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Pharmacopsychiatry 2023; 56(06): 219-226
DOI: 10.1055/a-2154-0828
Original Paper

Interpersonal Needs, Mental Pain, and Hopelessness in Psychiatric Inpatients with Suicidal Ideation

Isabella Berardelli
1   Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
,
Elena Rogante
2   Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università Rome, Italy
,
Salvatore Sarubbi
2   Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università Rome, Italy
,
Maria Anna Trocchia
3   Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant’Andrea Hospital, Rome
,
Ludovica Longhini
3   Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant’Andrea Hospital, Rome
,
Denise Erbuto
1   Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
,
Marco Innamorati
4   Department of Human Sciences, European University of Rome, Rome, Italy
,
Maurizio Pompili
1   Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Abstract

Introduction Suicide is a leading cause of death worldwide and models may help the understanding of the phenomenon and ultimately reduce its burden through effective suicide prevention strategies. The Interpersonal Theory of Suicide and Shneidman’s Model have tried to describe different unmet needs related to suicidal ideation. The study aims to assess the association between thwarted belongingness, perceived burdensomeness, and suicidal ideation in a sample of psychiatric inpatients and the mediating role of hopelessness and mental pain in this association.

Methods 112 consecutive adult psychiatric inpatients were administered the Columbia Suicide Severity Rating Scale (C-SSRS), the Italian version of the Interpersonal Needs Questionnaire-15-I (INQ-15-I), the Physical and Psychological Pain Scale, and the Beck Hopelessness Scale (BHS).

Results Mediation models indicated a significant indirect effect of perceived burdensomeness (with thwarted belongingness as covariates) on suicidal ideation intensity with hopelessness as a mediator. When thwarted belongingness (controlling for perceived burdensomeness as a covariate) was included in a model as an independent variable, direct and indirect effects on suicidal ideation intensity were not significant.

Conclusions Psychosocial interventions focusing on identifying and decreasing the perception of being a burden for others and the feeling hopeless could represent a powerful pathway for reducing suicidal ideation. Moreover, the attention toward unmet interpersonal needs may help increase and focus clinical discussions on risk factors, which may help engagement toward psychiatric care and downsize the stigma related to suicide. Raising awareness toward mental health topics is a goal of healthcare services globally.

Key Words

suicide - mental pain - thwarted belongingness - perceived burdensomeness - hopelessness.


