Category: Suicide and Self-Injury
Major depressive disorder (MDD) is a well-established risk factor for adolescent suicide (Goldston et al., 2009), and severity of depressive symptoms is associated with the onset and maintenance of suicidal ideation (Baek et al., 2015). However, little is known about how MDD influences treatment outcome for suicidal youth. The interpersonal theory of suicide (Joiner, 2005) posits that perceived burdensomeness and thwarted belongingness are two critical factors that explain suicidal ideation and behavior, and that other distal risk factors may influence desire for suicide by increasing perceived burdensomeness and thwarted belongingness (Van Orden et al., 2010). We examined whether MDD predicted treatment outcome for suicidal adolescents, and whether perceived burdensomeness and thwarted belongingness mediated this relationship.
Participants were 115 adolescents (Mage = 14.96, SDage = 1.66, 55.8% African American) treated for suicidal ideation and depressive symptoms. Participants completed the Diagnostic Interview Schedule for Children (Shaffer et al., 2000) at baseline, the Columbia-Suicide Severity Rating Scale (Posner et al., 2009) at baseline and post-treatment, and the Interpersonal Needs Questionnaire (Van Orden et al., 2012) at baseline and mid-treatment.
We used PROCESS for SPSS (Hayes, 2013) to conduct two mediation analyses. All analyses controlled for age, gender, racial minority status, and per capita family income. First, we tested perceived burdensomeness (week 8) as a mediator between MDD (week 0) and intensity of suicide ideation (week 16), controlling for baseline perceived burdensomeness and intensity of suicide ideation. Reductions in perceived burdensomeness mediated the association between baseline MDD and post-treatment reductions in intensity of suicide ideation (see Figure 1). A second, parallel mediation analysis revealed that reductions in thwarted belongingness did not mediate the association between baseline MDD and post-treatment reductions in intensity of suicide ideation.
Our findings indicate that reductions in perceived burdensomeness, but not thwarted belongingness, explained the relationship between MDD and treatment outcomes for suicidal adolescents. One plausible explanation for these results involves the strong associations between depression and self-hatred and low self-esteem (McKenzie et al., 2011), which are dimensions and indicators of perceived burdensomeness, but not of thwarted belongingness (Van Orden et al., 2010). Thus, treatments for suicidal adolescents with MDD may benefit from a particular focus on reducing perceptions of being a burden on family and loved ones, which can enhance treatment outcomes and reduce intensity of suicidal ideation.