Meaningful Associations Between Motivation for Treatment and Interpersonal Needs Within a Residential Sample of Women With Eating Disorders.

OBJECTIVE: Perceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment. METHODS: Participants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross-lagged panel models (AR-CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment. RESULTS: Motivation was significantly negatively correlated with PB and TB at all timepoints. In AR-CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR-CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint. DISCUSSION: This study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

Enabling and inhibiting doctors transitions: introducing the social identity resource and belonginess model (SIRB).

The transition into postgraduate medical training is complex, requiring an integration into the workplace, adjustment to new identities, and understanding of the social and organisational structure of healthcare. Studies suggest that social resources, including a sense of belonging, inclusivity from social groups, and having strong social identities can facilitate positive transitions. However, little is known about the role these resources play in junior doctors' transitions into the healthcare community. This study aimed to explore the implications of having access to social resources for junior doctors. This study undertook secondary analysis from a longitudinal qualitative study which followed 19 junior doctors (residents within two years of qualification) for nine months. Data were thematically analysed using an abductive approach, with the social identity resource and belongingness (SIRB) model as a conceptual lens to explore how social networks of support act as identity resources (IRs) for junior doctors as they experience transitions. The doctors narrated that having accessible IRs in the form of supportive workplace relationships enabled an integration and a sense of belonging into healthcare practice, supported the construction of new professional identities, and strengthened career intentions. Those with inaccessible IRs (i.e. poor workplace relationships) expressed a lack of belonging, and casted doubt on their identity as a doctor and their career intentions. Our study indicates that SIRB model would be beneficial for medical educators, supervisors, and managers to help them understand the importance and implications of having IRs within the workplace environment and the consequences of their accessibility for healthcare staff experiencing transitions.

Defeat, entrapment and suicidal ideation in a Turkish community sample of young adults: an examination of the Integrated Motivational-Volitional (IMV) model of suicidal behaviour.

The present study examines the relationships between defeat, entrapment, suicidal ideation, thwarted belongingness, and perceived burdensomeness through the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour in a sample of Turkish young adults. The sample consisted of 451 individuals (72.5% females, Mage= 25.20). The correlation analyses revealed significant relationships between defeat, entrapment, suicidal ideation, thwarted belongingness, perceived burdensomeness in the expected directions. Mediation and moderation analyses partly confirmed the assumptions of the motivational phase of the IMV model; entrapment played a mediating role between defeat and suicidal ideation, and thwarted belongingness (but not perceived burdensomeness) had a moderating role in the pathway between entrapment and suicidal ideation. These findings add a new dimension to the understanding of suicide risk and potential protective factors through the IMV model, which was tested for the first time in the Turkish population. It is anticipated that this study will contribute to suicide prevention intervention strategies, especially for young adults, at-risk group for suicide in Turkey.

Targeting belongingness among older people through engagement in senior centres: intervention development study in Denmark.

Adults often experience a loss of social relations and sense of belonging in later life, leading to the risk of social isolation. Municipal senior centres offer a potential site for intervention, as they provide social communities targeting older people. However, not all older people find it easy to access these social communities due to experiencing physical and/or psychosocial frailties and could therefore continue to experience a decline in social relations and sense of belonging, which potentiates poor physical and psychosocial health and well-being. To date, there are limited evidence-based interventions in Denmark. The present article describes the development of an intervention to increase belongingness and decrease social isolation among older people with frailties who attend Danish municipal senior centres. The development process was conducted with reference to the INDEX (IdentifyiNg and assessing different approaches to DEveloping compleX intervention) guidance. The development process resulted in a 6-month supportive intervention, consisting of four elements: skills development workshops for all staff members; a start conversation including frailty screening; allocation of a 'buddy' among existing service users; and monthly follow-up conversations with staff members. This theory-informed approach can progress to feasibility testing and outcome evaluation in order to generate an evidence base. Concurrently, the article reflects on current guidance for intervention development and how it may be used and optimized to strengthen developmental processes in the future.

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.

The Social Environment Matters for Telomere Length and Internalizing Problems During Adolescence.

Depression and anxiety symptoms are on the rise among adolescents. With increasing evidence that cellular aging may be associated with depressive and anxiety symptoms, there is an urgent need to identify the social environment context that may moderate this link. This study addresses this research gap by investigating the moderating role of the social environment on the relation between telomere length and emotional health among adolescents. Participants were 411 non-Hispanic (88.56%) Black (100%) adolescents (M = 14.23 years, SD = 1.85, female = 54%) in a major metropolitan city. Youth and parents reported on an array of social risk and protective factors, and youth provided DNA samples for telomere length measurement. Results demonstrated that the association of telomere length and anxiety symptoms was stronger among youth with higher perceived stress or lower school belongingness, and the association of telomere length with depressive symptoms was stronger under conditions of higher parent inter-partner psychological aggression. The results enhance our understanding of the complex associations between biological aging, the social environment, and mental health in adolescence.

