermediate type in the transition from suicidal ideation to suicidal attempt within the ideation-to-action framework. A sample of 1084 college students completed a measurement package consisting of suicide history, suicide risk factors, and demographic information. Stratified stepwise multiple regression models and mediated moderation models were used to examine the relationship among the variables. Pre-suicidal attempts rather than suicidal ideation are predictive of suicide attempts. Age, depression, thwarted belongingness, fearlessness about death, perceived burdensomeness and suicidal ideation were predictors of pre-suicidal attempts. Supporting the interpersonal theory of suicide, pre-suicidal attempts mediated the relationship between suicidal ideation and suicidal attempts and were positively moderated by pain tolerance and fearlessness about death. The pre-suicidal attempters scored higher on fearlessness about death and suicide risk than the ideators, while pre-suicidal attempters scored significantly lower on suicide risk than suicide attempters. As an independent intermediate type within the ideation-to-action framework, pre-suicidal attempts contribute to deepen the understanding of the intermediate transition from suicidal ideation to suicidal attempts. • We propose a novel "pre-suicidal attempt" to cover the series of preparatory actions that precede a suicidal attempt. • Depression, thwarted belongingness, fearlessness about death, perceived burdensomeness and suicidal ideation were predictors of pre-suicidal attempts. • Pre-suicidal attempts mediated the relationship between suicidal ideation and suicidal attempts and were positively moderated by pain tolerance and fearlessness about death. • The pre-suicidal attempters scored higher on fearlessness about death and suicide risk than the ideators, while pre-suicidal attempters scored significantly lower in suicide risk than suicide attempters. • Pre-suicidal attempts focus on the ambiguous areas of the Ideation-to-action framework, helping to provide insight into the mechanisms of transition from suicidal ideation to suicidal behavior and contributing to the development of the framework. [ABSTRACT FROM AUTHOR]

The relationship between suicide ideation (SI) and distress tolerance (DT) is characterized by inconclusive results. The current study aimed to test the association between tolerance for interpersonal distress and SI in light of the Interpersonal-Psychological Theory of Suicide. 194 participants ranging in SI severity were recruited via Amazon Mechanical Turk and completed a cognitive distress task (Distress Tolerance Task) and an interpersonal distress task (CyberBall) to assess (1) the association between SI severity and persistence with the tasks, and (2) self-reported psychological distress associated with the tasks. A series of multilevel model analyses showed that increased SI predicted greater persistence with the interpersonal-distress task versus the cognitive distress task. In addition, higher SI predicted more distress during the interpersonal task. Individuals with higher SI levels demonstrated a greater capability to persist with the interpersonal distress, despite feeling psychologically worse. These findings further support the central role of interpersonal needs in SI by emphasizing the importance of operationalizing DT in a manner that is relevant to suicide desire. SI is associated with persisting longer in interpersonally distressing situations. SI is also associated with higher levels of distress following social exclusion. In SI research the specific type of distress needs to be accurately operationalized. [ABSTRACT FROM AUTHOR]

Active service members and Veterans with a combat-related traumatic brain injury (TBI) are four times more likely to attempt suicide than those without a TBI. TBIs are the signature injuries of the Post-9/11 conflicts and Combat Veterans (i.e., current and former service members who deployed in support of a combat mission) with these injuries are entitled to receive the Purple Heart medal. However, potentially tens of thousands of Combat Veterans did not receive, or were denied the Purple Heart during the first decade of the Global War on Terrorism because a TBI was not documented during the deployment. To our knowledge, this is the first study to explore the meaning of the Purple Heart and examine the impact of the Purple Heart on Army Combat Veterans with a combat-related TBI. Findings from this mixed methods study revealed that not receiving the Purple Heart is associated with increased suicide risk and lower quality of life after a brain injury. Additionally, thwarted belongingness, perceived burdensomeness, and perceived military institutional betrayal are associated with increased suicide risk in Army Combat Veterans with a TBI. This mixed methods study provides important insights into how Army culture is perceived and the power of the Purple Heart among this high-risk group of Combat Veterans. [ABSTRACT FROM AUTHOR]

Background: Low self-esteem and self-burdensomeness have been proposed as risk factors for suicidal ideation. Yet, self-burdensomeness may be more relevant to suicidal ideation than low self-esteem. The purpose of the present study was to investigate the association between self-esteem, self-burdensomeness, and suicidal ideation in a sample of adult outpatients. Methods: Data from N = 202 patients (66.3% female; age: M[SD] = 39.87 [13.31], range: 19–73) who started therapy at an outpatient clinic were collected. A subsample of n = 111 patients (68.5% female; age: M[SD] = 38.50 [13.48], range: 20–73) also took part in a second assessment three-months later. Results: Self-burdensomeness was shown to predict suicidal ideation concurrently and prospectively – after controlling for age, gender, depression, and self-esteem. Furthermore, self-burdensomeness completely mediated the association between self-esteem and suicidal ideation. However, the reverse relationship, where the association between self-burdensomeness and suicidal ideation is mediated by self-esteem, was not supported. Conclusions: Self-burdensomeness might be understood as a driver of suicidal ideation. Findings point to the possibility that a focus on self-burdensomeness and/or low self-esteem might be relevant in the treatment of suicidal patients. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Perceived responsiveness, or the extent to which one feels understood, validated and cared for by close others, plays a crucial role in people's well‐being. Can this interpersonal process also protect people at risk? We assessed whether fluctuations in suicidal ideation were associated with fluctuations in the degree of perceived responsiveness that psychiatric patients (admitted in the context of suicide or indicating suicidal ideation) experienced in daily interactions immediately after discharge.Fifty‐seven patients reported on suicidal ideation (5 times a day) and perceived responsiveness (daily) for four consecutive weeks. The effects of established risk factors—thwarted belongingness, perceived burdensomeness, and hopelessness—were assessed as well.The more patients felt that close others had been responsive to them, the less suicidal ideation they reported. At low levels of thwarted belongingness, perceived burdensomeness, or hopelessness, perceived responsiveness seemed to play a protective role, negatively co‐occurring with suicidal ideation. When thwarted belongingness, perceived burdensomeness, and hopelessness were high, perceived responsiveness did not have an effect.Perceived responsiveness could be a protective factor for suicidal ideation for people at risk only when they are experiencing low levels of negative perceptions. When experiencing highly negative perceptions, however, perceived responsiveness seems to matter less. [ABSTRACT FROM AUTHOR]

Objective: The Interpersonal Theory of Suicide (ITS) could help identify differences in groups of suicidal adolescents and inform treatment. Method: Latent Profile Analysis (LPA) using thwarted belongingness (TB), perceived burdensomeness (PB), hopelessness, and capability was conducted on data from an at‐risk clinical sample (N = 500). The ITS prediction that changes in TB and PB are associated with changes in suicidal ideation was tested using admission and discharge data. Results: Latent Profile Analysis identified three profiles with increasing complexity and severity on ITS factors. The profiles were labelled low‐severity (7.6% of participants), moderate‐severity (45.2%), and high‐severity (47.2%). ITS predictions were partially supported for the full sample and only for the high‐severity and moderate‐severity subgroups, whereby changes in TB were significantly associated with changes in suicidal ideation over the course of treatment. However, changes in PB were only significant in the moderate‐severity subgroup, and none of the ITS predictions were supported in the low‐severity subgroup. Additionally, effect sizes for changes in TB and PB were modest in all analyses. Conclusions: Our findings highlight the importance reducing low belongingness in youth, which is a component of all supported interventions of youth suicide prevention. However, given the modest association of changes in ITS variables had with changes in suicidal ideation, it may be fruitful to elaborate on the relative importance on types of low belongingness or include other non‐ITS variables. [ABSTRACT FROM AUTHOR]

Joiner and colleagues' Interpersonal Theory of Suicide (IPTS), a prominent "desire-capability" model of suicide—based on the common-sense idea that people take their own lives because they want to, and can—is critiqued from a biological perspective. Tinbergen's ethological "four questions" guide the analysis: evolution, survival value, ontogeny, and proximate causation, each addressing a different aspect of biological understanding. Problems for IPTS emerge with all four. As a parsimonious solution, the desire-capability hypothesis is reconceived as an ultimate, instead of proximate, mode of explanation. By this light, desire and capability for suicide combined in our species' ancestral past, thus making suicide a recurrent survival threat, and driving the evolution of special-purpose defensive adaptations. This stance tallies with the pain-brain theory of the evolution of suicide, and with Joiner and colleagues' own investigation into organismic anti-suicide defenses, which appears to conflict conceptually with IPTS. These defenses' evolved algorithm may make suicide an intrinsically aleatory phenomenon, opaque to usefully accurate prediction. Positive implications for prevention and research are proposed. [ABSTRACT FROM AUTHOR]

This integrative review expands on the work of Kramer et al. (2020), by reviewing studies that utilized the Interpersonal Needs Questionnaire (INQ) to examine the interpersonal constructs (thwarted belongingness and perceived burdensomeness) of the Interpersonal Theory of Suicide (ITS) to understand suicidal thoughts and behaviors among service members and Veterans with combat experience. Very few studies (n = 9) in the literature were identified, however important relationships were revealed between combat exposure/experiences, thwarted belongingness, perceived burdensomeness, and suicidal thoughts and behaviors among military samples. Studies also reported risk factors for high levels of thwarted belongingness or perceived burdensomeness in military samples, such as moral injuries, betrayal, and aggression. This review highlights the utility of the INQ to measure ITS constructs among Post-9/11 U.S. Combat Veterans. [ABSTRACT FROM AUTHOR]

People with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder) are at increased risk of suicidal ideation (SI). Over-attribution of social threat, or attributing threatening emotions to neutral faces, may contribute to social isolation through increased social avoidance and decreased social approach motivation. These factors are related to suicide, as well as perceived burdensomeness (PB) and thwarted belongingness (TB). This study examined how over-attribution of threat relates to PB, TB, and social motivations. N = 273 participants with SMI were assessed for current SI and behavior, and were stratified into SI (N = 130) vs. non-SI (N = 143) groups. Participants completed smartphone surveys (via ecological momentary assessments [EMA]) 3×/day for 10 days. They also completed the Mobile Ecological Test of Emotion Recognition (METER) 1×/day. Linear mixed models and multi-level mediation tested the relationships between over-attribution of threat, METER performance, PB/TB, and social motivations. Participants with and without SI did not significantly differ in over-attribution of threat or METER performance. In separate models, there was a relationship of over-attribution of threat with increased PB (B = 1.00, SE = 0.21, t = 4.72, p <.001), reduced social approach motivation (B = -0.74, SE = 0.22, t = −3.33, p <.001), and increased social avoidance (B = 0.90, SE = 0.24, t = 3.70, p <.001), all significant when adjusting for facial affect recognition ability. A model examining social motivations as a mediator between over-attribution of threat and PB/TB was not significant. These results suggest that over-attribution of threat relates to interpersonal constructs related to SI irrespective of facial affect abilities. This study may inform understanding of social cognitive processes related to suicide in SMI. [ABSTRACT FROM AUTHOR]

