Publication year
2018
Citation Title
Non-suicidal self-injury and suicidal thoughts and behaviors: A study of the explanatory roles of the Interpersonal Theory variables among military Service members and Veterans.
Journal Name
Journal of Consulting and Clinical Psychology
Journal Volume
86
Issue Number
1
Page Numbers
56-68
DOI
10.1037/ccp0000262
Summary
Often an individual has engaged in non-suicidal self-injury prior to a suicide attempt. In this study, the relationship between non-suicidal self-injury and suicide was assessed by examining the following variables: thwarted belongingness (i.e., feelings that one does not belong in a given group), perceived burdensomeness (i.e., the perception that one's death would improve conditions for others), and capability for suicide (i.e., lowered fear of death and repeated exposure to painful or traumatic events). Results indicated that interpersonal troubles can be associated with non-suicidal self-injury and can increase the risk of a suicide attempt.
Key Findings
Nineteen percent of Service members reported engaging in non-suicidal self-injury in their lifetime.
Thwarted belongingness and perceived burdensomeness were significantly associated with whether a Service member had attempted suicide when that Service member rated at high levels of capability for suicide.
Service members who had a history of non-suicidal self-injury were more likely to have attempted suicide.
Implications for Program Leaders
Educate Service members and their spouses about the possible increased risk of suicide in Service members who think they don't belong or that they are a burden to their families
Offer workshops to Service members and their families to improve family cohesion and communication in an effort to improve belongingness
Tailor efforts for suicide prevention toward Service members who have current or past non-suicidal self-injury
Implications for Policy Makers
Promote the development of programs that address non-suicidal self-injury and suicidality in Service members
Integrate suicide prevention education into existing service delivery systems for military families
Recommend training professionals who work with Service members to better be able to identify thwarted belongingness and perceived burdensomeness
Methods
The Military Suicide Research Consortium funded 24 studies, four of which were recruited at the following locations in the southern U.S.: 1) Veterans at a Veteran's Administration, 2) Army and Marine Active Duty at Marine Corps bases (also western U.S.), 3) Veterans and Reserve Service members at a university, and 4) Army and Air National Guard Service members at a National Guard camp
The four studies included in this article differed in design and data collection approaches but utilized the same self-report questionnaires.
The questionnaires utilized in these studies took components of larger, more extensive questionnaires; however, researchers ensured that they were representative of the topics being studied.
Participants
Across all four studies, participants were 30 years old on average (SD = 11 years), 79% male, and races/ethnicities were White (64%), Black (19%), Latino (7%), Asian American (2%), Native American (1%), multiracial/other (13%), and unknown (1%).
Total participants included 973 Active Duty, Reserve, and National Guard Service members (78%) and Veterans (22%). Service members were in the Army (74%), Marines (11%), Air Force (2%), Navy (2%), or unknown (11%).
Across all four studies, 31% of participants were married, 48% single, 1% widowed, 19% divorced/separated, and 1% did not indicate their marital status.
Limitations
Data were collected through self-report only, which could limit its validity since suicide is a sensitive subject that may tend to be underreported.
Due to the cross-sectional nature of the study, risk trajectories and causality were not able to be established.
Only a small percentage of the participants were asked about depression so the ability to control for it was incomplete; yet the areas where depression was controlled did sometimes change the results.
Avenues for Future Research
Assess the onset, frequency, duration, and severity of both suicidal ideation and non-suicidal self-injury over time with Service members to better understand risk trajectories
Consistently assess for depression in order to control for it in a more uniform manner across all participants
Consider the interpersonal factors that might contribute to decreased belongingess and increased perceived burdensomeness
Focus
Multiple Branches
Target Population
Population Focus
Military Component
Abstract
Objective: Research has identified non-suicidal self-injury (NSSI) as a robust correlate of suicidal thoughts and behaviors; however, little is known regarding why these constructs may be related. Consistent with the interpersonal theory of suicide, this study investigated thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide (CS) as explanatory links in the association
between NSSI, ideation, and suicide attempt history. Method: Military service members and veterans (N = 973; agemean 29.9 years, 78.8% male, 63.8% Caucasian/White) completed measures of lifetime NSSI and suicide attempts; current suicidal ideation; TB, PB, and CS; and related psychiatric symptoms. Bootstrap moderated mediation analyses were employed to examine whether (a) TB moderated the mediating effect of PB on NSSI and ideation, (b) PB moderated the mediating effect of TB on NSSI and ideation, and (c) CS moderated the mediating effect of TB and PB on NSSI and attempts. Results: TB and PB significantly accounted for the relationship between lifetime NSSI and current ideation. TB did not moderate the mediating effect of PB on NSSI and ideation, and PB did not moderate the mediating effect of TB. However, CS significantly moderated the mediating effects of TB and PB on NSSI and attempt history. Conclusions: The interpersonal theory of suicide hypotheses were partially supported. Consistent with the theory, the interaction of TB and PB only explained NSSI and attempt history among service members with high levels of CS. TB and PB only individually explained the association between lifetime NSSI and recent suicidal ideation. Prospective studies are warranted to replicate these findings across other military samples.
between NSSI, ideation, and suicide attempt history. Method: Military service members and veterans (N = 973; agemean 29.9 years, 78.8% male, 63.8% Caucasian/White) completed measures of lifetime NSSI and suicide attempts; current suicidal ideation; TB, PB, and CS; and related psychiatric symptoms. Bootstrap moderated mediation analyses were employed to examine whether (a) TB moderated the mediating effect of PB on NSSI and ideation, (b) PB moderated the mediating effect of TB on NSSI and ideation, and (c) CS moderated the mediating effect of TB and PB on NSSI and attempts. Results: TB and PB significantly accounted for the relationship between lifetime NSSI and current ideation. TB did not moderate the mediating effect of PB on NSSI and ideation, and PB did not moderate the mediating effect of TB. However, CS significantly moderated the mediating effects of TB and PB on NSSI and attempt history. Conclusions: The interpersonal theory of suicide hypotheses were partially supported. Consistent with the theory, the interaction of TB and PB only explained NSSI and attempt history among service members with high levels of CS. TB and PB only individually explained the association between lifetime NSSI and recent suicidal ideation. Prospective studies are warranted to replicate these findings across other military samples.
Attach