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.

Connected for life: How social connectedness can help prevent suicide in American Indian and Alaska Native communities.

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

Thwarted Belongingness and Depressive Symptoms Among Older Adults: The Moderating Roles of Self-Warmth, Self-Coldness, and Place of Residence.

OBJECTIVES: This study investigated whether the relationship between thwarted belongingness and depressive symptoms was moderated by self-warmth and self-coldness and whether the moderating effects were conditional on place of residence (urban versus rural). METHODS: A sample of 236 Australian adults aged 65 to 97 years (M = 73.63, SD = 6.53) completed the Geriatric Depression Scale, Interpersonal Needs Questionnaire, and Self-Compassion Scale. RESULTS: The interaction between thwarted belongingness and self-warmth was significant for urban but not rural older adults. For urban older adults, the relationship between thwarted belongingness and depressive symptoms weakened as levels of self-warmth increased. The association between thwarted belongingness and depressive symptoms was significantly stronger for older adults living in rural areas than in urban areas. The relationship between thwarted belongingness and depressive symptoms strengthened as self-coldness levels increased. CONCLUSIONS: Self-warmth is a protective factor for older adults living in urban areas and experiencing thwarted belongingness. Self-coldness is an additional risk factor for older adults experiencing thwarted belongingness. CLINICAL IMPLICATIONS: Interventions focusing on increasing self-warmth among urban older adults and decreasing self-coldness among older adults might weaken the relationship between thwarted belongingness and depressive symptoms.

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.

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.

Do they really care? Specificity of social support issues in hoarding disorder and obsessive-compulsive disorder.

OBJECTIVES: Unmet interpersonal needs may play a role in excessive emotional attachments to objects for people with hoarding disorder (HD). Previous research indicates that social support (but not attachment difficulties) may be specific to HD. The study aimed to evaluate social networks and support in HD relative to clinical controls with obsessive-compulsive disorder (OCD) and healthy controls (HC). The secondary aim was to explore the extent of loneliness and thwarted belongingness. Potential mechanisms for deficits in social support were also considered. DESIGN: A cross-sectional between-groups design was used to compare scores on measures in those with HD (n = 37); OCD (n = 31); and HCs (n = 45). METHODS: Participants completed a structured clinical interview by telephone (to assign diagnostic categories) followed by online questionnaires. RESULTS: Whilst individuals with HD and OCD both report smaller social networks than HC, lower levels of perceived social support appear to be specific to HD. The HD group also showed higher levels of loneliness and thwarted belonging compared to OCD and HC. No differences were found between groups for perceived criticism or trauma. CONCLUSIONS: The results support previous findings of lower levels of self-reported social support within HD. Loneliness and thwarted belongingness also appear significantly elevated within HD compared with OCD and HC. Further research is required to explore the nature of felt support and belonging, direction of effect and to identify potential mechanisms. Clinical implications include advocating and promoting support systems (both personal supporters and professionals) for individuals with HD.

Understanding the role of parents' social connectedness in children's behavioral wellbeing in low-income communities: A study protocol.

Group-based parent-training (PT) is one of the most common and well-established approaches for strengthening parenting skills and reducing child behavior problems. When offered in school settings, the social connections formed among participants may generate additional benefits for parents, schools, and children. However, to date there has been limited research on the potential benefits or harms associated with social connectedness (SC) in group-based PT. This paper describes the study protocol for an ongoing National Institute of Nursing Research-funded mixed-methods study that aims to examine the extent to which group-based PT, delivered in elementary schools serving families from predominantly low-resource communities, generates SC among parents and if SC is associated with greater (a) reduction in child behavior problems and (b) engagement in their child's education. Using a prospective descriptive design, the study is nested within an ongoing quasi-experimental parent study evaluating the group-based PT intervention, the Chicago Parent Program (CPP) in Baltimore City schools. Challenges for this study include recruitment and retention of parents with constraints caused by the COVID-19 pandemic. The study uses multiple methods and informants to understand the potential mechanisms underlying PT group effects and results have the potential to serve as an important foundation for future studies focused on SC, its impacts on parent-child outcomes in low-resource settings, and strategies for strengthening SC in health promotion interventions. PATIENT OR PUBLIC CONTRIBUTION: Chicago Parent Program was developed with input from an advisory board of parents. Additionally, the parent study protocol was written and is co-led in partnership with a community organization.

