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.

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Study Objectives: Suicide is a serious public health problem, and suicide rates are particularly high in South Korea. Insomnia has been identified as a risk factor for suicidal ideation; however, little is known about the mechanisms accounting for this relationship in this population. Based on the premise that insomnia can be lonely (e.g., being awake when everyone else is asleep), the purpose of this study was to examine whether greater insomnia severity would be associated with higher levels of thwarted belongingness and suicidal ideation, and whether thwarted belongingness would mediate the relationship between insomnia and suicidal ideation. Methods: Predictions were tested in a sample of 552 South Korean young adults who completed self-report measures of insomnia severity, suicidal ideation, and thwarted belongingness. Results: Greater insomnia symptom severity was significantly and positively associated with thwarted belongingness and suicidal ideation. Mediation analyses revealed that thwarted belongingness significantly accounted for the relationship between insomnia severity and suicidal ideation. Conclusions: These findings highlight the potential importance of monitoring and therapeutically impacting insomnia and thwarted belongingness to help reduce suicide risk. Keywords: insomnia, thwarted belongingness, suicidal ideation, interpersonal theory of suicide, South Korea Citation: Chu C, Hom MA, Rogers ML, Ringer FB, Hames JL, Suh S, Joiner TE. Is insomnia lonely? Exploring thwarted belongingness as an explanatory link between insomnia and suicidal ideation in a sample of South Korean university students. J Clin Sleep Med 2016;12(5):647-652.