The Interpersonal Theory of Suicide: State of the Science

Robison, M., et al. (2024).

Behavior Therapy, 55(6), 1158–1171.

https://doi.org/10.1016/j.beth.2024.04.008

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.

US prison labor is cruel and pointless legalized slavery.

Dyjuan Tatro

The Guardian

Originally posted 22 Sept 23

Here is an excerpt:

It costs New York around $70,000 a year in taxpayer money to imprison someone. It costs the BPI about $10,000 a year to educate an incarcerated student. New York’s recidivism rate is 40%, while graduates of the BPI and similar programs recidivate at only 4%, a tenfold decrease. Yet, despite its clear positive record, only 300 of New York’s 30,000 incarcerated people are enrolled at the BPI in any given semester. I was one of a lucky few.

Prisons are designed to warehouse, traumatize and exploit people, then send them back home in worse shape than when they entered the system. Despite having worked every day, the vast majority of people are released with no job experience, no references and no hope. Some would take this to mean that the system is failing. And it is with regard to public safety, rehabilitation and justice, but it’s horrifyingly successful at two things: guaranteeing jobs for some and perpetuating slavery for others.

Over the years, I learned that prison officials were not interested in giving us fruitful educational and job opportunities that allowed us to go home and stay home. The reality is much more sinister. Prisons are a job program for officers that requires us to keep coming back.

The article is here.

Here is my summary:

The article is a personal account of the author's experience working in prison. Tatro argues that prison labor is a form of legalized slavery, and that it is cruel and pointless. He writes that his work in prison was meaningless and dehumanizing, and that it did not teach him any skills or prepare him for life outside of prison. He also argues that prison labor undermines the living standards of workers outside of prison, as businesses that use prison labor are able to pay their workers less.

Tatro's article is a powerful indictment of the US prison system, and it raises important questions about the role of labor in the rehabilitation of prisoners.

Moral injury in post-9/11 combat-experienced military veterans: A qualitative thematic analysis.

Kalmbach, K. C., Basinger, E. D.,  et al. (2023). 

Psychological Services. Advance online publication.

https://doi.org/10.1037/ser0000792

Abstract

War zone exposure is associated with enduring negative mental health effects and poorer responses to treatment, in part because this type of trauma can entail crises of conscience or moral injury. Although a great deal of attention has been paid to posttraumatic stress disorder and fear-based physiological aspects of trauma and suffering, comparatively less attention has been given to the morally injurious dimension of trauma. Robust themes of moral injury were identified in interviews with 26 post-9/11 military veterans. Thematic analysis identified 12 themes that were subsumed under four categories reflecting changes, shifts, or ruptures in worldview, meaning making, identity, and relationships. Moral injury is a unique and challenging clinical construct with impacts on the individual as well as at every level of the social ecological system. Recommendations are offered for addressing moral injury in a military population; implications for community public health are noted.

Impact Statement

Military veterans who experienced moral injury—events that violate deeply held moral convictions or beliefs—reported fundamental changes following the morally injurious event (MIE). The MIE ruptured their worldview, or sense of right and wrong, and they struggled to reconcile a prior belief system or identity with their existence post-MIE. Absent a specific evidence-based intervention, clinicians are encouraged to consider adaptations to existing treatment models but to be aware that moral injury often does not respond to treatment as usual for PTSD or adjacent comorbid conditions.

The article is paywalled, with the link noted above.

My addition:

The thematic analysis identified 12 themes related to moral injury, which were grouped into four categories:

• Changes in worldview: Veterans who experienced moral injury often reported changes in their worldview, such as questioning their beliefs about the world, their place in it, and their own goodness.
• Changes in meaning making: Veterans who experienced moral injury often struggled to make meaning of their experiences, which could lead to feelings of emptiness, despair, and hopelessness.
• Changes in identity: Veterans who experienced moral injury often reported changes in their identity, such as feeling like they were no longer the same person they were before the war.
• Changes in relationships: Veterans who experienced moral injury often reported changes in their relationships with family, friends, and others. They may have felt isolated, misunderstood, or ashamed of their experiences.

Why are America's farmers killing themselves in record numbers?

Debbie Weingarten
The Guardian
Originally published December 6, 2017

Here is an excerpt:

“Farming has always been a stressful occupation because many of the factors that affect agricultural production are largely beyond the control of the producers,” wrote Rosmann in the journal Behavioral Healthcare. “The emotional wellbeing of family farmers and ranchers is intimately intertwined with these changes.”

Last year, a study by the Centers for Disease Control and Prevention (CDC) found that people working in agriculture – including farmers, farm laborers, ranchers, fishers, and lumber harvesters – take their lives at a rate higher than any other occupation. The data suggested that the suicide rate for agricultural workers in 17 states was nearly five times higher compared with that in the general population.

After the study was released, Newsweek reported that the suicide death rate for farmers was more than double that of military veterans. This, however, could be an underestimate, as the data collected skipped several major agricultural states, including Iowa. Rosmann and other experts add that the farmer suicide rate might be higher, because an unknown number of farmers disguise their suicides as farm accidents.

The US farmer suicide crisis echoes a much larger farmer suicide crisis happening globally: an Australian farmer dies by suicide every four days; in the UK, one farmer a week takes his or her own life; in France, one farmer dies by suicide every two days; in India, more than 270,000 farmers have died by suicide since 1995.

The article is here.