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.

Suicidal ideation among men during COVID-19: Examining the roles of loneliness, thwarted belongingness, and personality impairment.

Suicidal ideation (SI) is a known precursor to suicide among men. While loneliness and thwarted belongingness (TB) have been identified as key factors influencing SI, no study has reported on all three constructs to investigate whether loneliness is associated with SI by way of TB. Furthermore, it is not clear whether personality impairment has a moderating role on this process. The present study examined the impact of loneliness on SI among men and whether TB mediated this relationship. Additionally, the study investigated whether personality impairment (i.e., self-functioning, interpersonal functioning) moderated the relationship between loneliness and TB. Canadian men (N = 434) completed an online survey that included self-report assessments of the study constructs. Conditional process modeling was used to test the indirect effect of loneliness on SI via the mediating effect of TB. Findings indicated a significant association between loneliness and SI that was mediated by TB. Further, impairment in self-functioning moderated the relationship between loneliness and TB, indicating that the relationship was stronger among men with greater difficulties in self-functioning. The findings are important to consider within the COVID-19 context, as they point to the need to reduce the detrimental impacts of loneliness, thereby potentially mitigating male SI.

Can I count on you? Social support, depression and suicide risk.

OBJECTIVES: Interpersonal factors play an important role in the etiology and treatment of depression. Social support derives from compassionate words and helpful actions provided by family, friends or a significant other. The present study was designed to examine various sources of social support as they relate to the severity of depressive symptoms, hopelessness and suicide risk in adult psychiatric outpatients. METHOD: Participants were recruited through mental health clinics at a veteran's affairs medical centre. A total of 96 depressed patients were assessed using a diagnostic interview and self-report measures of depression severity, hopelessness and social support. Among these depressed adults, 45.8% had attempted suicide at least once. Social support variables were compared between suicide attempters and non-attempters to better understand the relationship between social support and suicidal behaviour. RESULTS: Depression severity and hopelessness were both significantly associated with lower levels of social support in multiple areas. Individuals with a history of suicide attempt reported lower levels of available support as compared to those who have never attempted suicide. CONCLUSION: Deficient social relationships increase the risk of suicide in depressed patients, exceeding the impact of depression alone on suicide risk. The lack of social support may play a vital role in feelings of hopelessness and isolation that contribute to a suicidal crisis. Psychosocial treatment should be considered to reduce the risk of suicide and severity of depression by strengthening social support and bolstering interpersonal relationships.

Community belongingness during COVID-19 predicts anxiety and depression treatment change in college students.

OBJECTIVE: Community belongingness has been shown to be related to mental health outcomes in college students; however, little work has evaluated whether community belongingness impacts treatment change, especially during the COVID-19 pandemic, when social isolation and mental health concerns are exacerbated. Accordingly, the current study evaluated community belongingness as a predictor of treatment change for anxiety and depression in a university counseling center. METHOD: Participants included 516 young adults with clinical levels of anxiety or depression who attended at least two individual therapy sessions at a university counseling center during fall 2020. Participants completed broad measures of psychosocial functioning at each session. RESULTS: Paired-samples t-tests indicated that students demonstrated significant decreases in anxiety and depression after just one session. Linear stepwise regressions revealed that community belongingness was a significant predictor of symptom improvement for both anxiety and depression. CONCLUSION: These results suggest improving community belongingness on college campuses may be a way to buffer mental health and improve treatment outcomes for students seeking psychological services. Specific clinical and educational recommendations for ways to improve community belongingness are discussed.

Political violence and posttraumatic stress symptoms among Palestinians: The mediating roles of sense of belongingness and loneliness.

The current study investigated the correlation between political violence and posttraumatic stress symptoms (PTSS) and whether the sense of belongingness (SOB) and loneliness mediate the correlation between the two variables among Palestinians living in a society characterised by high political violence and prolonged traumatic events. The study sample consisted of 590 Palestinian adults, consisting of 360 men and 230 women, and were recruited using non-probabilistic convenience sampling methods from a village in the northern region of the occupied Palestinian territories. This study suggests a positive correlation between political violence and PTSS, a positive correlation between loneliness and PTSS, and a negative correlation between SOB and PTSS. SOB and loneliness mediated the correlation between political violence and trauma-related symptoms.