Kelly L. Zuromski

Perceived burdensomeness, thwarted belongingness, and suicide ideation: Re-examination of the Interpersonal-Psychological Theory in two samples.

The Interpersonal-Psychological Theory of Suicide (IPTS) proposes that suicide ideation is caused by the interaction of perceived burdensomeness and thwarted belongingness, in which each predictor amplifies the harm of the other. Though several studies support this synergy hypothesis, research has not considered potential quadratic effects of perceived burdensomeness and thwarted belongingness, which can distort the sign, size, and significance of interactions, if mistakenly neglected in a model. This investigation examined the synergy hypothesis in samples of university undergraduates and psychiatric inpatients, this time controlling for quadratic effects. Despite adequate power, results showed no interaction between perceived burdensomeness and thwarted belongingness in either sample, regardless of the presence of quadratic effects. Additionally, no quadratic effects were observed. The lower-order, linear perceived burdensomeness term was positively associated with suicide ideation in both samples, but the thwarted belongingness term was not associated with suicide ideation in either sample. The discussion considers implications of current findings for the IPTS, highlighting a need to formally test the impact of sample characteristics on the estimation of theory parameters. Recommendations for systematic evaluation of such sample and theory parameters are offered and their clinical implications are discussed.

PTSD symptom clusters are differentially associated with components of the acquired capability for suicide

Previous research has established the link between posttraumatic stress disorder (PTSD) and suicidal behavior. In the current study, constructs proposed to explain this relationship were examined, applying the framework of the interpersonal-psychological theory of suicide (IPTS). Relationships between acquired capability for suicide (ACS; i.e., fearlessness about death [FAD] and pain tolerance) and specific PTSD symptom clusters were explored. In a sample of 334 trauma-exposed undergraduates, anxious arousal and FAD were negatively associated, and numbing and pain tolerance were positively associated. Results establish a foundation for investigating the role of ACS in understanding observed relationships between suicidal behavior and PTSD symptoms.

Fasting and acquired capability for suicide: A test of the interpersonal-psychological theory of suicide in an undergraduate sample

Though some preliminary research within the framework of the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005) has postulated that restrictive eating may contribute to increased risk for suicide through its effect on the acquired capability for suicide (ACS; i.e., increased fearlessness about death and heightened physical pain tolerance), existing studies have not conducted direct tests of this relationship. To enhance understanding of this relationship, we compared undergraduates who endorsed one form of restrictive eating, fasting, (n = 99) to controls endorsing no forms of eating pathology over the lifetime (n = 94). We hypothesized that the fasting group would have higher ACS and higher likelihood of suicide attempt history. Contrary to hypotheses, no differences emerged between groups on ACS, and frequency of fasting within the fasting group was not significantly associated with ACS. Consistent with hypotheses, the fasting group was more likely to have suicide attempt history. Though results were not entirely consistent with hypotheses, the current study represents the first attempt at isolating and examining one form of restrictive eating (i.e., fasting) within the context of the IPTS. Results suggest that, in isolation, fasting may not be directly contributing to increases in ACS.

Increased prevalence of vegetarianism among women with eating pathology

OBJECTIVE Prior research has established a link between vegetarianism and disordered eating but has typically sampled vegetarians. This study examined prevalence of and variables related to vegetarianism in three samples with varying severity of eating pathology. METHOD Sample 1 consisted of female undergraduates who denied history of or current disordered eating (i.e., nonclinical; n=73), or engaged in disordered eating over past month (i.e., subclinical; n=136). Sample 2 included 69 female patients receiving residential treatment at an eating disorder center (i.e., clinical sample). Differences between groups were analyzed using Fishers exact test. RESULTS The prevalence of lifetime vegetarianism was lowest in the nonclinical group (6.80%) and highest in the clinical group (34.80%), with the subclinical group falling in between (17.60%). According to Fishers exact test, all pairwise comparisons between groups were statistically significant (ps<.05). Regarding current vegetarian status, the clinical group was more likely (11.10%) than both other groups to self-identify as current vegetarians. DISCUSSION Endorsement of vegetarianism was highest among females with severe eating pathology. Future research should use longitudinal data to examine the temporal relationship between these variables, or other underlying factors that may contribute to the co-occurrence of eating pathology and vegetarianism. Clinically, endorsement of vegetarianism may also be an important variable to consider in treatment disordered eating.

Suicidality in adolescents and adults with binge‐eating disorder: Results from the national comorbidity survey replication and adolescent supplement

OBJECTIVE The relation between binge-eating disorder (BED) and suicidality (i.e., suicide ideation, plan, and/or attempt) has not been studied extensively, and it is unknown whether BED is uniquely associated with suicidality when adjusting for comorbid psychopathology. Moreover, the course of suicidality in BED has not been determined and it is unknown whether BED precedes suicidality or vice versa. METHOD A total of 10,123 adolescents and 2,980 adults from two nationally representative surveys were administered diagnostic interviews assessing psychopathology and suicidality, as well the retrospectively reported ages of onset. RESULTS Among adults and adolescents, BED was associated with elevated odds of suicide ideation, plan, and attempt at a univariate level, but BED was not associated with elevated odds of suicidality when adjusting for comorbid psychopathology. Kaplan-Meier estimates of temporal patterns displayed that most adolescents experienced suicidality onset following BED onset, whereas most adults experienced suicidality onset prior to BED onset. DISCUSSION BED, comorbid disorders, and suicidality share common factors and interrelations, and individuals with BED and comorbid disorders may be at particularly high risk for suicidal outcomes. The presence of BED in adolescence may serve as a marker for more severe symptomatology that precedes the occurrence of suicidality. Research is needed to understand how eating disorder symptoms, comorbid symptoms, and suicidality affect one another over time.

Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research

Suicide is the second leading cause of death among individuals with anorexia nervosa (AN), and suicidal behavior is elevated in bulimia nervosa (BN) and binge eating disorder (BED) relative to the general population. This paper reviews the suicidality literature within each ED, as well as theoretical explanations for the elevated risk for suicidality among those with EDs. Approximately one-quarter to one-third of people with AN, BN, or BED have thought about suicide, and one-quarter to one-third of people with AN and BN have attempted suicide. Relative to gender and aged matched comparison groups, individuals with AN are 18 times more likely to die by suicide, and individuals with BN are seven times more likely to die by suicide. However, the majority of the research in this area is cross-sectional or retrospective, which leaves the timing of the mortality risk unclear. Longitudinal work that is designed to examine dynamic and acute fluctuations in suicidality among ED samples is needed in order to determine meaningful risk factors.

Posttraumatic Stress Disorder Symptom Clusters and Acquired Capability for Suicide: A Reexamination Using DSM-5 Criteria

This study used the interpersonal-psychological theory of suicide to explore the relationships among DSM-5 posttraumatic stress disorder (PTSD) symptom clusters derived from the six-factor anhedonia model and facets of acquired capability for suicide (ACS). In a sample of 373 trauma-exposed undergraduates, most PTSD symptom clusters were negatively associated with facets of ACS in bivariate correlations, but the anhedonia cluster was positively associated with ACS in regression models. Structure coefficients and commonality analysis indicated that anhedonia served as a suppressor variable for the other symptom clusters. Our findings further elucidate the complex relationship between specific PTSD symptom clusters and ACS.

The quadratic relationship between body mass index and suicide ideation: a nonlinear analysis of indirect effects

&NA; A nonlinear indirect effects framework was used to investigate potential interpersonal indirect effects (i.e., perceived burden and thwarted belonging) accounting for the nonlinear relationship between body mass index (BMI) and suicide ideation. Using a sample of 338 undergraduates, results revealed a significant quadratic effect of BMI on suicide ideation via perceived burden only, which became significant as BMI fell below 18.00 kg/m2 and above 28.00 kg/m2. Our results provide novel information relevant for suicide risk screening in the context of weight‐ and health‐related interventions and provide justification for future longitudinal trials assessing suicide risk across the BMI spectrum.

Insomnia symptoms drive changes in suicide ideation: A latent difference score model of community adults over a brief interval.

Insomnia is robustly associated with suicidal behavior, but methodological limitations in existing studies hinder nuanced understanding of this relationship. The current study addressed these limitations by utilizing a longitudinal design and advanced statistical modeling. Participants who endorsed lifetime experience of suicidal behavior were recruited through Amazon’s Mechanical Turk (N = 589) and completed self-report online surveys at 6 time points over a 15-day period. Latent difference score modeling was utilized to investigate whether levels and/or changes in insomnia symptoms drive subsequent changes in suicide ideation, or vice versa. Results revealed that previous level of insomnia symptoms was predictive of positive changes in suicide ideation (i.e., level of insomnia symptoms predicted lagged increases in suicide ideation). This relationship was not bidirectional (i.e., suicide ideation exerted no effects on insomnia symptoms). Additionally, only previous level, and not previous changes, in insomnia symptoms were predictive of changes in suicide ideation. Our results help clarify the nature of the relationship between insomnia symptoms and suicide ideation as one that is unidirectional, thereby offering evidence of insomnia symptoms as a variable risk factor for suicide ideation. These findings yield clinical implications, including the importance of screening for insomnia symptoms, and provide support for exploring the potential effectiveness of insomnia treatments to target suicide ideation. Moreover, our study design and methodology establish a foundation for more rigorous and nuanced investigations of imminent suicide risk in future studies, which can ultimately promote better clinical practice in the reduction of suicidal behavior.

Race, Offense Type, and Suicide Ideation: Tests of the Interpersonal‐Psychological Theory in Juvenile Offenders

This study evaluated the synergy hypothesis of the Interpersonal-Psychological Theory of Suicide (IPTS), which argues thwarted belongingness and perceived burdensomeness are positively interactive in their association with suicide ideation, in a group of juvenile offenders. It also examined whether this prediction is differentially applicable across race/ethnicity or offense type. Participants included 590 adjudicated and confined male juveniles. Regression was used to test the association between suicide ideation and thwarted belongingness, perceived burdensomeness, and their interaction term. Subsequent analyses included tests of group interactions related to race/ethnicity and offense type. No interaction between thwarted belongingness and perceived burdensomeness was observed, despite adequate power. No significant group interactions were observed for race/ethnicity or offense type. However, results did show significant linear relationships between thwarted belongingness, perceived burdensomeness, and ideation, highlighting their potential utility as intervention targets in this at-risk population. Thus, although the current results are the first to show the basic IPTS risk factors generalize across race/ethnicity and offense type, they also failed to support that those factors were interactive, a primary IPTS claim. The absence of an interaction between thwarted belongingness and perceived burdensomeness suggests their role in suicide ideation for juvenile offenders may be more parsimonious than the IPTS proposes.