Suicide is the leading cause of death in America's jails and the rate of suicide is nearly three times higher in jails than in prisons or the general public. Fatal suicides represent a small proportion of individuals who threaten or attempt suicide while incarcerated, or otherwise engage in serious self-harm. Yet, there is little research to date on the risk factors for jail detainees engaging in suicidal and/or self-harm behavior while incarcerated. Using logistic regression, we examine the risks factors for attempting and threatening suicide and/or self-harm during incarceration using a mixed-sex sample of 736 individuals incarcerated in a large metropolitan jail in the Midwest using the lens of the Interpersonal Theory of Suicide (ITS). We found support for ITS, as individuals with higher perceived burdensomeness and thwarted belongingness were more likely to attempt and/or threaten suicide and self-harm. Among the measures that proxied the belongingness-burdensomeness construct – mental health issues, drug dependence, direct and indirect victimization in jail, and psychological distress – were all associated with higher odds of threatening or attempting suicide and self-harm. We discuss the need for future research on suicidality and serious self-harm in jail, as well as recommendations for managing those most at-risk. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: To explore the association between Internet addiction and suicide ideation, we introduced the Interpersonal Theory of Suicide as a potential model to understand Internet addiction and suicidality. In addition, we intended to identify differences between genders and between subgroups of soldier and student in this association. Methods: We conducted a cross-sectional survey study of 661 participants, comprising military personnel (n = 399, 60.36%) and college students (n = 262, 39.64%). Several copies of anonymous questionnaire were used to assess variables, including Internet addiction, anxiety, depression, perceived burdensomeness, thwarted belongingness, acquired capability for suicide, and suicide ideation. Results: We found that 18% of participants (119 out of 661) met the criteria for Internet addiction. Internet addiction was significantly associated with higher anxiety (p < 0.001), significantly more severe depression (p < 0.001), significantly more perceived burdensomeness (p < 0.001), and significantly more perceived suicidal ideation (p < 0.001). Significant differences in study participants existed in genders (p < 0.001) and between the soldier and student groups (p < 0.001). In regression analyses, we found general associations between specific facets of Internet addiction, for example, compulsive use, and components of the interpersonal theory and thwarted belongingness of suicide. Conclusion: Internet addiction is linked to worse mental health and suicidality. Understanding the connections between Internet addiction and models such as the Interpersonal Theory of Suicide can inform prevention and treatment approaches for vulnerable groups.

Introduction Method Results Conclusion Guided by Opara et al.'s (2022), Integrated Model of the Interpersonal Psychological Theory of Suicide and Intersectionality Theory, the current study examined contextual stressors experienced disparately by Black youth (racial discrimination, poverty, and community violence) as moderators of the association between individual motivating factors for suicidal thoughts and behaviors (perceived burdensomeness, thwarted belongingness, and hopelessness) and active suicidal ideation.Participants were 457 Black adolescent boys (mean age = 15.31, SD = 1.26) who completed self‐report surveys.As predicted, the association between perceived burdensomeness and active suicidal ideation was significantly moderated by economic stress. In addition, the association between peer belongingness and suicidal ideation was significantly moderated by racial discrimination, but there were no moderating effects for school belongingness. Finally, the association between hopelessness and suicidal ideation was significantly moderated by both racial discrimination and witnessing community violence.These findings highlight the need for research, interventions, and policy work devoted to using integrated approaches of individual and socioeconomically relevant patterns of suicidal thoughts and behaviors to support Black youth exposed to various forms of structural oppression. [ABSTRACT FROM AUTHOR]

We lack knowledge about the short-term predictors of suicide attempts (SAs) among treatment-seeking individuals. The current study evaluated whether (a) interpersonal difficulties, hopelessness, and affective states are associated with an increased risk of SAs on the same and the next day; (b) these daily states are interconnected differently over time among inpatients who attempt suicide compared to those who do not. In total, 110 psychiatric inpatients who attempted suicide during their stay at a psychiatric hospital self-reported their suicidal ideation, negative affect, positive affect, wish to live, interpersonal needs, and hopelessness each day (3,018 daily reports). Multilevel structural equation modeling was used to examine same-day and next-day predictors of SAs. Multilevel temporal network models assessed interconnectedness between daily predictors and were compared to network models from a matched sample of 110 psychiatric inpatients who did not attempt suicide. In multivariate models, increases in perceived burdensomeness were significantly associated with same-day SAs, whereas increased hopelessness was associated with next-day SAs. Network models for patients who attempted suicide indicated that hopelessness and suicidal ideation were central to change, leading to next-day deteriorations in mental health. In subsequent models, feeling calm and relaxed, and feeling fresh and rested were centrally connected to other variables. The centrality of these metrics tended to be higher than in the network models for patients who did not attempt suicide, suggesting differences in the interplay between risk and protective factors. This study suggests routinely monitoring interpersonal factors and hopelessness may help identify increased short-term risk of SAs among psychiatric inpatients. General Scientific Summary: Daily fluctuations in cognitive–affective states, such as interpersonal difficulties and hopelessness, may signal short-term risk for suicide attempts beyond reported levels of suicidal ideation. Hopelessness in particular exhibits high interconnectedness with other risk factors, potentially making it an effective target for interventions. [ABSTRACT FROM AUTHOR]

Introduction: Suicide capability is posited to facilitate the movement from ideation‐to‐action. Emerging evidence suggests capability comprises both trait‐ and state‐like facets. This study examined fluctuations in and associations of acquired, dispositional, practical, and perceived capabilities, and suicidal mental imagery, and suicidal ideation. Method: Seventy‐five adults (48 females, Mage = 36.53 years) with lived experience of suicidal ideation and/or attempt responded to four prompts per day for 2 weeks that assessed suicide capability and suicidal ideation. Mean‐squared successive differences and probability of acute change indices and multilevel models were used for analyses. Results: All facets of suicide capability fluctuated. Acquired and dispositional capabilities were trait‐like, with practical and perceived capabilities being state‐like. Suicidal mental imagery was the only facet of suicide capability that distinguished participants with a suicide attempt in the past 12 months from participants with a suicide attempt more than 1 year ago and suicide ideators. Suicidal mental imagery was associated with concurrent suicidal ideation and predictive of next assessment suicidal ideation. Conclusion: Suicidal mental imagery may be uniquely associated with suicide capability. This study suggests there are trait‐ and state‐like facets of capability that can combine to potentially ready an individual to engage in suicidal behaviors. [ABSTRACT FROM AUTHOR]