Publication History

Received: 21 May 2023
Received: 13 July 2023

Accepted: 06 August 2023

Article published online:
12 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 World Health Organization. Live life: An implementation guide for suicide prevention in countries. Geneva: World Health Organization; 2021. 12.
    Google Scholar
  • 2 Franklin JC, Ribeiro JD, Fox KR. et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull 2017; 143: 187-232
    CrossrefPubMedGoogle Scholar
  • 3 Suokas J, Suominen K, Isometsä E. et al. Long-term risk factors for suicide mortality after attempted suicide – findings of a 14-year follow-up study. Acta Psychiatr Scand 2001; 104: 117-121
    CrossrefPubMedGoogle Scholar
  • 4 Caine ED. Forging an agenda for suicide prevention in the United States. Am J Public Health 2013; 103: 822-829
    CrossrefPubMedGoogle Scholar
  • 5 Large M, Corderoy A, McHugh C. Is suicidal behaviour a stronger predictor of later suicide than suicidal ideation? A systematic review and meta-analysis. Aust N Z J Psychiatry 2021; 55: 254-267
    CrossrefPubMedGoogle Scholar
  • 6 Joiner TE. Why people die by suicide. Cambridge, MA: Harvard University Press; 2005
    Google Scholar
  • 7 Van Orden KA, Witte TK, Cukrowicz KC. et al. The interpersonal theory of suicide. Psychol Rev 2010; 117: 575-600
    CrossrefPubMedGoogle Scholar
  • 8 Klonsky ED, May AM. Differentiating suicide attempters from suicide ideators: A critical frontier for suicidology research. Suicide Life Threat Behav 2014; 44: 1-5
    CrossrefPubMedGoogle Scholar
  • 9 Klonsky ED, May AM, Saffer BY. Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol 2016; 12: 307-330
    CrossrefPubMedGoogle Scholar
  • 10 Nock MK, Kessler RC, Franklin JC. Risk factors for suicide ideation differ from those for the transition to suicide attempt: The importance of creativity, rigor, and urgency in suicide research. Clin Psychol 2016; 23: 31-34
    PubMedGoogle Scholar
  • 11 Baumeister RF, Leary MR. The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychol Bull 1995; 117: 497-529
    CrossrefPubMedGoogle Scholar
  • 12 Fässberg MM, van Orden KA, Duberstein P. et al. A systematic review of social factors and suicidal behavior in older adulthood. Int J Environ Res Public Health 2012; 9: 722-745
    CrossrefPubMedGoogle Scholar
  • 13 Cacioppo JT, Cacioppo S. Social relationships and health: The toxic effects of perceived social isolation. Soc Personal Psychol Compass 2014; 8: 58-72 DOI: 10.1111/spc3.12087.
    CrossrefPubMedGoogle Scholar
  • 14 Holt-Lunstad J, Smith TB, Baker M. et al. Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspect Psychol Sci 2015; 10: 227-237
    CrossrefPubMedGoogle Scholar
  • 15 Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet 2016; 387: 1227-1239
    CrossrefPubMedGoogle Scholar
  • 16 Beck AT. Thinking and depression. I. Idiosyncratic content and cognitive distortions. Arch Gen Psychiatry 1963; 9: 326-333
    PubMedGoogle Scholar
  • 17 O’Connor RC. The integrated motivational-volitional model of suicidal behavior. Crisis 2011; 32: 295-298
    CrossrefPubMedGoogle Scholar
  • 18 Klonsky ED, May AM. The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. Int J Cogn Ther 2015; 8: 114-129
    CrossrefPubMedGoogle Scholar
  • 19 Valtonen H, Suominen K, Mantere O. et al. Suicidal ideation and attempts in bipolar I and II disorders. J Clin Psychiatry 2005; 66: 1456-1462
    CrossrefPubMedGoogle Scholar
  • 20 Brezo J, Paris J, Turecki G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: A systematic review. Acta Psychiatr Scand 2006; 113: 180-206
    CrossrefPubMedGoogle Scholar
  • 21 Pompili M. Critical appraisal of major depression with suicidal ideation. Ann Gen Psychiatry 2019; 18: 7
    CrossrefPubMedGoogle Scholar
  • 22 Flores-Kanter PE, García-Batista ZE, Moretti LS. et al. Towards an explanatory model of suicidal ideation: The effects of cognitive emotional regulation strategies, affectivity and hopelessness. Span J Psychol 2019; 22: E43
    CrossrefPubMedGoogle Scholar
  • 23 Teismann T, Forkmann T, Rath D. et al. Perceived burdensomeness and suicide ideation in adult outpatients receiving exposure therapy for anxiety disorders. Behav Res Ther 2016; 85: 1-5
    CrossrefPubMedGoogle Scholar
  • 24 Teismann T, Glaesmer H, von Brachel R. et al. A prospective examination of perceived burdensomeness and thwarted belongingness as risk factors for suicide ideation in adult outpatients receiving cognitive-behavioral therapy. J Clin Psychol 2017; 73: 1393-1402
