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

Isabella Berardelli; Elena Rogante; Salvatore Sarubbi; Maria Anna Trocchia; Ludovica Longhini; Denise Erbuto; Marco Innamorati; Maurizio Pompili

doi:10.1055/a-2154-0828

Pharmacopsychiatry, Table of Contents

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

Authors

Isabella Berardelli

¹Department 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

²Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università Rome, Italy
Salvatore Sarubbi

²Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università Rome, Italy
Maria Anna Trocchia

³Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant’Andrea Hospital, Rome
Ludovica Longhini

³Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant’Andrea Hospital, Rome
Denise Erbuto

¹Department 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

⁴Department of Human Sciences, European University of Rome, Rome, Italy
Maurizio Pompili

¹Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy

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.

Full Text

References

References
1 World Health Organization. Live life: An implementation guide for suicide prevention in countries. Geneva: World Health Organization; 2021. 12.
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
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
4 Caine ED. Forging an agenda for suicide prevention in the United States. Am J Public Health 2013; 103: 822-829
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
6 Joiner TE. Why people die by suicide. Cambridge, MA: Harvard University Press; 2005
7 Van Orden KA, Witte TK, Cukrowicz KC. et al. The interpersonal theory of suicide. Psychol Rev 2010; 117: 575-600
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
9 Klonsky ED, May AM, Saffer BY. Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol 2016; 12: 307-330
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
11 Baumeister RF, Leary MR. The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychol Bull 1995; 117: 497-529
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
13 Cacioppo JT, Cacioppo S. Social relationships and health: The toxic effects of perceived social isolation. Soc Personal Psychol Compass 2014; 8: 58-72
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
15 Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet 2016; 387: 1227-1239
16 Beck AT. Thinking and depression. I. Idiosyncratic content and cognitive distortions. Arch Gen Psychiatry 1963; 9: 326-333
17 O’Connor RC. The integrated motivational-volitional model of suicidal behavior. Crisis 2011; 32: 295-298
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
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
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
21 Pompili M. Critical appraisal of major depression with suicidal ideation. Ann Gen Psychiatry 2019; 18: 7
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
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
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
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
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
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
28 Forkmann T, Glaesmer H, Paashaus L. et al. Interpersonal theory of suicide: Prospective examination. BJ Psych Open 2020; 6: e113
29 Shneidman ES. Suicide as psychache. J Nerv Ment Dis 1993; 181: 145-147
30 Shneidman ES. The psychological pain assessment scale. Suicide Life Threat Behav 1999; 29: 287-294
31 Pompili M, Lester D, Leenaars AA. et al. Psychache and suicide: A preliminary investigation. Suicide Life Threat Behav 2008; 38: 116-121
32 Troister T, Holden RR. Factorial differentiation among depression, hopelessness, and psychache in statistically predicting suicidality. Meas Eval Couns Dev 2012; 46: 49-63
33 Verrocchio MC, Carrozzino D, Marchetti D. et al. Mental pain and suicide: A systematic review of the literature. Front Psychiatry 2016; 7: 108
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
35 Ducasse D, Holden RR, Boyer L. et al. Psychological pain in suicidality: A meta-analysis. J Clin Psychiatry 2018; 79: 16r10732
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
37 Pompili M, Innamorati M, Erbuto D. et al. High depression symptomatology and mental pain characterize suicidal psychiatric patients. Eur Psychiatry 2022; 65: e54
38 Patterson A. The role of unmet needs in self-harming behaviours. Dissertation, Queen’s University, Kingston, Ontario, Canada. 2015
39 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, DSM-5. Arlington, VA, USA: American Psychiatric Association; 2013
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
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
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
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
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
45 Beck AT, Steer RA. Manual for the Beck Hopelessness Scale. 2nd ed. Psychological Corp; San Antonio, TX, USA. 1993
46 Pompili M, Iliceto P, Lester D. et al. BHS Beck Hopelessness Scale: Manuale. Giunti OS Organizzazioni Speciali; Firenze, Italy. 2008
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
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
49 Beck AT. Hopelessness as a predictor of eventual suicide. Ann N Y Acad Sci 1986; 487: 90-96
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
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
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
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
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
55 Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications; 2017
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
57 Wenzel A, Beck AT. A cognitive model of suicidal behavior: Theory and treatment. Appl Prev Psychol 2008; 12: 189-201
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
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
60 Nalipay MJN, Ku L. Indirect effect of hopelessness on depression symptoms through perceived burdensomeness. Psychol Rep 2019; 122: 1618-1631
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
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
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
64 Kim YJ, Moon SS, Lee JH. et al. Risk factors and mediators of suicidal ideation among Korean adolescents. Crisis 2018; 39: 4-12
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
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
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
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
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
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
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