Obsessive-compulsive symptoms, perceived burdensomeness, and thwarted belongingness: Associations and implications among US veterans.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders worldwide, but has gone relatively unnoticed within the US veteran population. Simultaneously, suicide rates continue to remain high within this population despite the high volume of veterans who receive psychiatric care. With recent research demonstrating OCD's unique relationship with suicidality, it is imperative to explore this association and factors that may explain this association within veterans. METHODS: The present study investigated OCD symptoms and their relationship with two known risk factors of suicide, perceived burdensomeness (PB) and thwarted belongingness (TB), in two samples of veterans. RESULTS: In the first study (N = 100), OCD symptoms were found to be uniquely related to both PB and TB even after covarying for demographics, trauma exposure, and probable depression. In the second study (N = 99), these relationships were replicated longitudinally. OCD symptoms at baseline were found to be indirectly related to suicidal ideation severity at a 1-month follow-up via PB and TB at post-treatment. CONCLUSION: This study highlights the importance of assessing and addressing OCD symptoms within veterans due to the unique relationship these symptoms have with suicidal constructs. A deeper understanding of the impact of OCD within the veteran population will inform future prevention and intervention efforts.

Thwarted Belongingness and Suicide Risk in Primary Care: Perceived Burdensomeness and Psychache as Mediators.

Suicide is a significant public health concern, particularly among primary care patients, given that many individuals who die by suicide visit their primary care provider in the months prior to their death. We examined constructs from two prominent theories of suicide, the interpersonal and psychache theories, including thwarted belongingness, perceived burdensomeness, and psychache. Among our sample (n = 224) of patients, perceived burdensomeness and psychache, individually and in serial, mediated the relation between thwarted belongingness and suicidal behavior. Thwarted belongingness was associated with greater perceived burdensomeness and, in turn, with more psychache and increased suicide risk. Our results elucidate the associations between the interpersonal and psychache theories of suicide. Clinical strategies that may reduce thwarted interpersonal needs and psychache, and which are appropriate for medical settings, are discussed.

Exploring the use of the Interpersonal Needs Questionnaire to examine suicidal thoughts and behaviors among Post-9/11 U.S. Combat Veterans: An integrative review.

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.

Perceived COVID-19 Stress and Suicidal Ideation Among College Students: Meditation Roles of Family Cohesion and Unmet Interpersonal Needs.

Purpose: Few studies examined variables that might explain the link between perceived COVID-19 stress and suicidal ideation. The present study tested a multiple-sequence mediation model with family cohesion, thwarted belongingness, and perceived burdensomeness as mediators. Methods: The current study surveyed 1098 college students in China using questionnaires concerning perceived COVID-19 stress, family cohesion, unmet interpersonal needs, and suicide ideation. Results: Perceived COVID-19 stress was significantly associated with family cohesion, thwarted belongingness, perceived burdensomeness, and suicidal ideation. Family cohesion, thwarted belongingness, and perceived burdensomeness mediated the relationship between perceived COVID-19 stress and suicidal ideation separately. These factors also had multiple sequence-mediated effects between perceived COVID-19 stress and suicidal ideation. Conclusion: The study revealed pathways from perceived COVID-19 stress to suicidal ideation and suggested that interventions to increase family cohesion and reduce one's unmet interpersonal needs were beneficial in decreasing individuals' suicidal ideation.

Associations of adverse and protective childhood experiences with thwarted belongingness, perceived burdensomeness, and suicide risk among sexual minority men.

BACKGROUND: Sexual minority men (SMM) experience higher suicidal ideation and suicide attempts than the general population. We examined the associations of adverse childhood experiences (ACES) and protective and compensatory childhood experiences (PACES) with suicidal ideation and suicide attempts in adulthood via thwarted belongingness and perceived burdensomeness among SMM. METHODS: Data are from the UNITE study, a national longitudinal cohort study of HIV-negative SMM from the 50 U.S. states and Puerto Rico. Between 2017 and 2019, participants (N = 6303) completed web-based assessments at baseline and 12-month follow-up. ACES and PACES occurring before the age of 18, and current symptoms of thwarted belongingness and perceived burdensomeness were assessed at baseline. Past-week suicidal ideation and past-year suicide attempt were assessed at follow-up. RESULTS: 424 (6.7%) participants reported past-week suicidal ideation and 123 (2.0%) reported a past-year suicide attempt. The results of our multivariate model suggest that each additional adverse childhood experience was prospectively associated with 14% higher odds of past-week suicidal ideation (AOR = 1.14, 95% CI 1.09-1.19) and 19% higher odds of past-year suicide attempt (AOR = 1.19, 95% CI 1.11-1.29). Each additional protective childhood experience was prospectively associated with 15% lower odds of past-week suicidal ideation (AOR = 0.85, 95% CI 0.81-0.90) and 11% lower odds of past-year suicide attempt (AOR = 0.89, 95% CI 0.82-0.98). Perceived burdensomeness partially mediated these prospective associations. CONCLUSION: To reduce suicide, screening and treating perceived burdensomeness among SMM with high ACES may be warranted. PACES may decrease perceived burdensomeness and associated suicide risk.

