Generalisability of the interpersonal theory of suicide to latent profiles of young people attending treatment in a suicide prevention service.

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.

Temporal exploration of the interpersonal theory of suicide among adolescents during treatment.

OBJECTIVE: The interpersonal theory of suicide (ITS) predicts perceived burdensomeness, thwarted belongingness, and hopelessness lead to suicidal ideation and recommends burdensomeness and belongingness should be the targets of treatment. Limited research has tested if burdensomeness and belongingness temporally predict suicidal ideation during treatment. This study examined the bidirectional relationships between burdensomeness, belongingness, hopelessness, depression, and suicidal ideation in young people seeking treatment for suicide-related behaviors. METHOD: A sample of 638 Australian young people (69.3% females, Mage = 16.61 [SD = 2.99]) completed measures of burdensomeness, belongingness, hopelessness, depression, and suicidal ideation at each session of treatment (Msessions = 5.24 [SD = 2.16]). A random-intercept cross-lagged panel model examined the within-person direction of effects across the first five occasions of treatment. RESULTS: Autoregressive paths showed hopelessness had carryover effects across all time points. All other variables had carryover effects at four time points. Cross-lagged paths varied, with suicidal ideation predicting depression, burdensomeness, and hopelessness. Belongingness, burdensomeness, and hopelessness predicted suicidal ideation on one occasion. Hopelessness predicted burdensomeness and depression at three time points and predicted belongingness on one occasion. CONCLUSIONS: Results are partially consistent with the ITS, but in contrast to the theory, the most consistent predictor of suicidal ideation was prior suicidal ideation. Prior levels of hopelessness, belongingness, and burdensomeness did influence suicidal ideation at some time points, but the most consistent effects were from hopelessness toward burdensomeness. Theoretical and treatment implications for these findings are discussed, particularly the need to directly address hopelessness in treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychotherapy and youth suicide prevention: An interpretative phenomenological analysis of specialist clinicians' experiences.

The study explored psychologists' experiences in delivering short-term psychotherapy for suicidal adolescents and sought to clarify how these experiences fit with empirically supported interventions and the interpersonal psychological theory of suicide. Semistructured interviews were conducted with 12 psychologists' who provided short-term psychotherapy in a suicide prevention programme for youth (12- to 25-year-olds). Interview transcripts were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (i) understand the experience and context of the suicidality and the importance of a formulation-based approach to engagement and individualized treatment planning; (ii) involve broad support systems, and in particular families, to help the young person reduce feelings of burdensomeness and increase safety, connectedness and belonging; and (iii) improve affect regulation and reflective functioning, important not only for the young person but also for the support system to maximize the positive impact of supports via emotional coregulation and effective problem-solving. Interventions and approaches as well as the potential underlying processes of change being targeted are discussed in light of these findings. As an example, the development of a suicide safety plan was an intervention that traversed these themes. When used as a process tool, it helped foster a collaborative, formulation, dimensional and biopsychosocial approach to treat psychopathology and suicidality and extended beyond the therapist-client dyad. Moreover, treatment needs to be extended beyond the therapist-client dyad to allow therapists to facilitate a systemic treatment response, as this was seen as a major component of interventions for suicidal youth.

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

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