A Prospective Examination of the Interpersonal‐Psychological Theory of Suicidal Behavior Among Psychiatric Adolescent Inpatients

Abstract

The challenge of identifying suicide risk in adolescents, and particularly among high-risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS)—with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self-injury—predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three-way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2-way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12-month attempts. Results suggest gender-specific associations between theory components and attempts. The time-limited effects of these associations point to TB and PB being dynamic and modifiable in high-risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively.

Preliminary Examination of the Interpersonal Psychological Theory of Suicide in an Adolescent Clinical Sample

“…We found that perceived burdensomeness mediated the associations of two important variables, depression and hopelessness, with suicidal ideation. The stronger influence of perceived burdensomeness in comparison to thwarted belongingness is consistent with previous reports suggesting that the former may be the more strongly weighted of the two (Czyz et al 2014).…”

“…However, few studies have utilized clinical samples (Joiner et al 2009) or specifically adolescent clinical samples (exceptions are Czyz et al 2014;Klonsky et al 2013;Liu et al 2014;Nock et al 2006;Prinstein et al 2008;Sheftall et al 2013). Relative to studies on acquired capability for suicide, there are fewer studies focusing on thwarted belongingness and perceived burdensomeness with adolescent clinical samples in the IPTS literature.…”

“…In adults, some investigators have found evidence of the three-way interaction in association with suicidality (Joiner et al 2009), whereas others have not (Bryan et al 2010;Monteith et al 2013). To our knowledge, only one study has examined the three-way interaction in adolescents (Czyz et al 2014). Using proxy measures for key constructs, Czyz et al (2014) found that the three-way interaction did not longitudinally predict suicide attempts among an adolescent psychiatric inpatient sample.…”

“…To our knowledge, only one study has examined the three-way interaction in adolescents (Czyz et al 2014). Using proxy measures for key constructs, Czyz et al (2014) found that the three-way interaction did not longitudinally predict suicide attempts among an adolescent psychiatric inpatient sample. Further study of the interactive nature of the IPTS in suicidal adolescents, using specific measures of the constructs, is needed.…”

“…In earlier adult studies, and to date in all investigations in adolescents, IPTS core constructs were not directly assessed, but instead indicated by risk factors whose effects they were proposed to mediate. For example, a previous history of suicide attempt was used as a proxy for acquired capability for suicide (Czyz et al 2014;Joiner et al 2009), and foster home placement as a proxy for thwarted belongingness (Kretschmar and Flannery 2011). The use of proxy variables to measure the constructs central to the IPTS is not inherently problematic because they in fact reflect how the IPTS constructs develop in real world situations.…”