The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research

Abstract

Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum. (PsycINFO Database Record

Figure 1

Causal pathways to lethal or near-lethal suicidal behavior from the perspective of the Interpersonal Theory of Suicide (Joiner, 2005; Van Orden et al., 2010) are depicted with solid lines; sample items are presented in italics. Pathways tested in the current meta-analysis are indicated with dotted lines. Suicide risk represents an amalgamation of both suicidal ideation and suicide attempts.

Figure 2

Flow chart of screening process.

Figure 3

Forest plot depicting the Fisher’s z effects for the interaction between thwarted belongingness and perceived burdensomeness predicting suicidal ideation. The first author and publication date are listed.

Figure 4

Forest plot depicting the Fisher’s z effects for the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide predicting (continuous) suicide attempt history.

Figure 5

Plot of the interpersonal theory of suicide constructs predicting suicide attempt history (measured continuously). The interaction between thwarted belongingness and perceived burdensomeness at low (1 standard deviation below the mean) and high (1 standard deviation above the mean) levels of capability for suicide are presented. The effects obtained from the interaction models (not full models) were used to construct this plot.