Differences in how impulsivity is conceptualized, along with a myopic focus on impulsivity's relationship with historical suicidal behaviors, have resulted in limited implications made from prior research regarding impulsivity and suicidal thoughts and behaviors. The current study investigated the indirect effect facets of impulsivity may have on suicidal ideation, specifically, through thwarted interpersonal needs. Participants were N = 424 undergraduate students who completed a cross-sectional survey. Participants completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Impulsive Behavior Scale (UPPS), the Adult Suicide Ideation Questionnaire (ASIQ), and the Interpersonal Needs Questionnaire (INQ). Parallel mediation models were run to examine the relation between facets of impulsivity, perceived burdensomeness, thwarted belongingness, and suicidal ideation. Thwarted belonginess and perceived burdensomeness significantly accounted for the variance in the relation between negative urgency and suicidal ideation. Neither thwarted belongingness nor perceived burdensomeness significantly explained variance in the relation between (lack of) premeditation and suicidal ideation. Conversely, perceived burdensomeness and thwarted belonginess significantly explained the inverse relation between sensation seeking and suicidal ideation (i.e., greater sensation seeking was related to lower perceived burdensomeness and thwarted belongingness and in turn lower suicidal ideation). Negative urgency, in particular, is related to suicidal ideation through thwarted interpersonal needs. Future research should continue to differentiate between various types of impulsivity and its relationship with both suicidal ideation and behaviors utilizing both cross-sectional and ambulatory assessments of these constructs. Negative urgency is related to suicidal ideation. Negative urgency is related to thwarted interpersonal needs. Thwarted interpersonal needs partially explain the relation between negative urgency and suicidal ideation. [ABSTRACT FROM AUTHOR]

In this article we frame the crisis of Black transgender and gender-nonconforming (TGNC) youth suicide in the context of interpersonal theory of suicide, intersectionality theory, postmodern therapeutic approaches, and critical suicidology in promoting liberatory care. The constructs of each theory are illuminated by a case study that explores the narrative of a Black trans femme teen as she navigates mental health treatment after a suicide attempt. Opportunities for clinician learning, advocacy, and best practice are discussed. Practical resources are provided in case excerpts to enhance clinicians' understanding of topics such as gender-affirming care, respectful language, and intersections of anti-Black racism and transphobia. We close with a discussion of future directions for skill development and cultural humility in novice and seasoned providers working with this community. [ABSTRACT FROM AUTHOR]

Background: When compared to social drinkers, high levels of suicidal ideation have been observed in both heavy alcohol consumers and abstainers. Heavy alcohol use or abstention may indicate different risk pathways to the development of suicidal ideation (SI). Methods: Visitors to a mental health website (N = 1,561) completed a survey, and latent profile analysis (LPA) was used to explore differences in risk factor patterns. Risk factors explored included psychological distress, help-seeking intent, financial wellbeing, thwarted belongingness and perceived burdensomeness. Results: Most participants (75.1%) reported SI in the past four weeks. A three-class LPA model emerged as the optimal fit: (1) low SI/lower alcohol; (2) high SI/lower alcohol; (3) high SI/high alcohol. Members of the high SI/lower alcohol profile displayed significantly higher psychological distress, thwarted belongingness, and perceived burdensomeness; lower financial wellbeing and help-seeking intentions than both other profiles. Members of the high SI/high alcohol profile were more likely to be male and already receiving help for their psychological distress. Members of the high SI/lower alcohol profile were more likely to be younger and report lower help-seeking intent. Limitations: Our study design was cross-sectional, utilising a largely young, female, English-speaking, help-seeking sample that had chosen to visit a mental health website. Conclusions: While the links between heavy alcohol use and suicide risk are well documented, these findings suggest that practitioners should also be alert for abstention patterns, as they may be indicators of underlying psychosocial concerns that a client could be reluctant to disclose.

Introduction: This longitudinal study examined trajectories of depression, perceived burdensomeness (PB), thwarted belongingness (TB), and suicidality among emerging adults (18-24 years old) during the early COVID-19 pandemic. Demographic and contextual differences were explored. The study also examined how COVID-related stressors predicted mental health trajectories over time. Methods: One hundred ninety-eight participants completed three waves of online surveys between May and July 2020. Results: Depressive symptoms decreased marginally over time, but there were no changes in participants' PB, TB, suicidality, or likelihood of becoming clinically depressed. No demographic differences emerged. Participants who were under stay-at-home orders (vs. not) were more likely to endorse suicidality over time. Engaging with COVID-19-related media or talking about COVID-19 predicted greater TB and marginally greater suicide risk, but not depression or PB, over time. Those who endorsed a greater negative impact on their lives related to COVID-19 also reported greater depression, PB, TB, and suicidality over time. Discussion: The marginal decrease in depressive symptoms likely suggests that participants' distress reduced over time. However, clinical depression, PB, TB, and suicidality remained stable and high. Watching news and talking about COVID-19 might increase suicide risk and heighten feelings of disconnection. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

• Our goal was to advance critical suicidology by bringing youth's voices into research. • Participants conceptualize belongingness and burdensomeness consistent with the IPTS. • New conceptualizations highlight the unique sociocultural views of participants. • Including a diverse population in suicide research strengthens theoretical frameworks. • Relevant theoretical frameworks will aid clinical practice and intervention research. Guided by the Interpersonal Theory of Suicide (IPTS), this study aims to understand the applicability of the constructs of belongingness and burdensomeness and their relevance to suicide risk and mental health among ethnocultural minoritized youth. A qualitative exploratory study was conducted using five focus groups with 29 self-identified Latinx and Black adolescents aged 13–17 years to explore the meaning they ascribed to belongingness and burdensomeness. Views of social media related to these constructs were also explored. Template analysis was used to analyze the data. Themes highlighted dimensions such as caring, self-worth, and liability, congruent with the IPTS dimensions of belongingness and burdensomeness. Notably, new themes emerged reflecting the distinctive experiences of these populations, such as the importance of being true to themselves, the burden of not belonging to families, and cultural aspects of liability, highlighting dimensions not found in the existing IPTS theoretical constructs. Consideration of the diverse experiences of ethnocultural minoritized youth can strengthen theoretical constructs, clinical practice, and aid in developing intervention strategies to increase protective factors and decrease risk factors for suicide behaviors relevant to such youth. [ABSTRACT FROM AUTHOR]

