Category: Suicide and Self-Injury
Interpersonal Trauma, Mental Health Symptomatology, and the Interpersonal Theory of Suicide
Erin K. Poindexter, Ph.D., Sarah L. Brown, M.A., & Kelly C. Cukrowicz, Ph.D.
The interpersonal theory of suicide proposes three proximal indicators related to increased risk for death by suicide: feeling a thwarted sense of belonging (i.e., thwarted belongingness), feeling like a burden on others (i.e., perceived burdensomeness [PB]), and the ability to engage in lethal self-directed violence (acquired capability; Joiner, 2005). PB is comprised of feelings of self-hate and liability, which are theoretically increased by situational (e.g., homelessness, physical illness) and psychosocial (e.g., agitation, shame, feelings of expendability) stressors. Although previous literature indicates that PB is a robust and proximal risk factor associated with elevated suicide ideation (e.g., Van Orden et al., 2010), there is little empirical data indicating how PB might develop. Exposure to interpersonal trauma (e.g., sexual abuse) has been related to subsequent various situational and psychosocial concerns (e.g., physical illness, depression and posttraumatic stress disorder [PTSD]; Stein et al., 2010). Thus, the interplay of trauma exposure and situational and psychosocial concerns could be one route that increases the development of PB. Thus, it was hypothesized that the relation between interpersonal trauma and PB would be explained by greater PTSD and depressive symptoms.
Participants were 244 college students who endorsed at least one prior trauma assessed during prescreening. Participants completed the Interpersonal Needs Questionnaire (Van Orden et al., 2012), the Traumatic Events Questionnaire (Vrana & Lauterbach, 1994), and Depression, Anxiety, Stress scale (Lovibond & Lovibond, 1995). Parallel mediation was used to test the hypothesis (Hayes, 2013). The bootstrap model was built using 5,000 resamples and 95% bias corrected confidence intervals. Results indicated that the indirect effects of interpersonal trauma on PB through PTSD and depression were significant (model summary R = .60, R2 = .36; p < .001). For all paths tested, the indirect effects of PTSD and depression were significant.
The cross-sectional findings indicated that the relation between interpersonal trauma and PB was explained by PTSD and depressive symptoms. This suggests that PB may develop when individuals begin to experience elevated depression and PTSD, when exposed to interpersonal traumas such as sexual abuse. These results provide valuable clinical insights related to plausible temporal relations that increase PB, a robust and proximal risk factor related to elevated suicide risk. It is possible that decreasing depression and PTSD may help reduce PB and therefore reduce suicide risk.