The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) makes two overarching predictions: 1) that perceptions of burdening others and of social alienation combine to instill the desire for death; and 2) that individuals will not act on the desire for death unless they have developed the capability to do so -a capability that develops through exposure and thus habituation to painful and/or fearsome experiences, and which is posited by the theory to be necessary to overcome powerful self-preservation pressures. Two studies test these predictions. In Study 1, the interaction of (low) family social support (cf. social alienation or low belonging) and feeling like one does not matter (cf. perceived burdensomeness) predicted current suicidal ideation, beyond depression indices. In Study 2, the three-way interaction between a measure of low belonging, a measure of perceived burdensomeness, and lifetime number of suicide attempts (viewed as a strong predictor of the level of acquired capability for suicide) predicted current suicide attempt (vs. ideation) among a clinical sample of suicidal young adults, again beyond depression indices and other key covariates. Implications for the understanding, treatment, and prevention of suicidal behavior are discussed.Address correspondence to: Thomas E. Joiner, Jr., Florida State University, Tallahassee, Florida 32306-1270, joiner@psy.fsu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/abn. NIH Public AccessAuthor Manuscript J Abnorm Psychol. Author manuscript; available in PMC 2010 August 1. Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior: Empirical Tests in Two Samples of Young AdultsThe interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that an individual will not die by suicide unless s/he has both the desire to die by suicide as well as the ability to do so. What is the desire for suicide, and what are its component parts? What is the ability to die by suicide and in whom and how does it develop?In answer to the first question of who desires suicide, the theory asserts that when people hold two specific psychological states in their minds simultaneously, and when they do so for long enough, they develop the desire for death. The two psychological states are perceived burdensomeness and a sense of low belongingness or social alienation. In answer to the second question regarding capability for suicide, self-preservation is a powerful enough instinct that few can overcome it by force o...

The current article addresses the issue of warning signs for suicide, attempting to differentiate the construct from risk factors. In accordance with the characteristic features discussed, a consensus set of warning signs identified by the American Association of Suicidology working group are presented, along with a discussion of relevant clinical and research applications.

The relationships among suicide ideators, attempters, and multiple attempters were explored in 332 psychiatric patients referred specifically for suicidal ideation or behavior. Previous researchers have subsumed multiple attempters under the general category of attempters. However, comparisons across a range of variables, including Axis I diagnoses from the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) depressive and anxiety symptoms, suicidal ideation, hopelessness, problem solving, and a range of personality features revealed that multiple attempters presented a more severe clinical picture and, accordingly, elevated suicide risk compared with attempters and ideators. Observed differences between groups were maintained when attempters with "questionable intent" (i.e., those making equivocal attempts) were excluded from the analyses.

Suicidal patients are difficult and challenging clinical problems. Conceptual tools aid the clinician in organizing and evaluating the clinical situation. The authors provide a framework for suicide risk assessment that emphasizes 2 domains-history of past attempt and the nature of current suicidal symptoms-that have emerged in suicide research as crucial variables. These domains, when combined with other categories of risk factors, produce a categorization of risk for the individual patient, leading, in turn, to relatively routinized clinical decision making and activity.

Brief CBT was effective in preventing follow-up suicide attempts among active-duty military service members with current suicidal ideation and/or a recent suicide attempt.