Matthew C. Podlogar

The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research.

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 This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct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 Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples.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.

Conceptual and Empirical Scrutiny of Covarying Depression Out of Suicidal Ideation.

Depression and suicidal ideation are highly intertwined constructs. A common practice in suicide research is to control for depression when predicting suicidal ideation, yet implications of this practice have not been subjected to sufficient empirical scrutiny. We explore what, precisely, is represented in a suicidal ideation variable with depression covaried out. In an adult psychiatric outpatient sample (N = 354), we computed two variables—depression with suicidal ideation covaried out, and suicidal ideation with depression covaried out—and examined correlations between these residuals, three factors comprising a variegated collection of psychological correlates of suicidal ideation, psychiatric diagnoses, and past suicidal behavior. Findings indicated that suicidal ideation with depression covaried out appears to be characterized by fearlessness about death, self-sacrifice, and externalizing pathology. We propose that suicidal ideation may comprise two distinct components: desire for death (passive ideation and depressive cognitions) and will (self-sacrifice, fearlessness, externalizing behavior). Implications, limitations, and future directions are discussed.

Insomnia and suicide-related behaviors: A multi-study investigation of thwarted belongingness as a distinct explanatory factor

BACKGROUND Insomnia is a robust correlate of suicidal ideation and behavior. Preliminary research has identified thwarted belongingness (c.f. social disconnection) as an explanatory link between insomnia and suicidal ideation. OBJECTIVES This study replicates and extends previous findings using both cross-sectional and longitudinal designs in four demographically diverse samples. Additionally, the specificity of thwarted belongingness was evaluated by testing anxiety as a rival mediator. METHOD Self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation and behavior, and anxiety were administered in four adult samples: 469 undergraduate students, 352 psychiatric outpatients, 858 firefighters, and 217 primary care patients. RESULTS More severe insomnia was associated with more severe thwarted belongingness and suicidality. Thwarted belongingness significantly accounted for the association between insomnia and suicidality, cross-sectionally and longitudinally, beyond anxiety. Notably, findings supported the specificity of thwarted belongingness: anxiety did not significantly mediate the association between insomnia and suicidality, and insomnia did not mediate the relation between thwarted belongingness and suicidality. LIMITATIONS This study relied solely on self-report measures. Future studies incorporating objective sleep measurements are needed. CONCLUSION Findings underscore the utility of assessing and addressing sleep disturbances and social disconnection to reduce suicide risk.

Evidence for the Propositions of the Interpersonal Theory of Suicide Among a Military Sample.

OBJECTIVE Although the interpersonal theory of suicide may explain the elevated suicide risk among military service members, past explorations have been equivocal. This study aimed to investigate the propositions of the interpersonal theory in a sample of U.S. Army recruiters. METHOD Participants (N = 3,428) completed self-report measures assessing the interpersonal theorys constructs (i.e., thwarted belongingness (TB), perceived burdensomeness (PB), acquired capability for suicide), current suicidal ideation, agitation, and insomnia. History of depression was obtained from medical records. RESULTS Hierarchical multiple regression analyses revealed that the interaction between TB and PB was associated with current suicidal ideation, controlling for depression, agitation, and insomnia. This effect was especially notable among those with high capability for suicide. CONCLUSION Findings provide support for the interpersonal theory in a large, diverse military sample. It may be advantageous to assess and therapeutically address TB and PB among at-risk service members.

Initial Validation of Brief Measures of Suicide Risk Factors: Common Data Elements Used by the Military Suicide Research Consortium.

The Military Suicide Research Consortium (MSRC) developed a 57-item questionnaire assessing suicide risk factors, referred to as the Common Data Elements (CDEs), in order to facilitate data sharing and improve collaboration across independent studies. All studies funded by MSRC are required to include the CDEs in their assessment protocol. The CDEs include shortened measures of the following: current and past suicide risk, lethality and intent of past suicide attempts, hopelessness, thwarted belongingness, anxiety sensitivity, posttraumatic stress disorder symptoms, traumatic brain injury, insomnia, and alcohol abuse. This study aimed to evaluate the psychometric properties of the CDE items drawn from empirically validated measures. Exploratory factor analysis was used to examine the overall structure of the CDE items, and confirmatory factor analyses were used to evaluate the distinct properties of each scale. Internal consistencies of the CDE scales and correlations with full measures were also examined. Merged data from 3,140 participants (81.0% military service members, 75.6% male) across 19 MSRC-funded studies were used in analyses. Results indicated that all measures exhibited adequate internal consistency, and all CDE shortened measures were significantly correlated with the corresponding full measures with moderate to strong effect sizes. Factor analyses indicated that the shortened CDE measures performed well in comparison with the full measures. Overall, our findings suggest that the CDEs are not only brief but also provide psychometrically valid scores when assessing suicide risk and related factors that may be used in future research.

