Objective
Empirically informed suicide risk assessment frameworks are useful in guiding the evaluation and treatment of individuals presenting with suicidal symptoms. Joiner et al. (1999) formulated ...one such framework, which has provided a concise heuristic for the assessment of suicide risk. The purpose of this review is to ensure compatibility of this suicide risk assessment framework with the growing literature on suicide‐related behaviors.
Methods
This review integrates recent literature on suicide risk factors and clinical applications into the existing model. Further, we present a review of risk factors not previously included in the Joiner et al. (1999) framework, such as the interpersonal theory of suicide variables of perceived burdensomeness, thwarted belongingness, and capability for suicide (Joiner, 2005; Van Orden et al., 2010) and acute symptoms of suicidality (i.e., agitation, irritability, weight loss, sleep disturbances, severe affective states, and social withdrawal).
Results
These additional indicators of suicide risk further facilitate the classification of patients into standardized categories of suicide risk severity and the critical clinical decision making needed for the management of such risk.
Conclusions
To increase the accessibility of empirically informed risk assessment protocols for suicide prevention and treatment, an updated suicide risk assessment form and decision tree are provided.
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal ...theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum.
Public Significance Statement
This meta-analysis generally found support for the interpersonal theory of suicide-thwarted belongingness and perceived burdensomeness were significant correlates of suicidal ideation severity, and thwarted belongingness, perceived burdensomeness, and capability for suicide were significantly associated with suicide attempt history. Effect sizes for these relationships were weak-to-moderate, suggesting potentially modest clinical significance. However, there was insufficient research on the theory's specific hypotheses, including its capacity for predicting death by suicide and the role of viewing thwarted belongingness and perceived burdensomeness as intractable in suicidal desire.
Full text
Available for:
CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
Background
Psychological autopsy studies consistently report that the rate of detected mental disorders among suicide decedents is below 100%. This implies three possibilities: (a) a subset of ...suicide decedents did not have a mental disorder at the time of death; (b) all suicide decedents suffered from a mental disorder, but some were undetected due to methodological limitations; and/or (c) suicide decedents with an undetected mental disorder displayed significant and perhaps subclinical features of a mental disorder.
Objective
In this article, we examined these possibilities by evaluating the differences in symptoms and stressors between suicide decedents who were undiagnosed and those diagnosed with a mental disorder at the time of death.
Method
We reviewed 130 case studies of community‐based suicide decedents originally described in Robins’ (1981) psychological autopsy study.
Results
Without exception, suicide decedents in Robins’ sample suffered either from a clearly diagnosable mental disorder or displayed features indicative of a significant, even if subclinical, presentation of a mental disorder. Undiagnosed and diagnosed suicide decedents did not significantly differ with regards to demographics, violence of suicide method, suicide attempt history, the number and intensity of stressful life events preceding death, and whether their death was a murder‐suicide.
Conclusion
Although clearly not all who suffer from mental disorders will die by suicide, these findings imply that all who die by suicide appear to exhibit, at minimum, subclinical psychiatric symptoms with the great majority showing prominent clinical symptoms. We conclude with clinical implications and recommendations for future study.
The medical complications associated with purging Forney, K. Jean; Buchman-Schmitt, Jennifer M.; Keel, Pamela K. ...
The International journal of eating disorders,
March 2016, Volume:
49, Issue:
3
Journal Article
Objective
Exercise dependence has been linked to capability for suicide and suicidal behavior; however, less understood are which facets of exercise dependence confer risk for suicidal behavior and ...the potential mechanisms of this association. This study examined relationships between exercise dependence, capability for suicide, and past suicidal behavior.
Methods
A sample of 540 individuals recruited via MTurk completed online measures of their exercise dependence, capability for suicide, and history of suicidal behavior.
Results
Suicide attempters reported higher levels of continuance in exercise despite physical or psychological consequences, lack of control over exercise, and reductions in other activities due to exercise than nonattempters. Capability for suicide accounted for the relationship between continuance in exercise despite adverse consequences and lifetime number of suicide attempts.
Conclusions
When exercise becomes pathological in the form of exercise dependence, steps should be taken to reduce such engagement due to its observed association with suicidal behavior.
Objective
Research suggests that weight suppression (WS) is linked to non‐suicidal self‐injury (NSSI) and that drive for thinness and depression may explain this association. We conducted a ...proof‐of‐concept study using a randomized control trial design to determine if improving body esteem and reducing depressive symptoms reduced NSSI in individuals with WS.
Method
Weight suppressed participants (N = 60) who engaged in NSSI were recruited from the community and randomly assigned to an on‐line intervention or control condition. The on‐line intervention was adapted from a cognitive‐dissonance intervention originally designed to reduce thin‐ideal internalization in females to an intervention to reduce internalization of unhealthy body ideals in both genders. Participants' weight/shape concerns, depressive symptoms, and NSSI were assessed at pre‐ and post‐intervention, or at baseline and 2‐week follow‐up for controls.
Results
Compared to controls, participants in the treatment condition reported greater decreases in likelihood of future NSSI Cohen's d (95% CI) = −0.38 (−0.90–0.15), weight/shape concerns −1.19 (−1.75 to −0.62), depressive symptoms −1.00 (−1.56 to −0.45), and significant improvements in appearance 1.27 (0.70–1.84) and weight esteem 1.38 (0.80–1.96).
Discussion
Future work could test this intervention in a larger trial with an active alternative treatment condition.
Abstract Recent research suggests that firefighters experience elevated rates of suicidal ideation and behaviors. The interpersonal theory of suicide may shed light on this finding. This theory ...postulates that suicide desire is strongest among individuals experiencing perceived burdensomeness and thwarted belongingness, and that the combination of suicide desire and acquired capability for suicide is necessary for the development of suicidal behaviors. We tested the propositions of the interpersonal theory in a large sample of current United States firefighters ( N =863). Participants completed self-report measures of perceived burdensomeness, thwarted belongingness, fearlessness about death (FAD; a component acquired capability), and career suicidal ideation and suicide attempt history. Regression models were used to examine the association between interpersonal theory constructs, career suicidal ideation severity, and the presence of career suicide attempts. In line with theory predictions, the three-way interaction between perceived burdensomeness, thwarted belongingness, and FAD was significantly associated with career suicide attempts, beyond participant sex. However, findings were no longer significant after accounting for years of firefighter service or age. Contrary to predictions, the two-way interaction between perceived burdensomeness and thwarted belongingness was not significantly related to career suicidal ideation severity. Applications of the theory to firefighters and future research are discussed.
Abstract Loneliness has been repeatedly associated with sleep problems; however, there is a dearth of research examining the prospective relationship between insomnia and loneliness, as well as this ...association controlling for other psychiatric symptoms. This study evaluated the cross-sectional and prospective relationship between insomnia and loneliness using six samples: 666 undergraduates; 2,785 Army recruiters; 208 adults with a history of suicidality and/or depression; 343 adult psychiatric outpatients; 326 young adults at elevated suicide risk; and 183 undergraduates. A meta-analysis also was conducted to examine the magnitude of the relationship between insomnia and loneliness across the six studies. More severe insomnia symptoms were significantly associated with greater feelings of loneliness while accounting for some (e.g., anxiety, nightmares) but not all (i.e., depression) psychiatric covariates. Findings underscore the strength of the association between insomnia and loneliness and suggest that depression may account for this relationship. Additional studies are needed to further establish the temporal relationship between these variables, delineate the role of depression in the association between insomnia and loneliness, and test whether insomnia may confer unique risk for subsequent loneliness.
Anecdotal and theoretical work suggests blink rate as an indicator of imminent suicide risk. We sought to empirically examine whether suicide decedents displayed a reduced blink rate in goodbye ...videos filmed before death, compared to several control groups. Independent raters coded blink rates from videos of 34 suicide decedents and four comparison groups: "mundane" product review, non-suicidal arousal, non-suicidal depression, and non-imminent risk of suicidal ideation. Mean blink rate was lower in the suicide decedent group relative to all comparison groups (ps < .001), except the depressed (p = .976) and suicidal ideation (p = .393) groups. Findings indicate blink rate may be reduced among individuals at imminent risk for suicide, exhibiting clinically-significant depressive symptoms, or experiencing suicidal ideation.
PDF