Suicide poses a debilitating threat to adolescents' lives worldwide. Although suicide prevention efforts are evident globally, there is limited evidence on the prevalence and correlations of suicidal behaviour among school-going adolescents in Saint Lucia. We used a dataset from the 2018 Global School-based Student Health Survey to examine the prevalence and associated factors of suicidal behaviour among 1864 students from schools in Saint Lucia. Prevalence rates of 25.5%, 22.1%, and 17.5% were found for suicidal ideation, suicide plan, and suicide attempt, respectively. After adjusting for other factors, being male and having understanding parents were protective against suicidal behaviour. However, suicidal ideation was predicted by being physically attacked and bullied, parental guidance, tobacco use, loneliness, and worry. Moreover, being a victim of physical attacks and bullying, having close friends, being lonely, and worrying were predictive of making suicidal plans among adolescents. Attempting suicide was predicted by cigarette smoking, current use of tobacco and related products, bullying, having close friends, being lonely, and worrying. School-based preventive interventions are required to help address triggers of suicidal behaviour among adolescents in Saint Lucia and to help attain the targets for suicide prevention in the global Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

• Perceived burdensomeness (PB) is a salient risk factors for suicide. • PB is fluid in nature and may serve as a corrective target for intervention. • Decreased PB may mediate decreases in baseline to follow-up suicidal ideation. Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one's death is worth more than one's life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches—including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals—explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from.07–.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts. [ABSTRACT FROM AUTHOR]

Background: Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non‐autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non‐autistic adults. Methods: Participants (autistic adults n = 463, 61% female; non‐autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non‐autistic adults. Results: Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non‐autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. Conclusion: Autistic people experience more life stressors than non‐autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs. [ABSTRACT FROM AUTHOR]

Introduction: The unalleviated burden of chronic physical illness (CPI) increases the risk of suicidal behaviors (SB) in affected individuals. This study tested the interpersonal theory of suicide (ITS) in patients with CPI. Methods: Patients diagnosed with cardiovascular, cerebrovascular, and renal diseases were recruited from two hospitals in South Korea. Data from 257 participants who completed Time (T) 1 and T2 surveys were analyzed. Hierarchical regression analyses for passive and active suicide ideation (PSI and ASI), and suicide plans and attempts (SP and SA) at both time points were conducted. Results: Interpersonal theory of suicide hypotheses were partially supported. Even accounting for factors such as depression, anxiety, and lifetime SA, some main and interaction effects of the ITS constructs explained SB in a cross‐sectional examination, but to a lesser degree in a longitudinal examination that controlled for T1 SB. PB was a consistent correlate of SB. TB was also relevant, as PB–SA association was significant among participants with high TB both times. ASI was associated with SP and SA at T1, and the ASI‐SP association at T1 was stronger at a high CS level. Conclusions: Overall, the results suggest the relevance of ITS constructs that warrant attention to prevent SB in patients with CPI. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated demographic differences in interpersonal theory of suicide factors and their associations with suicide attempts among sexual minority young adults. Methods: 784 sexual minority young adults ages 18–29 (42.7% cisgender men, 42.2% cisgender women, 15.1% transgender/gender diverse; 62.2% non‐Hispanic White; 50.5% gay/lesbian, 49.5% bisexual+) completed an online survey assessing lifetime suicide attempts and interpersonal theory of suicide factors. Results: Demographic differences included (1) greater perceived burdensomeness among transgender/gender diverse participants compared to other gender groups; (2) greater acquired capability for suicide and suicide attempts among cisgender men compared to cisgender women; (3) greater acquired capability for suicide among bisexual+ compared to gay/lesbian participants; and (4) a lower number of suicide attempts among Asian/Asian American sexual minority participants compared to most other sexual minority participants. All interpersonal theory of suicide factors were significantly associated with a higher number of suicide attempts, though only perceived burdensomeness and acquired capability for suicide remained significant when examining all three simultaneously. No two‐ or three‐way interactions between interpersonal theory of suicide factors were significant. Conclusion: The interpersonal theory of suicide may be useful for understanding suicide attempts in this population, with perceived burdensomeness and acquired capability being particularly relevant to consider. [ABSTRACT FROM AUTHOR]

Suicide is a major cause of death in American youth. Suicide risk assessment is a promising suicide prevention strategy; however, little is known about school-based suicide risk assessment practices. The purpose of this study was to examine the scope of standardization, comprehensiveness, and follow-up procedures as part of the suicide risk assessment (SRA) process in use among school-based mental health professionals in Colorado. Participants were 72 school psychologists, school counselors, and school social workers employed in school districts across the state. Results indicate the reported ability of SRA procedures to identify imminent suicide risk was strong in relation to other aspects of suicide risk. The analysis of SRA alignment with the interpersonal theory of suicide model revealed that SRA procedures currently in place are significantly more helpful at investigating aspects of acquired capability in comparison to thwarted belongingness and perceived burdensomeness. Respondents were significantly less likely to agree with statements about the ability of SRA procedures to support re-entry and follow-up compared with statements about risk identification and treatment decision-making. The results of this survey suggest that school-based mental health professionals need increased support in developing school re-entry and follow-up procedures to monitor suicide risk. [ABSTRACT FROM AUTHOR]

Abstract Objective: Victims of bullying are at increased risk for suicidal ideation. The purpose of the current study is to examine the impact of bullying victimization in childhood on college student’s current report of suicidal ideation through two mechanisms derived from the interpersonal-psychological theory of suicide. Participants: Our sample consists of 304 undergraduate college students from a large, southeastern university. Methods: We employed a cross-sectional design with self-report surveys to examine the indirect effects of childhood bullying victimization frequency on suicidal ideation through thwarted belongingness and perceived burdensomeness. Results: The association between bullying victimization and suicidal ideation was explained by perceived burdensomeness, but not thwarted belongingness. Conclusions: Bullying victimization in childhood may have distal effects on suicidal ideation through influencing perceptions of worthlessness and self-hatred. Interventions in college settings that address the impact of bullying victimization on perceived burdensomeness may reduce potential for suicidal ideation among college students. [ABSTRACT FROM AUTHOR]

