A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents

Shira Barzilay¹, Alan Apter¹, Avigal Snir¹, Vladimir Carli², Christina W Hoven^{3

4}, Marco Sarchiapone^{5

6

7}, Gergö Hadlaczky², Judit Balazs^{8

9}, Agnes Kereszteny⁸, Romuald Brunner¹⁰, Michael Kaess^{11

12}, Julio Bobes¹³, Pilar A Saiz¹³, Doina Cosman¹⁴, Christian Haring¹⁵, Raphaela Banzer¹⁶, Elaine McMahon¹⁷, Helen Keeley¹⁷, Jean-Pierre Kahn¹⁸, Vita Postuvan¹⁹, Tina Podlogar¹⁹, Merike Sisask^{20

21}, Airi Varnik^{20

22}, Danuta Wasserman²

Affiliations

¹ Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.
² National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.
³ Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
⁴ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
⁵ Department of Health Sciences, University of Molise, Campobasso, Italy.
⁶ National Institute for Health, Migration and Poverty, Rome, Italy.
⁷ Kazakh National Medical University, Almaty, Kazakhstan.
⁸ Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.
⁹ Bjørknes University College, Oslo, Norway.
¹⁰ Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany.
¹¹ Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
¹² University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
¹³ Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain.
¹⁴ Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
¹⁵ Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria.
¹⁶ Addiction help services B.I.N., Innsbruck, Austria.
¹⁷ National Suicide Research Foundation, Cork, Ireland.
¹⁸ Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France.
¹⁹ Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia.
²⁰ Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.
²¹ School of Governance, Law and Society, Tallinn University, Tallinn, Estonia.
²² School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia.

PMID: 31512239
DOI: 10.1111/jcpp.13119

Multicenter Study

A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents

Shira Barzilay et al. J Child Psychol Psychiatry. 2019 Oct.

. 2019 Oct;60(10):1104-1111.

doi: 10.1111/jcpp.13119. Epub 2019 Sep 11.

Authors

Affiliations

¹ Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.
² National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.
³ Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
⁴ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
⁵ Department of Health Sciences, University of Molise, Campobasso, Italy.
⁶ National Institute for Health, Migration and Poverty, Rome, Italy.
⁷ Kazakh National Medical University, Almaty, Kazakhstan.
⁸ Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.
⁹ Bjørknes University College, Oslo, Norway.
¹⁰ Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany.
¹¹ Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
¹² University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
¹³ Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain.
¹⁴ Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
¹⁵ Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria.
¹⁶ Addiction help services B.I.N., Innsbruck, Austria.
¹⁷ National Suicide Research Foundation, Cork, Ireland.
¹⁸ Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France.
¹⁹ Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia.
²⁰ Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.
²¹ School of Governance, Law and Society, Tallinn University, Tallinn, Estonia.
²² School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia.

PMID: 31512239
DOI: 10.1111/jcpp.13119

Abstract

Background: Predictions of two different models for suicide attempts (SA) over 12 months, as differentially impacted by specific school-based suicide prevention interventions, were compared. These were as follows: (a) interpersonal theory (IPTS) and (b) a two-pathway model, one path associated with externalizing symptoms and continuum of self-harm behaviors, and the other with internalizing symptoms.

Methods: Self-report questionnaires were completed by 11,110 high school students from ten EU countries enrolled in the Saving and Empowering Young Lives in Europe (SEYLE) study. Baseline measures included perceived burdensomeness, thwarted belongingness from parents and peers, health risk behaviors, self-injury, suicide ideation (SI), and attempts (SA). SI and SA were reassessed at 12-month follow-up. Each model's predictions of SI and SA groups over time (i.e., repeated SA, remitted SA, SA onset, and no SA) were estimated in the no intervention/control group. The superior model was estimated across intervention groups.

Results: Interpersonal theory showed better fit compared to the two-pathway model. In partial agreement with IPTS predictions, parental low belongingness but not peer belongingness or burdensomeness predicted greater likelihood of SI. The likelihood of repeated SA versus no SA was higher among adolescents who reported SI, self-injury, risk behaviors, and particularly both SI and self-injury. All three interventions attenuated the combined effect of SI and self-injury. Youth Aware of Mental Health Program (YAM) additionally decreased the effect of risk behaviors on the likelihood of repeated SA.

Conclusions: Interpersonal theory assumptions were partially supported. Perceived interpersonal difficulties with parents were primarily related with SI, and risk behaviors and self-injury were important predictors of SA. Suicide prevention interventions may be effective by mitigating the hazardous effect of varying self-harm behaviors and may be further advanced by increasing parental involvement.

Keywords: Suicide; adolescence; belongingness; interpersonal theory of suicide; self-harm; suicide attempt; suicide prevention.

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References

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A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents

Affiliations

A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical