Interpersonal Processes in Depression Hames, Jennifer L; Hagan, Christopher R; Joiner, Thomas E
Annual review of clinical psychology,
03/2013, Volume:
9, Issue:
1
Journal Article
Peer reviewed
Humans have an intrinsic need for social connection; thus, it is crucial to understand depression in an interpersonal context. Interpersonal theories of depression posit that depressed individuals ...tend to interact with others in a way that elicits rejection, which increases their risk for future depression. In this review, we summarize the interpersonal characteristics, risk factors, and consequences of depression in the context of the relevant theories that address the role of interpersonal processes in the onset, maintenance, and chronicity of depression. Topics reviewed include social skills, behavioral features, communication behaviors, interpersonal feedback seeking, and interpersonal styles as they relate to depression. Treatment implications are discussed in light of the current research on interpersonal processes in depression, and the following future directions are discussed: developing integrative models of depression, improving measurement of interpersonal constructs, examining the association between interpersonal processes in depression and suicide, and tailoring interventions to target interpersonal processes in depression.
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 This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct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
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
Abstract Background Firefighters experience high-risk occupational hazards that may confer increased risk for suicide; however, prevalence rates of suicidal thoughts and behaviors among firefighters ...are unknown. The purpose of this study is to describe the career prevalence of suicide ideation, plans, attempts, and non-suicidal self-injury among firefighters, in addition to sociodemographic, physical health, and occupational correlates. Methods Data were obtained from a cross-sectional convenience sample of 1027 current and retired firefighters who completed a nationwide web-based survey on mental health (mean age=38.49, SD=11.70; 91.2% male; 87.3% White). Sociodemographic, physical health, and occupational correlates were assessed via a structured questionnaire. Suicidal thoughts and behaviors were assessed using a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF). Results The career prevalence estimates of suicide ideation, plans, attempts, and non-suicidal self-injury were found to be 46.8%, 19.2%, 15.5%, and 16.4%, respectively. Key factors associated with increased risk for reporting suicidal thoughts and behaviors included lower firefighter rank, fewer years of firefighter service, membership in an all-volunteer department, a history of professionally responding to a suicide attempt or death, and active duty military status. Limitations The current study utilized a cross-sectional convenience sample of firefighters. Conclusions Firefighters report an alarmingly high career prevalence of suicidal thoughts and behaviors. Our preliminary data are compelling, indicating the need for additional research as well as increased prevention and treatment efforts among firefighters to decrease suicide risk.
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.
Objective
Interoception deficits have been associated with various points on the suicidality continuum. Most research, however, has focused on general, rather than specific facets of, interoception. ...This study compared individuals with lifetime suicidal ideation, plans, and attempts using a multidimensional assessment of interoception.
Method
A total of 537 adults completed measures of their interoception and lifetime suicide histories.
Results
Individuals with lifetime suicidal ideation reported more worry about their bodily sensations. Those with lifetime suicide attempts reported a greater tendency to distract themselves from bodily sensations and less self‐regulation using bodily sensations. Individuals at all points of the suicidality continuum reported less trust of their bodily sensations.
Conclusion
These findings suggest that interoception may be impaired in those with a history of suicidal thoughts and behaviors. Longitudinal designs are needed to parse apart the interplay of these variables and directionality of these relationships.
Building upon the idea that humans may be a eusocial species (i.e., rely on multigenerational and cooperative care of young, utilize division of labor for successful survival), we conjecture that ...suicide among humans represents a derangement of the self-sacrificial aspect of eusociality. In this article, we outline the characteristics of eusociality, particularly the self-sacrificial behavior seen among other eusocial species (e.g., insects, shrimp, mole rats). We then discuss parallels between eusocial self-sacrificial behavior in nonhumans and suicide in humans, particularly with regard to overarousal states, withdrawal phenomena, and perceptions of burdensomeness. In so doing, we make the argument that death by suicide among humans is an exemplar of psychopathology and is due to a derangement of the self-sacrificial behavioral suite found among eusocial species. Implications and future directions for research are also presented.
Full text
Available for:
CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
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.
•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.
The conservative management of cervical radiculopathy is supported by moderate evidence to include interventions such as manual therapy, traction, and therapeutic exercise. There is sparse evidence, ...however, to support specific manual therapy techniques, particularly thrust manipulation.
A 35-year-old male presented to physical therapy with a clinical diagnosis of cervical radiculopathy. He complained of neck and upper arm pain with 1st and 2nd digit paresthesias. He was initially managed with repeated movements that restored the cervical range of motion and centralized neck and upper arm pain. Non-thrust upslope joint mobilizations resulted in improved sensation detection in the hand, but the paresthesias did not completely resolve. Immediately following cervical spine upslope thrust manipulation, symptoms fully resolved.
: The patient fully returned to prior level of function. His DASH score reduced from 40/100 to 2/100, PSFS improved from 1.66/10 to 9.66/10, and he reported to be 'a great deal better' on the GROC.
This case demonstrates the safe and effective utilization of cervical spine thrust manipulation and non-thrust mobilization in the management of a patient with cervical radiculopathy with lingering paresthesias in the distal upper extremity.
Abstract Background Suicide rates among veterans are disproportionately high compared to rates among the general population. Veterans may experience a number of negative emotions (e.g., anger, ...self-directed hostility, shame, guilt) during periods of postwar adjustment and reintegration into civilian life that may uniquely confer risk for suicide. Mechanisms of these associations, however, are less well studied. The purpose of the present study was to examine the relationship between negative emotions and suicide risk in veterans through the theoretical framework of the interpersonal theory of suicide. Methods A large sample of veterans ( N = 541) completed measures assessing their negative emotions, perceived burdensomeness, thwarted belongingness, and suicide risk. Results Self-directed hostility and shame related indirectly to suicide risk through both perceived burdensomeness and thwarted belongingness. Thwarted belongingness accounted for the association between anger and suicide risk, whereas perceived burdensomeness accounted for the relationship between guilt and suicide risk. Limitations This study had a cross-sectional design and relied solely on self-report measures. Conclusions These findings provide evidence for the role of negative emotions in conferring risk for suicide in veterans. Clinical implications, limitations, and future research directions are discussed.
The current study examined how the theory of planned behavior (TPB) constructs predict college students' intent to ask about suicide and refer a potentially suicidal peer to support. Using an ...experimental design, 420 college students (M
age
= 19.61, SD = 1.50 yrs) were randomly assigned to read one of four vignettes depicting a peer in distress that varied suicide risk severity (low vs. high) and perceived causes of the distress (internal vs. external). Participants read their vignette and answered questions measuring TPB constructs and items assessing intent to ask about suicide and intent to refer the peer to services. Results indicated that subjective norms were associated with intent to ask about suicide and attitudes impact intent to refer. Only the interaction between risk severity and perceived behavioral control in predicting intent to refer and intent to ask were significant. Peers who perceive risk to be high are more likely to refer peers regardless of perceived behavioral control and are increasingly more likely to ask about suicide as perceived behavioral control increases. When risk severity is low and perceived behavioral control is low, peers are less likely to refer or ask about suicide. The theory of planned behavior has relevance to understanding peer intent to intervene with an at-risk peer and may be beneficial to guiding the development of effective suicide prevention programs.
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