Browsing by Subject "Psychological Theory"
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Item Emotion Dysregulation and the Interpersonal Theory of Suicide in Adolescents(2017-07-28) Eaddy, Michael E.; Stewart, Sunita M.; Kennard, Beth D.; Hughes, Jennifer L.; Schuster, Lisa; Emslie, Graham; Diederich, AndrewThe lack of progress in suicide prevention has been attributed to fractured investigations of disparate risk factors and inadequate theoretical frameworks. Adolescents are different from adults in ways that are likely to influence suicide ideation and acts. The Interpersonal Theory of Suicide (IPTS) is a promising theory that proposes three "final common pathways", perceived burdensomeness, thwarted belongingness, and acquired capability, as the most proximal risk factors to suicidal ideation and attempts. There is a growing body of literature that demonstrates that many known risk factors for suicidality are associated with these three IPTS variables, and that the IPTS variables account for the relationship between these known risk factors and suicidality. The current pair of studies was guided by two areas of interest in the current literature. First, emotional dysregulation has been consistently linked to suicide attempts, and appears to have a complex relationship with IPTS constructs in adults, but has been under-investigated in clinical adolescents when it may have particular relevance to suicidality. Second, little is known about the IPTS variables in relation to response to treatment, and whether individual characteristics interact with IPTS variables to promote or hinder changes in suicidality. This work is an examination of the relationship between emotion dysregulation and suicidality within the IPTS framework in a clinical sample of adolescents. The questions it will address are a) whether emotion dysregulation accounts for variance in suicidality independently of IPTS variables, and b) whether emotion dysregulation influences response to treatment for suicide ideation, and if so, whether this influence occurs in the context of the IPTS framework. This work will be structured as follows: An initial introductory context relevant to both studies will be provided. The measures used are the same in both studies and will be described next. These shared components will be followed by the study-specific components: abstract, introduction, aims of the study, study-specific methods, results and discussion. There is significant overlap in the references for each study and these will be condensed at the end.Item Implementing an Interpersonal Theory of Suicide Treatment Approach to Improve Outcomes in Suicidal Youth(2019-07-12) Zullo, Lucas Peter Salvatore; Stewart, Sunita M.; Lee, Simon Craddock; Emslie, Graham; Hughes, Jennifer L.; Kennard, Beth D.Suicide is the second leading cause of death among adolescents in the United States, with rates that have continued to increase over the past several years. Theoretical models of suicide have arisen in order to provide an organizing framework to better understand this phenomenon. Among them, the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, 2005) has gathered significant empirical support. This theory proposes two interpersonal constructs that serve as a final common pathway to understanding suicidal ideation: thwarted belongingness and perceived burdensomeness. There has been limited translation of core themes of this theory to clinical care and there are few theory informed interventions present in the field of suicide prevention overall. We aimed to address this gap in the literature by intentionally targeting cognitions related to perceived burdensomeness with a series of novel interventions by conducting two separate studies. In Study 1 we first gathered information about the manifestation of perceived burdensomeness among suicidal adolescents from teens, their parents, and clinicians working with this population through a series of qualitative interviews. Results from these interviews indicated a need for an enhanced model of perceived burdensomeness highlighting potential mechanisms of change that may be harnessed during therapeutic interventions. Possible clinical interventions operating through these pathways were then developed for examination. In Study 2, a clinical trial was conducted in an intensive outpatient program (IOP) administering evidence-based care for suicidal youth. Participants were 124 adolescents who completed measures on IPTS variables, depressive symptoms, and suicide risk at intake, discharge, and one-month follow-up. The control arm of the study consisted of the treatment provided by the unchanged IOP and the experimental arm added the study interventions to standard care. Results demonstrated that the intervention did not result in a significant difference in perceived burdensomeness or suicide risk between the control and experimental arms. However, there was a difference between groups on thwarted belongingness, with a greater drop in the experimental condition from intake to discharge. Furthermore, the study interventions indicated a small effect size on the majority of study variables. Feasibility and acceptability ratings from study clinicians were supplemented by qualitative exit interviews with parents and adolescents. Feedback gathered during this stage of the study provided support for several of the study interventions and endorsed them as worthwhile additions to the IOP. During exploratory analyses with a sample combining the experimental and control groups, results indicated that the pathway by which suicide risk changes from intake to discharge is through a change in perceived burdensomeness and depressive symptoms. From discharge to one-month follow-up, the pathway explaining a change in suicide risk includes both a change in thwarted belongingness and perceived burdensomeness with a change in depressive symptoms. This finding supports the notion of IPTS variables contributing unique variance to changes in suicide risk even when depressive symptoms are included in the model. Results also support the trend in the literature emphasizing the proximal role of perceived burdensomeness to suicide risk and capitalizing on the need to better target this construct in a clinical setting. This study adds to the literature by being the first to utilize the construct of perceived burdensomeness in clinical interventions for suicidal youth and effectively translating theory to clinical application.Item Tests of the Interpersonal Psychological Theory of Suicide among Adolescents(2015-07-17) Horton, Sarah Elizabeth; Stewart, Sunita M.; Glasier, Paul; Kennard, Beth D.; Roaten, Kimberly Dayle; Westers, NicholasSelf-injurious behaviors tend to first manifest during adolescence, marking this developmental period as an important context for suicide research. The lack of theory-driven research in this area has made it difficult to integrate scattered findings in a way that increases understanding of suicidal behaviors. The Interpersonal Psychological Theory of Suicide (IPTS; Joiner, 2005) aims to remedy this issue by offering an organizing framework that has many conceptual and practical merits. Although this theory has a growing base of evidence among adults, it has yet to be tested in adolescents using direct measures of its central constructs. The current study offers preliminary examinations of 1) psychometric properties of scales to assess key constructs in the IPTS: perceived burdensomeness and thwarted belongingness assessed by the Interpersonal Needs Questionnaire (INQ), and acquired capability for suicide measured by the Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD) and 2) hypotheses guided by the IPTS in an adolescent clinical sample. Participants were 147 adolescents on an inpatient psychiatric unit, who completed measures of key IPTS constructs, depression severity, hopelessness, severity of suicidal symptoms, and various constructs relevant to convergent and discriminant validity. Factor analyses and evidence for construct validity of the 15-item INQ and 7-item ACSS-FAD provided preliminary support for utilization of these scales in this population (Study 1). Study 2 findings were largely consistent with hypotheses derived from the IPTS: perceived burdensomeness, and at a marginal level, thwarted belongingness, were independently associated with current suicidal ideation. The thwarted belongingness by perceived burdensomeness interaction distinguished between adolescents with passive and active suicidal ideation. Acquired capability for suicide was associated with recent suicidal intent. IPTS constructs and their interactions were associated with suicidal symptom severity. This study offers strong, albeit preliminary, support of the IPTS in a clinical adolescent sample. Assessment of IPTS constructs may be useful in determining persistent risk for suicide attempts. Prospective tests of the theory, and extensions to intervention and prevention should be considered in future IPTS research.