Objective: The Interpersonal Theory of Suicide has been foundational in guiding current suicide literature. Despite recent research underscoring fluctuations of suicidal ideation within hours, there have been few studies examining the key constructs of perceived burdensomeness and thwarted belongingness within an intensive framework. Thus, the current study aimed to add cumulative knowledge regarding the within‐person relationship between perceived burdensomeness, thwarted belongingness, and active suicidal ideation as assessed within an ecological momentary assessment design. Method: A final sample of 35 individuals with a past‐year history of suicidal thoughts or behaviors completed brief surveys four times per day for 30 days. Results: Findings highlighted that the addition of covariates may offer small improvements in modeling subsequent suicidal ideation, while controlling for SI at the prior time. Further, both thwarted belongingness and perceived burdensomeness were associated with next timepoint suicidal ideation, and their interaction added little incremental value. Conclusion: Findings demonstrate the potential importance of thwarted belongingness in predicting suicidal ideation. Further, results highlight that the main effects of thwarted belongingness and perceived burdensomeness, rather than their interaction, may be more important to consider in relation to active suicidal ideation. [ABSTRACT FROM AUTHOR]

The dualistic model of passion proposes two passion types, harmonious and obsessive, representing adaptive and maladaptive passion, respectively. Studies suggest interpersonal experiences explain harmonious passion benefits and obsessive passion negative consequences. However, research has not examined passion among individuals with clinically elevated suicide risk, nor the associations between passion types and suicide-related outcomes. The present study presents a conceptual model linking the dualistic model of passion and the interpersonal theory of suicide constructs [specifically, thwarted belongingness (TB) and perceived burdensomeness (PB)]. U.S. adults with clinically elevated suicide risk (N = 484) completed online, cross-sectional assessments of harmonious and obsessive passion, TB, PB, and future dispositions (i.e., positive focus, negative focus, and suicide orientation). A mediation model indicated the effects of harmonious and obsessive passion on positive and negative focus and suicide orientation were largely explained by TB and PB. The present findings suggest engaging in a passion activity may be meaningfully related to suicide-related interpersonal perceptions (i.e., TB and PB). [ABSTRACT FROM AUTHOR]

While a growing number of studies have documented significant links between online racism (e.g., racist interactions, contents on racial violence) and comorbid factors (e.g., depression) associated with suicide risk, no studies have examined whether online racism predicts suicide ideation and if interpersonal factors can help explain this link. Thus, the current study examined the direct relationship between online racism and suicide ideation among racial minority emerging adults, and the indirect relationships via the interpersonal factors (perceived burdensomeness and thwarted belongingness). Using data from a convenience sample of 338 racial minority emerging adults, we conducted a path analysis with online racism predicting suicide ideation through thwarted belongingness and perceived burdensomeness. Online racism significantly predicted suicide ideation via perceived burdensomeness but not thwarted belongingness. Post hoc multi-group analysis found that this pathway was consistent across Black, Asian, and Latinx groups but was completely mediated for the Asian group. The findings suggest that online racism can increase feelings of being a burden to society, which can trigger thoughts of suicide. This process may be particularly salient among Asian individuals. Implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Bisexual-identifying individuals are at heightened risk for engaging in non-suicidal self-injury (NSSI), with the odds up to six times higher compared to heterosexual individuals and up to four times higher compared to lesbian/gay (L/G) individuals. While research has established that sexual minorities may be at increased risk because minority stressors exacerbate psychological processes associated with NSSI, little research has examined bisexual-specific pathways of risk. In this study, we replicated findings that suggest Interpersonal Theory of Suicide (IPTS) variables (i.e., perceived burdensomeness and thwarted belongingness) mediate the association between minority stress and NSSI and extended these findings by examining whether such mediation is moderated by sexual minority identity. Furthermore, we explored whether IPTS variables mediate the association between bisexual-specific minority stress and NSSI. Method: A sample of 259 cisgender L/G (n = 93) and bisexual (n = 166) MTurk workers completed measures assessing minority stress, NSSI, and IPTS variables. Results: Mediation analyses replicated findings that experiences of minority stress increase NSSI by increasing perceived burdensomeness [PB], though moderated mediation analyzes failed to provide evidence that sexual minority identity moderated this indirect effect. Rather, minority stress from both heterosexual and L/G individuals increased NSSI through increased PB for bisexual individuals. Limitations: The use of cross-sectional data does not allow conclusions of causal relationships. Conclusions: These results suggest that for bisexual individuals, minority stress from both heterosexual and L/G individuals increases NSSI by increasing PB. Future researchers and clinicians should consider the additive burden of minority stress in bisexual individuals.

Background: Suicide capability (fearlessness about death [FAD], preparation, and perceived capability [PC]) is presumed to be static, or to increase with exposure to provocative events. However, tests of this assumption have primarily used non-clinical samples. We examined short-term changes in capability among patients in a partial hospital program. Methods: We enrolled 296 adult patients (186 [62.7%] female; Mage=36.13, SDage=14.75) who completed diagnostic interviews and questionnaires assessing demographics, capability, and suicide ideation (SI) at intake. Capability was re-assessed twice during treatment and again at discharge, and SI was re-assessed at discharge. We used latent growth modeling (LGM) to quantify changes in capability. Results: FAD, preparation, and PC decreased from intake to discharge (ps

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.