The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions.

OBJECTIVE: The purpose of this study was (1) to examine the degree to which perceived burdensomeness mediates the relationship between pain severity and suicidal cognitions and (2) to determine whether this mediated relationship was moderated by pain acceptance. We predicted that high levels of pain acceptance would buffer relationships on both paths of the indirect effect. METHODS: Two-hundred seven patients with chronic pain completed an anonymous self-report battery of measures, including the Chronic Pain Acceptance Questionnaire, the Interpersonal Needs Questionnaire, the Suicidal Cognitions Scale, and the pain severity subscale of the West Haven-Yale Multidimensional Pain Inventory. Conditional process models were examined with Mplus. RESULTS: Chronic pain acceptance significantly moderated both paths of the mediation model. Results from the conditional indirect effect model indicated that the indirect effect was significant for those with low (b = 2.50, P = .004) and medium (b = 0.99, P = .01) but not high (b = 0.08, P = .68) levels of pain acceptance and became progressively stronger as pain acceptance scores decreased. The nonlinear indirect effect became nonsignificant at acceptance scores 0.38 standard deviation above the mean-a clinically attainable treatment target. CONCLUSIONS: Higher acceptance mitigated the relationship between pain severity and perceived burdensomeness and the relationship between perceived burdensomeness and suicidal cognitions in this clinical sample of patients experiencing chronic pain. Findings indicate that any improvement in pain acceptance can be beneficial, and they provide clinicians with a clinical cut-point that might indicate lower vs higher suicide risk.

COVID-19 anti-Asian racism, perceived burdensomeness, thwarted belongingness, and suicidal ideation among Asian American Emerging Adults.

Since the start of the COVID-19 pandemic, there has been a significant surge in COVID-19 related anti-Asian racism and hate crimes. Given the ostracising and dehumanising narrative of COVID-19 related anti-Asian hate, we examined whether COVID-19 anti-Asian racism would be associated with suicidal ideation through increased thwarted belongingness and perceived burdensomeness among Asian American emerging adults. With data from 139 participants (Mage = 23.04), we conducted a path analysis of COVID-19 anti-Asian racism (four items) predicting suicidal ideation (item nine; Patient Health Questionnaire-9) via perceived burdensomeness and thwarted belongingness (Interpersonal Needs Questionnaire). COVID-19 anti-Asian racism significantly predicted suicidal ideation. The indirect effect through perceived burdensomeness was significant but not through thwarted belongingness; greater COVID-19 anti-Asian racism was associated with greater perceived burdensomeness, which in turn was associated with greater suicidal ideation. The significance of perceived burdensomeness was substantiated given the non-significant direct effect. The results suggest that the ongoing COVID-19 anti-Asian racism may be an alarming risk factor for suicidal ideation for Asian American emerging adults.

Association between perceived social support and suicide ideation distress among psychiatric inpatients: The role of thwarted interpersonal needs.

INTRODUCTION: The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) are proximal risk factors for suicide ideation; however, there are mixed results regarding this hypothesis among psychiatric inpatients. OBJECTIVE: The current study examined the mediating role of TB and PB in the relationship between perceived social support (i.e., support from family, friends, a significant other, and total) and suicide ideation distress among psychiatric inpatients. METHODS: Participants (short-term psychiatric inpatients; N = 139) were administered self-report assessments cross-sectionally. RESULTS: Nonparametric mediation results indicated that the total (additive) indirect effects of TB and PB, in parallel, were significant in all models, yet there were only significant specific (unique) indirect effects of PB. CONCLUSION: TB and PB, in combination, may be proximal risk factors for suicide ideation distress among psychiatric inpatients with lower perceived social support from family, friends, a significant other, and in total. These findings are congruent with the interpersonal theory of suicide's propositions that the combination of TB and PB increases the risk for suicide ideation. Clinicians may consider using interventions that target increasing perceived social support and decreasing TB and PB (i.e., cognitive behavioral therapy and social skills training) for this population.

