Suicidal Behavior

Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E., Jr. (2008). Suicidal desire and the capability for suicide: Tests of the Interpersonal-Psychological Theory of Suicidal Behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72-83.

    The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that an individual will not die by suicide unless he/she has both the desire to die by suicide and the ability to do so. Three studies test the theory’s hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed.

CLICK HERE for information on the INQ & ACSS, including the questionnaires [file is attached, and includes the scales as well as a designation of which items were included in the JCCP paper].

CLICK HERE for psychometrics on the INQ: Van Orden, K. A., (2009). Construct validity of the Interpersonal Needs Questionnaire. Unpublished Doctoral Dissertation, Florida State University.

CLICK HERE for powerpoint slides on the INQ from AAS in 2009: Van Orden, K. A., & Joiner, T. E. (2009). Construct Validity of the Interpersonal Needs Questionnaire. Paper presented at the Annual Meeting of the American Association of Suicidology, San Francisco, CA.

Bernert, R.A., Joiner, T.E., Cukrowicz, K.C., Schmidt, N.B., Krakow, B. (2005). Suicidality and sleep disturbances. SLEEP, 28(9), 1135-1141.

    A growing body of research indicates that sleep disturbances may be specifically linked to suicidal behaviors. It remains unclear, however, whether this link is largely explained by depressive symptoms. The present study investigated the relationship between suicidality, depression, and sleep complaints in a clinical outpatient setting. Upon admission, 176 outpatients completed measures on sleep disturbances, suicidal symptoms, and depression. Several sleep disturbances were evaluated with regard to suicidal ideation, including insomnia, nightmares, and sleep-related breathing symptoms. Regression analyses revealed that insomnia and nightmare symptoms were associated with both depressive symptoms and suicidality. Sleep-related breathing symptoms were associated with depressive symptoms, but did not show an association with suicidal ideation. After controlling for depressive symptoms, only nightmares demonstrated an association with suicidal ideation. This relationship emerged as a nonsignificant trend (P = .06). Nightmares were particularly associated with suicidality among women compared with men. Posthoc analyses revealed that, after controlling for sex and depressive symptoms, nightmare symptoms were significantly associated with suicidality (P = .04). Although insomnia and nightmares were significantly associated with depressive and suicidal symptoms, after controlling for additional variables, such as depression and sex, only nightmares remained associated with suicidality. This association was slightly stronger among women compared with men.

Joiner, Jr., T.E., Conwell, Y., Fitzpatrick, K.K., Witte, T.K., Schmidt, N.B., Berlim, M.T., Fleck, M.P.A., Rudd, M.D. (2005). Four Studies on How Past and Current Suicidality Relate Even When "Everything but the Kitchen Sink" is Covaried. Journal of Abnormal Psychology, 114, 291-303.

    Joiner's (2002, 2004) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across four populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior.

Stellrecht, N. E., Gordon, K. H., Van Orden, K., Witte, T. K., Wingate, L. R., Cukrowicz, K. C., Butler, M., Schmidt, N. B., Fitzpatrick, K. K., & Joiner, T. E. (in press). Practical applications of the interpersonal-psychological theory of attempted and completed suicide. Journal of Clinical Psychology.

  This article reviews the interpersonal-psychological theory of attempted and completed suicide and describes its applications in suicide risk assessment, crisis intervention, and skills-based psychotherapies. Three components are necessary, but not sufficient, for an individual to die by suicide: 1) the acquired capability to enact lethal self-injury, 2) a sense that one is a burden on others, and 3) the sense that one does not belong to a valued social group. We suggest that therapeutic interventions should focus on ascertaining the presence of these components and work to amend the cognitive distortions, negative interpersonal response styles, and ineffective coping behaviors that serve to maintain suicidal urges.

Van Orden, K. A., Lynam, M. E., Hollar, D., & Joiner, T. E., Jr. (in press). Perceived Burdensomeness as an Indicator of Suicidal Symptoms. Cognitive Therapy and Research.

  The Interpersonal-Psychological Theory of Serious Suicidal Behavior proposes precursors to serious suicidality, including the perception that one is a burden on loved ones. The purpose of the present study was to evaluate the association of perceived burdensomeness and key suicide-related variables in 343 adult outpatients of the Florida State University Psychology Clinic (187 female; 156 male). Participants completed the Beck Scale for Suicide Ideation and the Beck Depression Inventory, as well as items on perceived burdensomeness and hopelessness. Perceived burdensomeness remained a significant predictor of suicidality indicators (i.e., attempt status and BSSI scores) above and beyond the contribution one of the most robust predictors of suicidality, hopelessness. Results suggest that both burdensomeness and hopelessness display predictive power with regards to suicidal behavior and that perceived burdensomeness displayed the signature of a resilient suicide risk factor. Thus, targeting perceived burdensomeness in the assessment of suicidal behavior may aid in treatment and prevention efforts.

Van Orden, K. A., Merrill, K. A., & Joiner, Jr., T. E. (2005). Interpersonal-Psychological Precursors to Suicidal Behavior: A Theory of Attempted and Completed Suicide. Current Psychiatry Reviews, 1, 187-196.

  Suicidal ideation is not uncommon in the general population and is even more prevalent in psychiatric samples; however, most individuals who experience ideation will not attempt suicide and even fewer will complete suicide. Despite these discrepancies, the number of studies investigating risk factors for serious suicidal behavior (i.e., attempts and completions) is relatively small. We first review studies in the literature which focus on the distinction between attempted and completed suicide and/or which predict completion status. We then highlight a program of research in our own laboratory which is grounded in Joiner's interpersonal-psychological theory of attempted and completed suicide. The theory posits that serious suicidal behavior will not occur unless an individual has both the desire to commit suicide and the ability to do so. Two factors contribute to an individual's desire for suicide, a thwarted sense of belongingness and a sense of perceived burdensomeness on others, while the ability to commit suicide can be acquired over time through habituation to the physical and mental pain involved in self-injury. Finally, we discuss implications of the theory for assessment and treatment of suicidal behavior.

Witte, T.K., Fitzpatrick, K.K., Joiner, Jr., T.E., & Schmidt, N.B. (in press). Variability in suicidal ideation: A better predictor for past attempt than intensity and duration of ideation? Journal of Affective Disorders.

  Background: Much of the suicidology literature focuses on establishing contextual risk factors for suicidal behavior. However, the study of the parameters of suicidal behavior (e.g., intensity, duration, and variability) has been somewhat neglected. Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. Having previously established a relationship between variability in suicidal ideation and a previous history of suicide attempts, we felt it important to assess the liability conferred by a variable pattern of ideation compared to the intensity and duration of suicidal thoughts. We also examined if there was an interaction between gender and the parameters of intensity, duration, and variability. Method: One hundred eight participants (54 non-attempters, 35 single attempters, and 19 multiple attempters) completed the Suicide Probability Scale every day for 4 weeks, allowing us to measure the parameters of interest. These variables were entered into a regression model as predictors of previous suicide attempts. Results: Consistent with prediction, high variability of ideation was the only significant predictor of previous attempt status. In addition, an interaction between gender and variability in suicidal ideation suggested that variability appeared more critical in predicting previous attempts for males. Limitations: The limited number of multiple attempters in our sample and the use of college students limit the current study. Conclusions: Variability appears to be the most potent predictor of attempt status among the parameters of suicidal ideation examined in the current study. This relationship appears to be particularly important in males, suggesting that fluctuating levels of suicidal ideation may confer future risk for suicide.