Who Are We Missing? Nondisclosure In Online Suicide Risk Screening Questionnaires

The use of self-report surveys for suicide risk screening is a key first step in identifying currently suicidal individuals and connecting them with appropriate follow-up assessment and care. Online methods for suicide risk screening are becoming more common, yet they present a number of complexities compared with traditional methods. This study aimed to assess whether forcing item responses may unintentionally hide or misrepresent otherwise useful missing suicide risk data. We investigated in secondary analyses of 3 independent samples of undergraduates (ns = 1,306; 694; 172) whether participants who chose not to respond specifically to current suicide risk screening items (i.e., Nondisclosers) scored significantly different from other risk response groups (i.e., Deniers, Lower-Risk Endorsers, and Higher-Risk Endorsers) on auxiliary measures related to suicidality. Multivariate Analysis of Variance (MANOVA) tests for each sample revealed that Nondisclosers were rare (ns = 7, 6, 7) and scored significantly higher than Deniers and similarly to Endorsers on suicide risk related measures. In 1 sample, Nondisclosers tended to score higher than all groups on suicide risk related measures. These findings suggest that nondisclosure for suicide risk screening questions is a preferred option for a distinct group of respondents who are likely at elevated suicide risk. Allowing for and flagging Nondisclosers for follow-up suicide risk assessment may be an ethical and feasible way to enhance the sensitivity of online suicide risk screenings for weary respondents, who if forced, may choose to underreport their suicide risk and misrepresent data. (PsycINFO Database Record

Perceived burdensomeness and thwarted belongingness predict excessive reassurance seeking among clinical outpatients.

OBJECTIVE The current study aimed to investigate whether perceived burdensomeness and thwarted belongingness (i.e., suicide risk factors) were associated with excessive reassurance seeking (a behavior linked to rejection). It was predicted that perceived burdensomeness and thwarted belongingness would predict higher levels of excessive reassurance seeking, controlling for depressive symptoms and global functioning. METHOD A cross-sectional sample of 415 clinical outpatients (62% female; mean age = 28) was examined. RESULTS Perceived burdensomeness and thwarted belongingness significantly predicted excessive reassurance seeking, controlling for depressive symptoms and global functioning. CONCLUSIONS Perceived burdensomeness and thwarted belongingness predicted excessive reassurance seeking, suggesting that it would be beneficial for clinicians to assess for and target excessive reassurance seeking among individuals experiencing perceived burdensomeness and thwarted belongingness so that excessive reassurance seeking does not elicit interpersonal rejection.

Ethical issues and practical challenges in suicide research: collaboration with institutional review boards

Background: Research with human subjects represents a critical avenue for suicide prevention efforts; however, such research is not without its ethical and practical challenges. Specifically, given the nature of research with individuals at elevated risk for suicide (e.g., increased concerns regarding participant safety, adverse events, liability, difficulties often arise during the institutional review board (IRB) evaluation and approval process. Aims: This paper aims to discuss IRB-related issues associated with suicide prevention research, including researcher and IRB panel member responsibilities, suicide risk assessment and management ethics and procedures, informed consent considerations, preparation of study protocols, and education and training. Points to consider and components to potentially include in an IRB application for suicide-related research are additionally provided. Method: Literature relevant to ethics in suicide research and suicide risk assessment and management was reviewed and synthesized. Results: Suicide research can be conducted in accordance with ethical principles while also furthering the science of suicide prevention. Conclusion: Despite the challenging nature of suicide prevention research, empirically informed solutions exist to address difficulties that may emerge in interfacing with IRBs. There remain areas for improvement in the IRB approval process that warrant further investigation and work.

Implicit Measures of Suicide Risk in a Military Sample

Suicide has become an issue of great concern within the U.S. military in recent years, with recent reports indicating that suicide has surpassed combat related deaths as the leading cause of death. One concern regarding suicide risk in the military is that existing self-report measures allow service members to conceal or misrepresent current suicidal ideation or suicide plans and preparations. Implicit association tests (IATs) are computer-based, reaction time measures that have been shown to be resilient to such masking of symptoms. The death/suicide implicit association test (d/s-IAT) is an empirically supported IAT that is specific to death and suicide. The present study examined whether the performance of 1,548 U.S. military service members on the d/s-IAT significantly predicted lifetime suicidal ideation and depression. Zero-inflated negative binomial regression analyses were used to test these associations. Results indicated that the d/s-IAT was neither associated with history of suicidal ideation nor history of depression.

Anxiety, depression, and the suicidal spectrum: a latent class analysis of overlapping and distinctive features

ABSTRACT Anxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: (1) a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (2) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and (3) a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report of worthlessness, crying, and sadness; higher levels of anxious arousal and negative affect; and lower levels of positive affect. Depression and anxiety diagnoses were not discriminant between higher and lower suicide risk classes. This transdiagnostic and dimensional approach to understanding the suicidal spectrum contrasts with treating it as a depressive symptom, and illustrates the advantages of a tripartite model for conceptualising suicide risk.