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

Abstract

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 that 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 This paper aimed to: (1) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors; (2) conduct meta-analyses testing the interpersonal theory hypotheses; and (3) 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 Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct published and unpublished samples.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.

A longitudinal examination of the interpersonal theory of suicide and effects of school‐based suicide prevention interventions in a multinational study of adolescents

“…Consistent with IPTS predictions and prior studies (Chu et al., ), in the present study, thwarted belongingness to parents predicted higher levels of SI as assessed one year later. This effect remained significant after controlling for depression and anxiety.…”

“…Furthermore, not all the interactions suggested by the IPTS model were tested in the current study. However, these interactions reported having a relatively small additional effect (Chu et al., ). Additionally, the D‐SIB measure used in the SEYLE study did not ask about suicidal intent.…”

“…Specifically, we conducted a multigroup, multinominal model in which the multinominal outcome variable was the trajectory of change in SA over time (with the repeated SA group as the reference group to allow differentiation for number of attempts as suggested by Chu et al. ()). The grouping variable was the intervention type (QPR, YAM, ProfScreen, and control).…”

Perceived burdensomeness, bullying, and suicidal ideation in suicidal military personnel

“…However, this association has tended to be small in magnitude, and recent scholarship has noted the need for both refinement of these constructs relative to the intractability of thwarted interpersonal needs, as well as investigation concerning the unique contribution of each variable above and beyond their interaction (Chu et al, 2017). Finally, our analysis of TB and PB as mediators of the association between bullying and level of suicidal ideation does not account for the interaction between these two variables, which has been found to be associated with suicide-specific outcomes.…”

Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample

“…As acquired capability accumulates, the instinct for self‐preservation is broken down, and consequently, suicide risk increases. A meta‐analysis across 122 samples (Chu et al., ) largely found support for the key theory hypotheses. The interaction between thwarted belongingness and burdensomeness was associated with suicide ideation, and the interaction of all three theory components was associated with suicide attempts (as a continuous not a dichotomous variable), although four alternate hypotheses (the interaction between (1) capability and burdensomeness (2) capability and thwarted belonging and (3) burdensomeness and thwarted belonging are all associated with suicide attempt; the interaction of three theory components was associated with suicide ideation) were also supported (Chu et al., ).…”