    CrossrefPubMedGoogle Scholar
  • 25 Hallensleben N, Glaesmer H, Forkmann T. et al. Predicting suicidal ideation by interpersonal variables, hopelessness and depression in real-time. An ecological momentary assessment study in psychiatric inpatients with depression. Eur Psychiatry 2019; 56: 43-50
    CrossrefPubMedGoogle Scholar
  • 26 Kyron MJ, Hooke GR, Page AC. Assessing interpersonal and mood factors to predict trajectories of suicidal ideation within an inpatient setting. J Affect Disord 2019; 252: 315-324
    CrossrefPubMedGoogle Scholar
  • 27 Ma J, Batterham PJ, Calear AL. et al. A systematic review of the predictions of the Interpersonal-Psychological Theory of Suicidal Behavior. Clin Psychol Rev 2016; 46: 34-45
    CrossrefPubMedGoogle Scholar
  • 28 Forkmann T, Glaesmer H, Paashaus L. et al. Interpersonal theory of suicide: Prospective examination. BJ Psych Open 2020; 6: e113
    PubMedGoogle Scholar
  • 29 Shneidman ES. Suicide as psychache. J Nerv Ment Dis 1993; 181: 145-147
    CrossrefPubMedGoogle Scholar
  • 30 Shneidman ES. The psychological pain assessment scale. Suicide Life Threat Behav 1999; 29: 287-294
    CrossrefPubMedGoogle Scholar
  • 31 Pompili M, Lester D, Leenaars AA. et al. Psychache and suicide: A preliminary investigation. Suicide Life Threat Behav 2008; 38: 116-121
    CrossrefPubMedGoogle Scholar
  • 32 Troister T, Holden RR. Factorial differentiation among depression, hopelessness, and psychache in statistically predicting suicidality. Meas Eval Couns Dev 2012; 46: 49-63
    PubMedGoogle Scholar
  • 33 Verrocchio MC, Carrozzino D, Marchetti D. et al. Mental pain and suicide: A systematic review of the literature. Front Psychiatry 2016; 7: 108
    CrossrefPubMedGoogle Scholar
  • 34 Holden RR, Mehta K, Cunningham EJ. et al. Development and preliminary validation of a scale of psychache. Can J Behav 2001; 33: 224-232
    CrossrefPubMedGoogle Scholar
  • 35 Ducasse D, Holden RR, Boyer L. et al. Psychological pain in suicidality: A meta-analysis. J Clin Psychiatry 2018; 79: 16r10732
    CrossrefPubMedGoogle Scholar
  • 36 Pompili M, Erbuto D, Innamorati M. et al. The relationship between mental pain, suicide risk, and childhood traumatic experiences: Results from a multicenter study. J Clin Psychiatry 2022; 83: 21m14176
    CrossrefPubMedGoogle Scholar
  • 37 Pompili M, Innamorati M, Erbuto D. et al. High depression symptomatology and mental pain characterize suicidal psychiatric patients. Eur Psychiatry 2022; 65: e54
    CrossrefPubMedGoogle Scholar
  • 38 Patterson A. The role of unmet needs in self-harming behaviours. Dissertation, Queen’s University, Kingston, Ontario, Canada. 2015
    PubMedGoogle Scholar
  • 39 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, DSM-5. Arlington, VA, USA: American Psychiatric Association; 2013
    CrossrefGoogle Scholar
  • 40 Posner K, Brown GK, Stanley B. et al. The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 2011; 168: 1266-1277
    CrossrefPubMedGoogle Scholar
  • 41 Silverman MM, Berman AL, Sanddal ND. et al. Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life Threat Behav 2007; 37: 248-263
    CrossrefPubMedGoogle Scholar
  • 42 Silverman MM, Berman AL, Sanddal ND. et al. Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 2007; 37: 264-277
    CrossrefPubMedGoogle Scholar
  • 43 Van Orden KA, Cukrowicz KC, Witte TK. et al. Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychol Assess 2012; 24: 197-215
    CrossrefPubMedGoogle Scholar
  • 44 Iliceto P, D’Antuono L, Fino E. et al. Psychometric properties of the Italian version of the Interpersonal Needs Questionnaire-15 (INQ-15-I). J Clin Psychol 2021; 77: 268-285
    CrossrefPubMedGoogle Scholar
  • 45 Beck AT, Steer RA. Manual for the Beck Hopelessness Scale. 2nd ed. Psychological Corp; San Antonio, TX, USA. 1993
    PubMedGoogle Scholar
  • 46 Pompili M, Iliceto P, Lester D. et al. BHS Beck Hopelessness Scale: Manuale. Giunti OS Organizzazioni Speciali; Firenze, Italy. 2008
    PubMedGoogle Scholar
  • 47 Olié E, Guillaume S, Jaussent I. et al. Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord 2010; 120: 226-230
    CrossrefPubMedGoogle Scholar
  • 48 Nilsson ME, Suryawanshi S, Gassmann-Mayer C. et al. Columbia – suicide severity rating scale scoring and data analysis guide. CSSRS Scoring Version 2013; 2: 1-13
    PubMedGoogle Scholar