Predicting suicidal ideation in a nationally representative sample of young adults: a 12-month prospective study.

BACKGROUND: Evidence-based theoretical models outlining the pathways to the development of suicidal ideation may inform treatment. The current research draws from the Interpersonal Theory of Suicide (IPT) and the Integrated Motivational-Volitional (IMV) Model of suicidal behaviour and aims to test the interaction between perceived burdensomeness and thwarted belongingness as proposed by the IPT model, and the defeat-entrapment pathway as proposed by the IMV model, in the prediction of suicidal ideation at 12-month follow-up. METHODS: The Scottish Wellbeing Study is a nationally representative prospective study of young people aged 18-34 years (n = 3508) from across Scotland, who completed a baseline interview and a 12-month follow-up (n = 2420). The core factors from both the IPT (perceived burdensomeness and thwarted belongingness) and the IMV model (defeat, internal and external entrapment) were measured alongside demographics, depressive symptoms and suicidal ideation at baseline. At 12-month follow-up, suicidal ideation was assessed again. RESULTS: In multiple regression analysis perceived burdensomeness and internal entrapment, with baseline suicidal ideation, predicted 12-month suicidal ideation. No support for the interaction between perceived burdensomeness and thwarted belongingness in predicting 12-month suicidal ideation was found. However, there was evidence that internal, but not external, entrapment mediated the relationship between defeat and 12-month suicidal ideation, but no support was found for the moderation of burdensomeness and belongingness on the entrapment to suicidal ideation pathway. CONCLUSIONS: The current findings highlight the importance of targeting perceived burdensomeness and internal entrapment to reduce the likelihood that suicidal ideation emerges in at risk individuals.

Reciprocal/Authoritarian Filial Piety and Mental Well-Being in the Chinese LGB Population: The Roles of LGB-Specific and General Interpersonal Factors.

Although filial piety is considered as a salient value in the Chinese culture, studies on the mental well-being of Chinese lesbian, gay, and bisexual (LGB) individuals rarely take filial piety into account or examine it in relation to other variables to clarify the mechanism between filial piety and mental well-being. A total of 1453 LGB participants from 30 provinces and regions in Mainland China completed the online survey. They provided demographic information and completed measures of filial piety, a general interpersonal factor (i.e., perceived burdensomeness and thwarted belongingness), an LGB-specific interpersonal factor (i.e., perceived parental support for sexual orientation), and mental well-being. Structural equation modelling results indicated that higher reciprocal filial piety was directly, and indirectly through lower thwarted belongingness, associated with better mental well-being. Lower authoritarian filial piety was indirectly associated with better mental well-being through higher perceived parental support for sexual orientation and lower thwarted belongingness. In addition, reciprocal filial piety had a stronger effect on perceived parental support for sexual orientation and perceived burdensomeness among lesbians and bisexual women than gay and bisexual men. These findings suggest that reciprocal filial piety is a protective factor, whereas authoritarian filial piety is a risk factor, for the mental well-being of Chinese LGB persons. Moreover, perceived parental support for sexual orientation and thwarted belongingness might be the mechanisms underlying the effect of reciprocal/authoritarian filial piety on mental well-being. Implications of findings for practice and research are discussed.

Depressive rumination and life satisfaction among institution-dwelling Chinese older adults: the roles of perceived burdensomeness and social support from individuals within the institution.

Objectives: We examined how institution-dwelling older adults' depressive rumination was associated with their life satisfaction by taking perceived burdensomeness as a mediator and social support from individuals within the institution (SSII) as a moderator.Method: A total of 194 older adults from 24 institutions in four provinces of China completed a questionnaire survey.Results: Depressive rumination was negatively associated with life satisfaction, and perceived burdensomeness mediated this association. Moreover, SSII moderated the indirect association between depressive rumination and life satisfaction through perceived burdensomeness. Specifically, depressive rumination had a negative effect on life satisfaction through perceived burdensomeness only for older adults with less SSII.Conclusion: Our study indicated that depressive rumination could damage older adults' life satisfaction by increasing their perceived burdensomeness. Fortunately, older adults' perception of social support from individuals within the institution could attenuate this negative effect. This study has implications for designing intervention programs to improve the institution-dwelling older adults' life satisfaction.

