Robison, M., et al. (2024).
Behavior Therapy, 55(6), 1158–1171.
Abstract
In this state-of-the-science review, we summarize the key constructs and concepts within the interpersonal theory of suicide. The state of the scientific evidence regarding the theory is equivocal, and we explore the reasons for and some consequences of that equivocal state. Our particular philosophy of science includes criteria such as explanatory reach and pragmatic utility, among others, in addition to the important criterion of predictive validity. Across criteria, the interpersonal theory fares reasonably well, but it is also true that it struggles somewhat—as does every other theory of suicidality—with stringent versions of predictive validity. We explore in some depth the implications of the theory and its status regarding people who are minoritized. Some implications and future directions for research are also presented.
Highlights
• The full Interpersonal Theory of Suicide (ITPS) has yet to be empirically tested.
• However, the ITPS provides explanation, clinical utility, and predictive validity.
• The IPTS may be intensified by non-humanness, lack of agency, and discrimination.
• Minoritized people may benefit by integrating the IPTS and Minority Stress Theory.
Here are some thoughts:
The article reviews the empirical and theoretical foundations of the Interpersonal Theory of Suicide (ITS), which seeks to explain suicidal ideation and behavior. The theory identifies four central constructs: thwarted belongingness (a perceived lack of meaningful social connections), perceived burdensomeness (the belief that one’s existence is a burden on others), hopelessness about these states improving, and the capability for suicide (fearlessness about death and high pain tolerance). While thwarted belongingness and perceived burdensomeness contribute to suicidal ideation, the capability for suicide differentiates those who act on these thoughts.
The article highlights that perceived burdensomeness has the strongest link to suicidality, driven by a tragic misperception that others would be better off without the individual. Thwarted belongingness emphasizes subjective feelings of isolation rather than objective social circumstances. Hopelessness compounds these states by fostering a belief that they are permanent. The capability for suicide, often acquired through exposure to painful experiences or self-harm, explains why only some individuals transition from ideation to action.
Despite its clinical utility, testing ITS comprehensively remains challenging due to measurement limitations and the complexity of suicide. For example, constructs like perceived burdensomeness overlap with suicidal ideation in measurement tools, complicating empirical validation. Additionally, the theory’s applicability across diverse populations, including minoritized groups, requires further exploration.
Clinicians can use ITS to identify risk factors and tailor interventions—such as fostering social connections or addressing distorted beliefs about burdensomeness. However, its predictive validity is limited, underscoring the need for ongoing refinement and research into its constructs and applications.