  • 49 Beck AT. Hopelessness as a predictor of eventual suicide. Ann N Y Acad Sci 1986; 487: 90-96
    CrossrefPubMedGoogle Scholar
  • 50 Beck AT, Brown G, Steer RA. Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness. J Consult Clin Psychol 1989; 57: 309-310
    CrossrefPubMedGoogle Scholar
  • 51 Beck AT, Brown G, Berchick RJ. et al. Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. Am J Psychiatry 1990; 147: 190-195
    CrossrefPubMedGoogle Scholar
  • 52 Pompili M, Innamorati M, Gonda X. et al. Affective temperaments and hopelessness as predictors of health and social functioning in mood disorder patients: A prospective follow-up study. J Affect Disord 2013; 150: 216-222
    CrossrefPubMedGoogle Scholar
  • 53 Innamorati M, Lester D, Balsamo M. et al. Factor validity of the Beck Hopelessness Scale in Italian medical patients. J Psychopathol Behav Assess 2014; 36: 300-307
    CrossrefPubMedGoogle Scholar
  • 54 Granö N, Oksanen J, Kallionpää S. et al. Specificity and sensitivity of the Beck Hopelessness Scale for suicidal ideation among adolescents entering early intervention service. Nord J Psychiatry 2017; 71: 72-76
    CrossrefPubMedGoogle Scholar
  • 55 Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications; 2017
    Google Scholar
  • 56 Beck AT, Steer RA, Kovacs M. et al. Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 1985; 142: 559-563
    CrossrefPubMedGoogle Scholar
  • 57 Wenzel A, Beck AT. A cognitive model of suicidal behavior: Theory and treatment. Appl Prev Psychol 2008; 12: 189-201
    CrossrefPubMedGoogle Scholar
  • 58 Baryshnikov I, Rosenström T, Jylhä P. et al. Role of hopelessness in suicidal ideation among patients with depressive disorders. J Clin Psychiatry 2020; 81: 19m12866
    CrossrefPubMedGoogle Scholar
  • 59 Jahn DR, Cukrowicz KC, Linton K. et al. The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults. Aging Ment Health 2011; 15: 214-220
    CrossrefPubMedGoogle Scholar
  • 60 Nalipay MJN, Ku L. Indirect effect of hopelessness on depression symptoms through perceived burdensomeness. Psychol Rep 2019; 122: 1618-1631
    CrossrefPubMedGoogle Scholar
  • 61 Roeder KM, Cole DA. Simultaneous longitudinal examination of hopelessness, thwarted belongingness, and perceived burdensomeness as predictors of suicide ideation. Suicide Life Threat Behav 2019; 49: 1058-1071
    CrossrefPubMedGoogle Scholar
  • 62 Hovey JD, Roley-Roberts ME, Hurtado G. et al. Coping competence and hopelessness moderate the influence of perceived burdensomeness on suicidal ideation in undergraduate college students. Curr Psychol 2022; 1-8
    PubMedGoogle Scholar
  • 63 Chu C, Buchman-Schmitt JM, Stanley IH. et al. The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychol Bull 2017; 143: 1313-1345
    CrossrefPubMedGoogle Scholar
  • 64 Kim YJ, Moon SS, Lee JH. et al. Risk factors and mediators of suicidal ideation among Korean adolescents. Crisis 2018; 39: 4-12
    CrossrefPubMedGoogle Scholar
  • 65 Van Orden KA, Lynam ME, Hollar D. et al. Perceived burdensomeness as an indicator of suicidal symptoms. Cognit Ther Res 2006; 30: 457-467
    CrossrefPubMedGoogle Scholar
  • 66 Spínola J, Campos RC, Marques D. et al. Psychache, unmet interpersonal needs, childhood trauma and suicide ideation in young adults. Death Stud 2022; 46: 930-939
    CrossrefPubMedGoogle Scholar
  • 67 Cero I, Zuromski KL, Witte TK. et al. Perceived burdensomeness, thwarted belongingness, and suicide ideation: Re-examination of the Interpersonal-Psychological Theory in two samples. Psychiatry Res 2015; 228: 544-550
    CrossrefPubMedGoogle Scholar
  • 68 Bryan CJ, Clemans TA, Hernandez AM. Perceived burdensomeness, fearlessness of death, and suicidality among deployed military personnel. Pers Individ Differ 2012; 52: 374-379
    CrossrefPubMedGoogle Scholar
  • 69 Rizk MM, Choo TH, Galfalvy H. et al. Variability in suicidal ideation is associated with affective instability in suicide attempters with borderline personality disorder. Psychiatry 2019; 82: 173-178
    CrossrefPubMedGoogle Scholar
  • 70 Di Nota PM, Anderson GS, Ricciardelli R. et al. Mental disorders, suicidal ideation, plans and attempts among Canadian police. Occup Med 2020; 70: 183-190
    CrossrefPubMedGoogle Scholar
  • 71 Söderholm JJ, Socada JL, Rosenström T. et al. Borderline personality disorder with depression confers significant risk of suicidal behavior in mood disorder patients-a comparative study. Front Psychiatry 2020; 11: 290
    CrossrefPubMedGoogle Scholar