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.

The Roots of Social Trauma: Collective, Cultural Pain and Its Consequences

Abrutyn, S. (2023).

Society and Mental Health.

https://doi.org/10.1177/21568693231213088

Abstract

Since Kai Erikson’s landmark study of the devastation of five communities in West Virginia, sociology has leveraged the concept of trauma to describe certain social phenomena. Collective trauma came to refer to the destruction of social infrastructure and the ensuing negative mental health outcomes, while cultural trauma has come to describe the imposition of historical and ongoing attacks by a dominant group on the culture (broadly defined) of a group of people sharing a collective identity. The following article sketches out a theory of social trauma designed to bring these two types of sociological trauma together, highlight their similarities and differences, and unite them by grounding them in the neuroscience of (social) pain. The term trauma, borrowed from medical and psychological study, implies pain, but the sociological version of trauma is best understood as the collectivization and enculturation of social pain, or the evolved negative affective response to separation, rejection, exclusion, and isolation from cherished social objects including statuses. The article concludes by modeling the process by which an event transforms individual social pain into collective social trauma as well as the pathways through which social trauma becomes enculturated in a collective identity. Implications for the sociology of mental health follow.

The article is here.

Here are some thoughts:

The article presents a unifying theory of social trauma, integrating the sociological concepts of collective trauma and cultural trauma. Abrutyn argues that both forms of trauma are rooted in social pain, an evolved emotional response to separation, rejection, exclusion, and isolation from valued social connections. He emphasizes that trauma fundamentally involves pain and notes that social pain activates the same neural pathways as physical pain, underscoring the deep human need for social bonds. In this framework, collective trauma arises from the breakdown of social infrastructure, leading to mental health challenges; for instance, Erikson’s (1976) study on the Buffalo Creek flood showed how community destruction left individuals feeling isolated and unsupported. By contrast, cultural trauma captures the long-term impact of historical and ongoing attacks on a shared identity, such as the trauma experienced by Indigenous populations due to forced displacement and assimilation.

To bridge these concepts, Abrutyn introduces social trauma as an overarching term that encompasses both collective and cultural trauma. He defines it as “the collectivized separation, rejection, isolation, and exclusion of a corporate and/or categoric unit,” resulting in affective, cognitive, and behavioral responses that become ingrained in a collective identity. Social pain is the connecting factor between the two traumas, with collective trauma focusing on the acute disruption of social infrastructure and cultural trauma emphasizing exclusion from cultural and social symbols. Abrutyn identifies several factors that shape social trauma’s impact: magnitude (the scale and suddenness of the trauma), extent (the geographic and demographic reach), temporality (the duration and potential for reactivation), and recovery (the availability of resources for healing).

This theory of social trauma has far-reaching implications for sociological research and community intervention. First, it calls for a structured exploration of social pain and affect, recognizing the profound effects of social pain on well-being. Second, Abrutyn’s framework sheds light on various social issues, from the opioid crisis and political polarization to mental health struggles in marginalized communities. Finally, understanding the dynamics of social trauma can help guide effective interventions for supporting traumatized communities and building resilience. Through impactful quotes, such as Wallace’s (2003) description of a ruined community as “the destruction of the whole world,” Abrutyn’s work vividly illustrates the critical role of social connection and belonging for individual and collective well-being. His theory provides a robust lens for examining the pervasive effects of social trauma on individuals and communities alike.

Americans are lonely and it’s killing them. How the US can combat this new epidemic.

Adrianna Rodriguez

USA Today

Originally posted 24 Dec 23

America has a new epidemic. It can’t be treated using traditional therapies even though it has debilitating and even deadly consequences.

The problem seeping in at the corners of our communities is loneliness and U.S. Surgeon General Dr. Vivek Murthy is hoping to generate awareness and offer remedies before it claims more lives.

“Most of us probably think of loneliness as just a bad feeling,” he told USA TODAY. “It turns out that loneliness has far greater implications for our health when we struggle with a sense of social disconnection, being lonely or isolated.”

