Thwarted interpersonal needs and suicide ideation among psychiatric inpatients: An examination of six psychological processes underlying acceptance and commitment therapy



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Suicide is one of the leading causes of death in psychiatric hospitals. The interpersonal theory of suicide (IPTS) posits that desire for suicide occurs when thwarted belongingness and perceived burdensomeness are experienced simultaneously, and one feels hopeless that these states will change. Given some of the mixed findings related to the IPTS among psychiatric inpatients, there may be utility in incorporating other empirically-supported theories that may not have received much attention in the suicide literature to help explain the conditions that may strengthen the relation between thwarted belongingness and suicide ideation, and perceived burdensomeness and suicide ideation. The psychological flexibility model is comprised of six interrelated processes: experiential avoidance (as opposed to experiential acceptance), cognitive fusion (as opposed to cognitive defusion), inflexible attention (as opposed to flexible attention to the present moment), self-as-content (as opposed to self-as-context), disruption of values (as opposed to valued living), and inaction toward values (as opposed to committed action). The aim of the current study was to integrate the IPTS and the psychological flexibility model. Participants in the current study included 118 psychiatric inpatients. Results indicated a significant positive association between thwarted belongingness and suicide ideation, but not between perceived burdensomeness and suicide ideation after adjusting for depressive symptoms, social desirability bias, age, and gender. Results also indicated that experiential avoidance, cognitive fusion, flexible attention to the present moment, and self-as-context did not significantly moderate the relation between thwarted belongingness and suicide ideation or between perceived burdensomeness and suicide ideation after adjusting for covariates. Further, there were significant direct negative associations between valued living and suicide ideation, valued living and thwarted belongingness, and valued living and perceived burdensomeness. These results suggest that reporting a stronger connection with one’s values is associated with less suicide ideation, less thwarted belongingness, and less perceived burdensomeness among psychiatric inpatients. Importantly, it appears that the strength of the negative association between valued living and thwarted belongingness and between valued living and perceived burdensomeness does not decrease as a function of committed action. Additional research and possibly refinement of the IPTS and psychological flexibility model are suggested prior to the development and implementation of suicide-specific treatments.



Suicidal ideation, Psychological flexibility, Interpersonal theory of suicide