Moderating effects of brooding on the link between functional impairment and interpersonal needs in survivors of serious trauma.

OBJECTIVES: Trauma and resulting functional limitations demonstrate associations with perceived burdensomeness and thwarted belongingness, factors contributing to elevated risk for suicidal ideation. However, survivors display differential risk in response to impairment, highlighting the need for research on exacerbating factors. The current study examined the impact of brooding on the association of functional impairment with burdensomeness and belongingness among trauma-exposed undergraduates (N = 262). METHOD: Trauma was assessed via clinical interview with questionnaires for study variables. Regression models examined the unique and interactive effects of physical impairment, emotional impairment, and brooding on burdensomeness and thwarted belongingness. RESULTS: An interaction of brooding and impairment due to emotional difficulties was observed for burdensomeness with impairment linked to elevated burdensomeness at high (ß = -0.46; p < 0.001), but not low (ß = -0.07; p = 0.476) brooding. Impairment due to emotional difficulties (ß = -0.38; p < 0.001) and brooding (ß = 0.25; p < 0.001) were associated with belongingness. CONCLUSIONS: Findings identify brooding as a potential target for assessment and intervention in trauma-exposed individuals.

Better off with you: Exploring congruity between caregivers' and Veterans' experience of efforts to cope with suicide.

The interpersonal theory of suicide posits people are more likely to consider suicide when they perceive themselves as alone and as a burden. However, there is limited research on whether these self-perceptions reflect caregiver experiences. As part of a larger study of collaborative safety planning, 43 Veteran/caregiver dyads (N = 86 individuals) completed measures of belongingness and burdensomeness, caregiver burden, family problem solving, and suicide-related coping. We conducted dyad-level actor interdependence models allowing two types of social coping (i.e., general problem solving and suicide-specific coping) to predict Veteran's self-views and caregiver interpersonal perceptions. Results suggested that Veteran social coping predicted lower Veteran thwarted belonginess and burdensomeness and caregiver involvement in problem solving was similarly associated with their own lower caregiver emotional burden. But examination of cross-partner effects demonstrated that greater Veteran coping was associated with greater time burden for caregivers. Findings suggest that social coping is associated with positive perceptions at the individual level (i.e., Veterans and caregivers to themselves) but does not indicate positive effects at the partner level. Clinicians working with Veterans may wish to involve supports in care to encourage effective collaboration that meets both caregiver/recipient needs.

Psychometric properties of the interpersonal needs questionnaire (INQ-15) in Army soldiers: Implications and future directions.

The Interpersonal Theory of Suicide posits that two unmet interpersonal needs, thwarted belongingness and perceived burdensomeness, interact to predict suicide desire. These two constructs are frequently assessed using the 15-item Interpersonal Needs Questionnaire (INQ-15); however, this measure has never been validated in military service members. The current study analyzed the psychometric properties of the INQ-15 in a sample of (N = 1096) military personnel stationed overseas. Results indicated that the two-factor model of the INQ-15 had a poor model fit in this population; however, a bifactor model with two specific factors representing TB and PB demonstrated good fit. As seen in previous research, perceived burdensomeness was more strongly related to suicidal ideation severity than thwarted belongingness. Implications and future directions for research are discussed.

Coping competence and hopelessness moderate the influence of perceived burdensomeness on suicidal ideation in undergraduate college students.

According to the interpersonal theory of suicide, the perception of imposing a burden on loved ones increases the risk for suicidal ideation. Little research, however, has examined the interaction of burdensomeness with cognitive variables in predicting suicidal ideation in college students even though the relationship between burdensomeness and ideation may be contingent on levels of cognitive risk factors. The present study thus examined the relationships between burdensomeness, hopelessness, coping competence, and suicidal ideation. Questionnaires were administered to 279 undergraduate students from a university in the Midwest United States. After controlling for depression, hopelessness, and coping competence, burdensomeness significantly predicted ideation and accounted for variance above and beyond the control variables. Moreover, the relationship between burdensomeness and suicidal ideation was significantly moderated by coping competence and hopelessness. The findings suggest that perceived burdensomeness plays a critical role in the risk for suicide in college students. More specifically, the findings suggest that coping competence and hopelessness can be ideal targets for interventions as changes in these variables may attenuate the association between perceived burdensomeness and suicidal ideation.