Loneliness is detrimental to mental and physical health, experts say, leading to an increased risk of heart disease, dementia, stroke and premature death. As researchers track record levels of self-reported loneliness, public health leaders are banding together to develop a public health framework to address the epidemic.

“The world is becoming lonelier and there’s some very, very worrisome consequences,” said Dr. Jeremy Nobel, founder of The Foundation for Art and Healing, a nonprofit that addresses public health concerns through creative expression, which launched an initiative called Project Unlonely.

“It won’t just make you miserable, but loneliness will kill you," he said. "And that’s why it’s a crisis."

The info is here.

Key points:

• Loneliness Crisis: America faces a growing epidemic of loneliness impacting mental and physical health, leading to increased risks of heart disease, dementia, stroke, and premature death.
• Diverse and Widespread: Loneliness affects various demographics, from young adults to older populations, and isn't limited by social media interaction.
• Health Risks: The Surgeon General reports loneliness raises risk of premature death by 26%, equivalent to smoking 15 cigarettes daily. Heart disease and stroke risks also increase significantly.
• Causes: Numerous factors contribute, including societal changes, technology overuse, remote work, and lack of genuine social connection.
• Solutions: Individual actions like reaching out and mindful interactions help. Additionally, public health strategies like "social prescribing" and community initiatives are crucial.
• Collective Effort Needed: Overcoming the epidemic requires collaboration across sectors, fostering stronger social connections within communities and digital spaces.

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.

The COVID-19 era: How therapists can diminish burnout symptoms through self-care

Rokach, A., & Boulazreg, S. (2020). 

Current psychology,1–18. 

Advance online publication. 

https://doi.org/10.1007/s12144-020-01149-6

Abstract

COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians’ awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.

Here is an excerpt:

Navigating Ethical Dilemmas

An important impact of competence constellations is its aid to clinicians facing challenging dilemmas in the therapy room. While numerous guidelines and recommendations based on a code of ethics exist, real-life situations often blur the line between what the professional wishes to do, rather than what the recommended ethical action is most optimal to the sovereignty of the client. Simply put, “no code of ethics provides a blueprint for resolving all ethical issues, nor does the avoidance of violations always equate with ideal ethical practice, but codes represent the best judgment of one’s peers about common problems and shared professional values.” (Welfel, 2015, p. 10).

As the literature asserts—even in the face of colleagues acting unethically, or below thresholds of competence, psychologists don’t feel comfortable directly approaching their coworkers as they feel concerned about harming their colleagues’ reputation, concerned that the regulatory board may punish their colleague too harshly, or concerned that by reporting a colleague to the regulatory board they will be ostracized by their colleagues (Barnett, 2008; Bernard, Murphy, & Little, 1987; Johnson et al., 2012; Smith & Moss, 2009).

Thus, a constellation network allows a mental health professional to provide feedback without fear of these potential repercussions. Whether it is guised under friendly advice or outright anonymous, these peer networks would allow therapists to exchange information knowingly and allow for constructive criticism to be taken non-judgmentally.

The info is here.

A Prominent Economist’s Death Prompts Talk of Mental Health in the Professoriate

Emma Pettit
The Chronicle of Higher Education
Originally posted March 19, 2019

Reaching Out

For Bruce Macintosh, Krueger’s death was a reminder of how isolating academe can be. Macintosh is a professor of physics at Stanford University who was employed at a national laboratory, not a university, until about five years ago. That culture was totally different, he said. At other workplaces, Macintosh said, you interact regularly with peers and supervisors, who are paying close attention to you and your work.

“There’s nothing like that in an academic environment,” he said. “You can shut down completely for a year, and no one will notice,” as long as the grades get turned in.

It seems, Macintosh said, as if there should be multiple layers of support within a university department to help faculty members who experience depression or other forms of mental illness. But certain barriers still exist between professors and the resources they need.

A 2017 survey of 267 faculty members with mental-health histories or mental illnesses found that most respondents had little to no familiarity with accommodations at their institution. Even fewer reported using them.

The info is here.

Note: Career success, wealth, and prestige are not protective factors for suicide attempts or completions.  Interpersonal connections to family and friends, access to quality mental health care, problem-solving skills, meaning in life, and purposefulness are.