In the field of suicide, three theories (the interpersonal theory of suicide—IPTS, the integrated motivational–volitional—IMV—model, and the three-step theory—3ST) have emerged within the ideation-to-action framework. These theories distinguish between two processes, the development of suicidal ideation and the progression from ideation to suicidal action. In relation to the development of suicidal ideation, each theory proposes different key elements (perceived burdensomeness and thwarted belongingness—IPTS; defeat and entrapment—IMV; and psychological pain and hopelessness—3ST). Through the implementation of network analysis, specifically Gaussian graphical models (GGMs), this study aims to explore the relationship between the variables of the three theories and their relationship (direct and indirect) with suicidal desire after partialing out all the other variables. In this cross-sectional study, 644 young adults, selected according to age, sex, and educational level, completed an online survey. The network analysis indicated that all the variables, except thwarted belongingness, formed a network model with strong connections. Defeat is the most central variable, and it has the greatest influence in the network. Suicidal desire is only connected directly to perceived burdensomeness, psychological pain, and defeat. The development of suicidal ideation could be understood as a complex set of concurrent and potentially interactive variables. [ABSTRACT FROM AUTHOR]

Objective: Using the Interpersonal Theory of Suicide (IPTS) as a framework, this two‐study investigation tested whether burdensomeness and low belongingness explained the association between body and muscle dysmorphia symptoms and suicidal ideation (tested in Study 1 and Study 2), and if fearlessness about death and pain tolerance explained the association between dysmorphia symptoms and previous suicide attempt frequency (tested in Study 2). Methods: Study 1 used a community sample (n = 273) and Study 2 used an at‐risk population sample (n = 261). Participants completed cross‐sectional questionnaires online. Results: In Study 1, both types of dysmorphic symptoms related to suicidal ideation through burdensomeness, but only body dysmorphic symptoms related to suicidal ideation through low belongingness. In Study 2, results were replicated as both types of dysmorphic symptoms related to suicidal ideation through burdensomeness. While both types of symptoms related to low belonging, low belonging did not relate to suicidal ideation. Neither dysmorphic symptoms nor capability for suicide related to frequency of suicide attempts. Conclusions: Results suggest that improving interpersonal needs, such as feeling more effective, may be important treatment targets for individuals with dysmorphic symptoms who also experience suicidal ideation. Future work should continue to identify mediators for suicide attempts among individuals with dysmorphia symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is a substantial public health burden, particularly among veterans. Risk factors have been delineated for suicide; however, the dynamic interrelations between risk factors have not been fully examined. Such research has the potential to elucidate processes that contribute to suicide risk between individuals with a past suicide attempt (attempters) and those without a past suicide attempt (nonattempters). Methods: In the current study, network analysis was used to compare networks between attempters and nonattempters in a high‐risk veteran sample (N = 770; Mage = 32.3 years, SD = 6.8; 326 with a past suicide attempt) who were followed over 1 year. Networks were estimated to examine (1) concurrent relations of suicide risk factors at baseline and (2) predictability of prospective suicidal behavior (SB). Results: There were no differences in the overall connectivity of attempter and nonattempter networks. Perceived burdensomeness and posttraumatic stress disorder (PTSD) symptoms were most central in the attempters' network, whereas PTSD symptoms and insomnia were most central in the nonattempters' network. The risk factors prospective SB in either network. However, attempters were more likely to engage in SB over the course of the study. Conclusion: These findings highlight the difficulty in predicting who will attempt suicide. [ABSTRACT FROM AUTHOR]

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The Interpersonal-Psychological Theory of Suicidal Behaviour proposes that a number of distal and proximal risk factors moderate the pathway to suicidal behaviour. Distal risk factors include social, demographic and neurobiological correlates. The aim of the present study was to explore the sociodemographic variables associated with constructs of the Interpersonal-Psychological Theory of Suicidal Behaviour. In the study, I employed a cross-sectional survey design method to recruit 239 South African mental health outpatients aged 18-68 years. The participants completed a sociodemographic questionnaire, the interpersonal needs questionnaire, the interpersonal hopelessness scale and the acquired capability for suicide scale. Multiple regression analyses indicated that scores on the perceived burdensomeness subscale of the interpersonal needs questionnaire were positively associated with females, being unemployed and a lower level of educational attainment, whereas scores on the Thwarted Belongingness subscale and the interpersonal hopelessness scale were not associated with any of the sociodemographic variables. Scores on the acquired capability for suicide scale were found to be positively associated with younger ages, being male, and being employed. The study findings indicate that gender, age, unemployment and lower levels of education were implicated in the development of the perceived burdensomeness scale and the acquired capability for suicide scale. The implications of the findings for social work practice are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Whereas the interpersonal theory of suicide entails the assumption that thwarted belongingness and perceived burdensomeness are equally important, mutually moderating, proximal causes of active ideation, evidence suggests these may not be co‐moderating processes. We tested an alternative perspective, hypothesizing that burden mediates the longitudinal relationship of thwarted belonging with active ideation. Methods: A 6‐week, four‐wave prospective online survey was completed by 298 undergraduates. We tested cross‐sectional and cross‐lagged panel models (CLPM, with and without random effects) with belonging, burden, and ideation at 2‐week lags, and post hoc models with burden as a concurrent mediator of ideation. Results: Approximately 28% of undergraduates reported active ideation at baseline. Cross‐sectionally, thwarted belonging had no direct influence on ideation but indirectly affected ideation via burden. This result was not confirmed in the 2‐week CLPM analyses. In post hoc analyses, we found belonging operated indirectly via later burden to influence contemporaneous ideation. Conclusions: Findings suggest thwarted belonging influences active ideation indirectly via perceived burden. The effect of burden as a mediator appears to depend on its temporal proximity to ideation. Future research should delimit the period during which perceived burden is an active mediator, accommodate dual‐process approaches, and explore other mediation alternatives to co‐moderation. [ABSTRACT FROM AUTHOR]

