Implementing the interpersonal theory of suicide to improve outcomes in suicidal adolescents: A pilot trial

Abstract

Introduction The Interpersonal Psychological Theory of Suicide proposes two constructs that serve as a final common pathway to suicidal ideation: thwarted belongingness and perceived burdensomeness. There have been few translations of this theory to clinical care. This study aimed to address this limitation by targeting burden cognitions with novel interventions. Methods A pilot clinical trial was conducted in an evidence‐based intensive outpatient program for suicidal youth. Participants were 123 adolescents who completed measures at intake, discharge, and one‐month follow‐up. The experimental group consisted of standard care plus study interventions, which was compared with an active control group of standard care. Feedback on intervention acceptability was gathered through qualitative interviews with parents and adolescents. Results There was a statistically significant drop in thwarted belongingness at discharge and an improvement in perceived burdensomeness at discharge (not statistically significant, small effect size). Feedback on acceptability was favorable and supported implementation. Conclusion This study adds to the literature by being the first to utilize the construct of perceived burdensomeness in clinical interventions for suicidal youth; illustrating one potential avenue for translating theory to practice. The unexpected effects on thwarted belongingness have implications for the role of these constructs in a treatment setting.

Brief modular approach to target perceived burdensomeness in clinic‐referred youth

“…This builds on and extends prior research demonstrating that two online, self‐administered sessions can reduce burdensomeness in youth from community settings (Hill & Pettit, 2019). Prior research among suicidal youth in an intensive outpatient program (IOP) setting was less supportive, as an enhanced IOP treatment targeting burdensomeness was not superior to standard IOP care (Zullo et al, 2021). It is possible that cognitions related to burdensomeness are more malleable in youth who experience less severe psychopathology, or that the narrow, direct focus of the current module and the intervention used in Hill and Pettit (2019) produce more concentrated and specific effects on burdensomeness.…”

“…Research has established perceived burdensomeness toward others as a correlate and risk factor for suicide ideation in youth (Buitron et al, 2016; Buitron, Hill, et al, 2020; Buitron, Vaclavik, et al, 2020; Hill et al, 2018; Hunt et al, 2020), highlighting the promise of perceived burdensomeness as a novel preventive intervention target. We are aware of only two studies that have examined an intervention targeting perceived burdensomeness in youth (Hill & Pettit, 2019; Zullo et al, 2021). In 80 non‐referred youths ages 13 to 19 years sampled from the community, participants who completed two self‐administered, online sessions targeting perceived burdensomeness using cognitive‐behavioral strategies showed significantly lower levels of perceived burdensomeness compared with participants who received online psychoeducation (Hill & Pettit, 2019).…”

“…Tempering this excitement is the finding that approximately 50% of participants did not complete the intervention. In 123 youths ages 12 to 18 years sampled from an intensive outpatient program (IOP) for suicidal youth, participants who completed an enhanced IOP intervention that targeted perceived burdensomeness in individual and group therapy sessions showed a reduction in perceived burdensomeness that did not significantly differ from participants who received the standard IOP (Zullo et al, 2021).…”

Development and initial validation of a parent report measure of youth belongingness and burdensomeness

“…These findings on the INQ‐10p position researchers to complement youth self‐report with a parent‐report measure to evaluate changes in burdensomeness and belongingness in trials that target them. There is growing interest in the evaluation of interventions that directly target youth beliefs about burdensomeness, in particular (e.g., Buitron, Bose, et al, 2020; Hill & Pettit, 2019; Zullo et al, 2021). Further, the finding that parents recognize and report on youth experiences of burdensomeness and belongingness also holds implications for the treatment development.…”

“…Findings consistent with our hypotheses would provide initial support for the factor structure and validity of the INQ‐10p. With a valid parent‐report measure of youth burdensomeness and belongingness, researchers will be positioned to advance theory and research by more fully testing the ITS and evaluating changes in burdensomeness and belongingness in trials that target them (e.g., Hill & Pettit, 2019; Zullo et al, 2021). Further, a valid parent‐report measure of these variables might enhance case identification in clinical assessment of suicide‐related behavior.…”