Examining the Interpersonal Psychological Theory of Suicide in Psychosis
Presentation Type
Poster Presentation - Campus Access Only
Category
Social Sciences/Humanities
Abstract/Artist Statement
Psychotic disorders confer an exceptionally high risk for suicidality. The literature on suicide has identified several risk factors. However, isolated risk factors identify a relatively large group of people at risk. Clinically, they are limited in informing prevention efforts for psychosis that target the complexity of factors underlying risk specific to suicide in this population. A theory-driven approach may advance understanding of the complex processes and mechanisms involved in the development of suicide ideation and behavior given the unique determinants of suicide within psychotic disorders. The Interpersonal Psychological Theory of Suicide (IPTS) posits that the desire to die by suicide (thwarted belongingness and perceived burdensomeness) and the acquired capability to do so increase suicide risk. Thwarted belongingness and perceived burdensomeness demonstrate associations with suicide ideation in psychotic disorders. To our knowledge, the relationship between acquired capability and suicidal behavior has not been assessed in adult samples with psychosis. This relationship is important to examine because appraisals of psychotic experiences and symptoms that produce distress may serve as mechanisms through which acquired capability for suicide may develop. We examined baseline data from an ongoing longitudinal, multi-site study of 200 adults with psychosis (30% schizophrenia; 35% schizoaffective disorder; 33% bipolar disorder I or II with psychotic features; 2% major depressive disorder with psychotic features) to: a) replicate previous findings regarding relationships among thwarted belongingness, perceived burdensomeness, and suicidal ideation in a broader sample; b) expand on previous research by examining the relationship between acquired capability for suicide and history of suicidal behavior; and c) explore relationships among positive and negative symptoms of psychosis and the IPTS constructs. T-test analyses revealed that participants with current suicidal ideation endorsed greater levels of thwarted belongingness and perceived burdensomeness than those without recent ideation (p’s < 0.001). Contrary to expectations, a history of suicide attempts was not associated with acquired capability for suicide (p > 0.05). Among the positive/negative symptom clusters, suspiciousness/persecution and emotional withdrawal were associated with higher scores of perceived burdensomeness (suspiciousness/persecution: r = 0.221, p = 0.002; emotional withdrawal: r = 0.185, p = 0.009) and thwarted belongingness (suspiciousness/persecution: r = 0.331, p < 0.01; emotional withdrawal: r = 0.267, p < .01). Overall, the present findings provide further support for maladaptive beliefs as salient processes involved in increased suicide risk in psychosis. Having a better understanding of specific factors underlying heightened risk for suicide behavior may improve the accuracy of suicide risk detection and the efficacy of suicide prevention efforts. The IPTS, in particular, may identify modifiable targets for improving suicide risk assessment and therapeutic targets in treatment for individuals who experience psychosis.
Mentor Name
Duncan Campbell
Examining the Interpersonal Psychological Theory of Suicide in Psychosis
UC North Ballroom
Psychotic disorders confer an exceptionally high risk for suicidality. The literature on suicide has identified several risk factors. However, isolated risk factors identify a relatively large group of people at risk. Clinically, they are limited in informing prevention efforts for psychosis that target the complexity of factors underlying risk specific to suicide in this population. A theory-driven approach may advance understanding of the complex processes and mechanisms involved in the development of suicide ideation and behavior given the unique determinants of suicide within psychotic disorders. The Interpersonal Psychological Theory of Suicide (IPTS) posits that the desire to die by suicide (thwarted belongingness and perceived burdensomeness) and the acquired capability to do so increase suicide risk. Thwarted belongingness and perceived burdensomeness demonstrate associations with suicide ideation in psychotic disorders. To our knowledge, the relationship between acquired capability and suicidal behavior has not been assessed in adult samples with psychosis. This relationship is important to examine because appraisals of psychotic experiences and symptoms that produce distress may serve as mechanisms through which acquired capability for suicide may develop. We examined baseline data from an ongoing longitudinal, multi-site study of 200 adults with psychosis (30% schizophrenia; 35% schizoaffective disorder; 33% bipolar disorder I or II with psychotic features; 2% major depressive disorder with psychotic features) to: a) replicate previous findings regarding relationships among thwarted belongingness, perceived burdensomeness, and suicidal ideation in a broader sample; b) expand on previous research by examining the relationship between acquired capability for suicide and history of suicidal behavior; and c) explore relationships among positive and negative symptoms of psychosis and the IPTS constructs. T-test analyses revealed that participants with current suicidal ideation endorsed greater levels of thwarted belongingness and perceived burdensomeness than those without recent ideation (p’s < 0.001). Contrary to expectations, a history of suicide attempts was not associated with acquired capability for suicide (p > 0.05). Among the positive/negative symptom clusters, suspiciousness/persecution and emotional withdrawal were associated with higher scores of perceived burdensomeness (suspiciousness/persecution: r = 0.221, p = 0.002; emotional withdrawal: r = 0.185, p = 0.009) and thwarted belongingness (suspiciousness/persecution: r = 0.331, p < 0.01; emotional withdrawal: r = 0.267, p < .01). Overall, the present findings provide further support for maladaptive beliefs as salient processes involved in increased suicide risk in psychosis. Having a better understanding of specific factors underlying heightened risk for suicide behavior may improve the accuracy of suicide risk detection and the efficacy of suicide prevention efforts. The IPTS, in particular, may identify modifiable targets for improving suicide risk assessment and therapeutic targets in treatment for individuals who experience psychosis.