Insomnia is associated with suicide risk in civilian and military populations. Thwarted belongingness is proposed as a mediator of this relationship under the Interpersonal Theory of Suicide (IPTS). The present study explored how insomnia relates to suicidal ideation in conjunction with thwarted belongingness among civilians, Service members, and Veterans. Methods. Data from the Military Suicide Research Consortium for N = 6556 individuals (6316 with non-missing suicidal ideation status) were divided into 4 subgroups: civilians, never deployed Service members, previously deployed Service members, and Veterans. Robust Poisson models evaluated the associations between insomnia severity/subtype and current suicidal ideation, with bootstrap mediation models assessing thwarted belongingness as a mediator. Results. A 5-point increase in insomnia severity was associated with a 38% increased risk for current suicidal ideation among civilians, a 56% greater risk among never deployed Service members, an 83% greater risk among previously deployed Service members, and a 37% greater risk among Veterans. Moreover, active Service members showed greater associations between difficulty falling asleep and staying asleep with suicidal ideation than civilians. These associations were independent of covariates and only mediated by thwarted belongingness among Veterans. Conclusions. The relationship between insomnia and suicide is not purely explained by thwarted belongingness except among Veterans. Future research should explore additional psychological and neurobiological mechanisms connecting insomnia and suicidality. [ABSTRACT FROM AUTHOR]

Introduction: The Minnesota Multiphasic Personality Inventory‐2‐Restructured Form (MMPI‐2‐RF Ben‐Porath & Tellegen, 2008/2011) has been applied to suicide risk assessment through derived proxy indices of perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide (Anestis et al., 2018, Joiner, 2005). However, limited research has examined the clinical utility of these proxy indices outside the outpatient setting. This study examined the performance of these proxy indices in identifying past‐month suicide ideation intensity and attempts upon admission to a psychiatric inpatient program and changes in suicidal ideation intensity at discharge. We expected these indices and their interaction would be associated with suicide ideation intensity and attempts at baseline and with a lack of significant improvement in suicide ideation intensity at discharge, including when controlling for MMPI‐2‐RF Suicide/Death Ideation (SUI) scale scores. Method: Participants were 1007 patients in a private inpatient psychiatric hospital in the southwestern United States, 968 of whom completed study measures at admission and discharge. Participants were administered the C‐SSRS and MMPI‐2‐RF upon admission, while the C‐SSRS was administered again prior to discharge. A series of moderation analyses were conducted to examine the main and interaction effects of the MMPI‐2‐RF derived proxy indices on suicidal ideation intensity and suicide attempts at admission. Logistic regression analyses were conducted to examine whether MMPI‐2‐RF proxy index scores at admission were associated with changes in suicidal ideation intensity at discharge. Results: Neither the proxy indices nor their interaction was associated with all study outcomes. The acquired capability for suicide proxy index and its interaction with other indices were not associated with suicide attempt status at admission. However, high thwarted belongingness proxy index scores were associated with greater suicidal ideation intensity at admission; high perceived burdensomeness proxy index scores were indicative of a lack of significant change in suicide ideation intensity at discharge. Conclusion: These results indicate a need to further examine these proxy indices in high acuity samples. [ABSTRACT FROM AUTHOR]

Objectives: We sought to characterize the social networks of older adults who report feeling lonely or like a burden on others, psychological states that are associated with risk for suicide according to the Interpersonal Theory of Suicide. Methods: We used a latent class analysis to identify distinct groups of older adults based on social network characteristics and perceptions of their networks within a sample of older adults endorsing loneliness and/or feeling like a burden. We examined associations between class membership and mental health outcomes. Results: Four network types were identified: small, cohabitating networks with daily contact; moderate‐sized family‐oriented networks with multiple contacts weekly; moderate‐sized friend‐oriented networks with weekly contact; and average‐sized mixed networks with weekly contact. The friend‐oriented class reported the greatest loneliness, perceived burden, and lifetime prevalence of suicidal ideation and attempts. Conclusions: Social network composition may be more explanatory of loneliness and perceived burden than number of members alone. Profile differences in outcomes suggest utilizing tailored social connectedness interventions. Individuals with small‐to‐moderate networks may benefit most from interventions designed to build friendships. Individuals with many close confidants may benefit most from psychotherapy. Individuals reporting moderately frequent contact with moderately‐sized networks may benefit from both intervention types. [ABSTRACT FROM AUTHOR]

Sexual minority (e.g., gay, lesbian, bisexual) people are at increased risk for suicidal thoughts and behaviors compared to their heterosexual peers. The interpersonal theory of suicide proposes that perceived burdensomeness and thwarted belongingness are central to the desire to die, and both are associated with suicidal ideation in sexual minority samples. The Interpersonal Needs Questionnaire (INQ) was developed to measure these risk factors and has become the most commonly used measure. However, it is unknown whether the INQ demonstrates similar measurement properties across subgroups of sexual minority people. Therefore, the goal of this study was to examine whether the 15-item version of the INQ exhibited measurement invariance (MI) across sexual orientation (gay/lesbian vs. bi+), gender identity (cisgender men vs. cisgender women vs. transgender/gender diverse individuals), and race/ethnicity (non-Latinx White individuals vs. people of color) in a sample of 792 sexual minority young adults (ages 18–29). A series of multigroup measurement invariance models indicated that the INQ-15 met strict invariance (i.e., equal factor loadings, item intercepts, and residual variances) across all three dimensions of identity. This indicates that it can be used and compared across diverse samples of sexual minority young adults. Results also indicated that perceived burdensomeness was greater for transgender/gender diverse individuals than for cisgender men and women, and that perceived burdensomeness and thwarted belongingness were greater for people of color than for non-Latinx White individuals. In contrast, gay/lesbian and bi+ individuals did not differ. Additional research is needed to understand the factors that account for these group differences. Public Significance Statement: This study demonstrated that the psychometric properties of the Interpersonal Needs Questionnaire (INQ-15) do not differ across sexual orientation, gender identity, and race/ethnicity groups in a sample of sexual minority young adults. Therefore, the INQ-15 can be used with confidence with diverse samples of sexual minority young adults. [ABSTRACT FROM AUTHOR]