What can we learn from Dartmouth?

Leah Somerville
www.sciencemag.org
Originally posted November 20, 2018

Here are two excerpts:

There are many urgent discussions that are needed right now to address the cultural problems in academia. We need to find ways to support trainees who have experienced misconduct, to identify malicious actors, to reconsider departmental and institutional policies, and more. Here, I would like to start a discussion aimed at the scientific community of primarily well-intentioned actors, using my own experiences as a lens to consider how we can all be more attuned to the slippery slope on which a toxic environment can be built.

Blurry boundaries. In scientific laboratories, it can be easy to blur lines between the professional and the personal. People in labs spend a lot of time together, travel together, and in some cases socialize together. Some people covet a close, “family-like” lab environment. For faculty members, what constitutes appropriate boundaries is not always obvious; after all, new faculty members are often barely older than their trainees. But whether founded on good intentions or not, close personal relationships can be a slippery slope because of the inherent power differential between trainee and mentor.

(cut)

Shame and isolation. It is harder to appreciate the sheer dysfunctionality of an environment if you believe you are experiencing it alone. Yet even if multiple individuals have similar experiences, they may hesitate to share them out of fear and shame or a sense of pluralistic ignorance. The result? Toxic environments can remain shrouded in secrecy, allowing them to perpetuate and intensify over time. For example, a friend of mine from this era did not tell me until years later that she was the recipient of an unwanted sexual advance. This event and its aftermath had an excruciating impact on her experience as a graduate student, yet she suffered through this turmoil in silence.

It is crucial that people in positions of power appreciate the shame and isolation that can accompany being a recipient of inappropriate behavior and the great personal cost of coming forward. Silence should not be interpreted as a signal that the events were not serious and damaging. Moreover, students need to perceive that clear channels of support and communication are available to them.

The info is here.

Loneliness Might Be a Killer, but What’s the Best Way to Protect Against It?

Rita Rubin
JAMA. 2017;318(19):1853-1855.

Here is an excerpt:

“I think that it’s clearly a [health] risk factor,” first author Nancy Donovan, MD, said of loneliness. “Various types of psychosocial stress appear to be bad for the human body and brain and are clearly associated with lots of adverse health consequences.”

Though the findings overall are mixed, the best current evidence suggests that loneliness may cause adverse health effects by promoting inflammation, said Donovan, a geriatric psychiatrist at the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital in Boston.

Loneliness might also be an early, relatively easy-to-detect marker for preclinical Alzheimer disease, suggests an article Donovan coauthored. She and her collaborators recently reported in JAMA Psychiatry that loneliness was associated with a higher cortical amyloid burden in 79 cognitively normal elderly adults. Cortical amyloid burden is being investigated as a potential biomarker for identifying asymptomatic adults with the greatest risk of Alzheimer disease. However, large-scale population screening for amyloid burden is unlikely to be practical.

Regardless of whether loneliness turns out to be a marker for preclinical Alzheimer disease, enough is known about its health effects that physicians need to be able to recognize it, Holt-Lunstad says.

“The cumulative evidence points to the benefit of including social factors in medical training and continuing education for health care professionals,” she and Brigham Young colleague Timothy Smith, PhD, wrote in an editorial.

The article is here.

Very overweight teens face stigma, discrimination, and isolation

From a synopsis in the British Medical Journal

Here is an excerpt of the synopsis of the article:

In general, young people thought that individuals were responsible for their own body size. They associated excess weight with negative stereotypes of laziness, greed, and a lack of control. And they felt that being overweight made an individual less attractive and opened them up to bullying and teasing.

Young people who were already overweight tended to blame themselves for their size. And those who were classified as very overweight said they had been bullied and physically and verbally assaulted, particularly at school. They endured beatings, kickings, name-calling, deliberate and prolonged isolation by peers, and sniggering/whispering.

Some young people described coping strategies, such as seeking out support from others. But the experiences of being overweight included feeling excluded, ashamed, marked out as different, isolated, ridiculed and ritually humiliated. Everyday activities, such as shopping and socialising, were difficult.

The entire synopsis is here.

A link to the study is here.