The Neural Processes Interlinking Social Isolation, Social Support, and Problem Alcohol Use.

BACKGROUND: Subjective feeling of social isolation, as can be measured by perceived burdensomeness (PB), is a major risk factor for alcohol misuse. Heightened PB is associated with elevated stress response and diminished cognitive control, both of which contribute to problem drinking. Here, we sought to identify the neural substrates underlying the relationship between PB and alcohol misuse. METHODS: We employed resting-state functional magnetic resonance imaging data collected from 61 problem drinkers to characterize the functional connectivity of the hypothalamus and ventral striatum (VS) in relation to PB. We specifically examined whether the connectivities of the hypothalamus and VS were differentially influenced by PB to produce contrasting effects on alcohol use. Finally, we evaluated how individual differences in social support modulate the inter-relationships of social isolation, neural connectivity, and the severity of problem drinking. RESULTS: Whole-brain multiple regressions show a positive relationship between PB and hypothalamic connectivity with the hippocampus and an inverse pattern for VS connectivity with the middle frontal gyrus. Difference in strength between the 2 connectivities predicted the severity of problem drinking, suggesting an imbalance involving elevated hypothalamic and diminished prefrontal cortical modulation in socially isolated problem drinkers. A path analysis further revealed that the lack of social support was associated with a bias toward low prefrontal connectivity, which in turn increased PB and facilitated problem drinking. CONCLUSIONS: Altered hypothalamus and VS connectivity may underlie problem drinking induced by social isolation. The current findings also highlight the important role of social support as a potential protective factor against alcohol misuse.

Prediction and network modelling of self-harm through daily self-report and history of self-injury.

BACKGROUND: Self-harm is a significant public health issue, and both our understanding and ability to predict adverse outcomes are currently inadequate. The current study explores how preventative efforts could be aided through short-term prediction and modelling of risk factors for self-harm. METHODS: Patients (72% female, Mage = 40.3 years) within an inpatient psychiatric facility self-reported their psychological distress, interpersonal circumstances, and wish to live and die on a daily basis during 3690 unique admissions. Hierarchical logistic regressions assessed whether daily changes in self-report and history of self-harm could predict self-harm, with machine learning used to train and test the model. To assess interrelationships between predictors, network and cross-lagged panel models were performed. RESULTS: Increases in a wish to die (ß = 1.34) and psychological distress (ß = 1.07) on a daily basis were associated with increased rates of self-harm, while a wish to die on the day prior [odds ratio (OR) 3.02] and a history of self-harm (OR 3.02) was also associated with self-harm. The model detected 77.7% of self-harm incidents (positive predictive value = 26.6%, specificity = 79.1%). Psychological distress, wish to live and die, and interpersonal factors were reciprocally related over the prior day. CONCLUSIONS: Short-term fluctuations in self-reported mental health may provide an indication of when an individual is at-risk of self-harm. Routine monitoring may provide useful feedback to clinical staff to reduce risk of self-harm. Modifiable risk factors identified in the current study may be targeted during interventions to minimise risk of self-harm.

The significance of the Interpersonal-Psychological Theory of Suicide in an oncological context-A scoping review.

OBJECTIVES: Since individuals afflicted with cancer are at an elevated risk of dying by suicide, understanding suicide-related ideation and behaviours is critical in identifying vulnerable patients. The interpersonal theory of suicide (IPTS) provides a framework to research risk factors for suicide and has been validated in different samples. The aim of this scoping review is to study literature related to IPTS and cancer patients. METHODS: This scoping review was registered with the OPEN Science Framework (osf.io/92465). The databases PsycINFO, Web of Science, PubMed and PubMed Central were searched. Eligible research needed to use a minimum of one psychometric element to measure at least one of the factors of the IPTS in individuals with cancer. RESULTS: Ninety-six studies were identified and screened. Eligible research included individuals with cancer and the use of at least one measurement of at least one of the factors of the IPTS. Overall, four articles met the inclusion criteria and three studies found significant associations of components of the IPTS and suicidal ideation/behaviour. CONCLUSION: While these initial findings support the notion that the IPTS is relevant for individuals with cancer as well, a direct validation of the IPTS in cancer patients is needed.

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.

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.