Empirical extension of the interpersonal theory of suicide: Investigating the role of interpersonal hopelessness

Highlights

• Interpersonal hopelessness (IH) was positively correlated to suicide risk.

• IH was positively correlated to thwarted belongingness (TB).

• IH was positively correlated to perceived burdensomeness (PB).

• Interaction of IH×TB×PB predicted suicide risk.

• Interaction of general hopelessness×TB×PB did not predict suicide risk.

Abstract

The Interpersonal Theory of Suicide posits that hopelessness about thwarted belongingness and perceived burdensomeness is an important risk factor for the desire for suicide and suicide risk. Past research has indicated that general feelings of hopelessness interact with the constructs of thwarted belongingness and perceived burdensomeness to predict suicide ideation. However, no research has explicitly tested whether hopelessness specific to the interpersonal constructs of thwarted belongingness and perceived burdensomeness predicts suicide ideation and suicide risk. Participants in the current study (N = 173) were undergraduate students oversampled for history of suicide ideation, planning for suicide, and suicide attempt(s). Participants completed study measures online, including a new measure of hopelessness about thwarted belongingness and perceived burdensomeness. Results indicated that a three-way interaction of thwarted belongingness, perceived burdensomeness, and hopelessness about these interpersonal constructs, but not general hopelessness, predicted unique variance of suicide ideation and suicide risk. Results suggest that hopelessness about thwarted belongingness and perceived burdensomeness may be an important target for reducing suicidal desire.

Introduction

Suicide-related behaviors are a source of considerable public health burden and represent a significant unaddressed mental health need (United States Department of Health and Human Services, 2012). As a result, professional organizations and experts in the field have called for the development of additional suicide prevention programs (e.g., Asarnow and Miranda, 2014; Suicide Prevention Resource Center and SPAN USA, 2010). Development of efficacious prevention programs, however, requires a thorough empirical foundation and theoretical understanding (Craig et al., 2008). Thus, efforts to clarify and refine theoretical models of suicide-related behaviors are paramount.

The construct of hopelessness is posited to be an important etiological and maintaining factor of suicide risk which has been integrated in multiple theoretical models of suicide (Baumesiter, 1990; Klonsky and May, 2015; O’Connor, 2011; Van Orden et al., 2010; Wenzel et al., 2009). Hopelessness is defined as experiencing negative expectancies for oneself and one's future (Beck et al., 1974). Strong empirical support exists for positive associations between hopelessness and behaviors along the suicide spectrum, including suicide ideation (e.g., Brezo et al., 2006; Russell and Joyner, 2001), suicide attempts (Valtonen et al., 2005), and death by suicide (Beck et al., 1989, Kovacs and Garrison, 1985, Brown et al., 2000). Given that research supports a strong relationship between hopelessness and suicidal thoughts and behaviors, it is not surprising that hopelessness has been adopted as a central component of contemporary theories of suicide, such as the Interpersonal Theory of Suicide (ITS; Joiner, 2005; Van Orden et al., 2010).

Briefly, the ITS posits that death by suicide is comprised of two key factors, suicidal desire and capability to make a lethal suicide attempt. Suicidal desire develops as a result of experiencing thwarted belongingness, perceived burdensomeness, and hopelessness about the future improvement of these states (Van Orden et al., 2010). Thwarted belongingness is defined as a perception of a lack of desired, reciprocally caring relationships and an unmet desire to belong. Perceived burdensomeness is the perception (whether objectively true or not) that one is a burden on others and that one's friends, family, or society generally would be improved if the individual were to die (Van Orden et al., 2010). The theory suggests that the simultaneous presence of both perceived burdensomeness and thwarted belongingness creates the desire to die and poses the high risk for suicide ideation. However, these constructs are viewed as varying over time due to changing interpersonal and intrapersonal variables (Van Orden et al., 2010). As such, it is hypothesized that the presence of these constructs leads to the development of passive suicide ideation; however, when these cognitive states are perceived as unlikely to change with the passing of time, active suicidal desire may surmount. Van Orden et al. (2010) posited that individuals develop active suicidal desire when there is a simultaneous presence of global perceived burdensomeness, complete thwarted belongingness, and hopelessness regarding future changes in interpersonal relationships. Therefore, it is the addition of hopelessness regarding the interpersonal constructs of perceived burdensomeness and thwarted belongingness (i.e., interpersonal hopelessness) that moves an individual from passive suicidal desire (unstable, changing perceptions) to active suicidal desire (stable perceptions about the self, world, and future; Hagan et al., 2016; Van Orden et al., 2010).

Two studies have provided some initial support for the ITS assertion that hopelessness interacts with thwarted belongingness and perceived burdensomeness in the prediction of suicidal desire. Hagan et al. (2015) found that general hopelessness moderated the interaction of thwarted belongingness and perceived burdensomeness’ prediction of suicidal thoughts and urges among college students and clinical outpatients. Talley et al. (2015) also found that proxy measures of thwarted belongingness, perceived burdensomeness, and general hopelessness interacted in the prediction of suicide ideation in a sample of women endorsing high levels of sexual self-concept ambiguity. It should be noted however that other research has failed to find support for the theorized interactive effect (Christensen et al., 2013, Wolford-Clevenger et al., 2016).

The inconsistency in research support for the interactive relationship between hopelessness, thwarted belongingness, and perceived burdensomeness may be in part due to the assessment of general levels of hopelessness. No published study that we are aware of has measured hopelessness specific to feelings of thwarted belongingness and perceived burdensomeness. For this reason, the current study sought to initially validate a new self-report measure of hopelessness regarding the constructs of thwarted belongingness and perceived burdensomeness. In addition, the current study tests the central ITS argument that the interaction of thwarted belongingness, perceived burdensomeness, and hopelessness about these interpersonal states increases susceptibility for active suicidal desire. In line with the ITS, we expect the three-way interaction between thwarted belongingness, perceived burdensomeness, and hopelessness about these constructs would predict suicide ideation and suicide risk. Additionally, we hypothesized that this effect will be stronger than the relationship between suicide risk and the interaction of thwarted belongingness, perceived burdensomeness, and general hopelessness.