*Denotes Auburn student co-author
*Zuromski, K. L., *Cero, I., & Witte, T. K. (2017). Insomnia symptoms drive changes in suicide ideation: A latent difference score model of community adults over a brief interval. Journal of Abnormal Psychology, 126, 739-749.
Insomnia is robustly associated with suicidal behavior, but methodological limitations in existing studies hinder nuanced understanding of this relationship. The current study addressed these limitations by utilizing a longitudinal design and advanced statistical modeling. Participants who endorsed lifetime experience of suicidal behavior were recruited through Amazon's Mechanical Turk (N = 589) and completed self-report online surveys at 6 time points over a 15-day period. Latent difference score modeling was utilized to investigate whether elvels and/or changes in insomnia symptoms drive subsequent changes in suicide ideation, or vice versa. Results revealed that previous level of insomnia symptoms was predictive of positive changes in suicide ideation (i.e., level of insomnia symptoms predicted lagged increases in suicide ideation). This relationship was not bidirectional (i.e., suicide ideation exerted no effects on insomnia symptoms). Additionally, only previous level, and not previous changes, in insomnia symptoms were predictive of changes in suicide ideation. Our results help clarify the nature of the relationship between insomnia symptoms and suicide ideaiton as one that is unidirectional, thereby offering evidence of insomnia symptoms as a variable risk factor for suicide ideation. These findings yield clinical implications, including the importance of screening for insomnia symptoms, and provide support for exploring the potential effectiveness of insomnia treatments to target suicide ideation. Moreover, our study design and methodology establish a foundation for more rigorous and nuanced investigations of imminent suicide risk in future studies, which can ultimately promote better clinical practice in the reduction of suicidal behavior.
*Cero, I., *Zuromski, K. L., Witte, T. K., *Fix, R., & Burkhart, B. (in press). Race, offense type, and suicide ideation: Tests of the interpersonal-psychological theory in juvenile offenders. Suicide and Life Threatening Behavior.
This study evaluated the Synergy Hypothesis of the Interpersonal-Psychological Theory of Suicide (IPTS), which argues thwarted belongingness and perceived burdensomeness are positively interactive in their association with suicide ideation, in a group of juvenile offenders. It also examined whether this prediction is differentially applicable across race/ethnicity or offense type. Participants included 590 adjudicated and confined male juveniles. Regression was used to test the association between suicide ideation and thwarted belongingness, perceived burdensomeness, and their interaction term. Subsequent analyses included tests of group interactions related to race/ethnicity and offense type. No interaction between thwarted belongingness and perceived burdensomeness was observed, despikte adequate power. No significant group interactions were observed for race/ethnicity or offense type. However, results did show significant linear relationships between thwarted belongingness, perceived burdensomeness, and ideation, highlighting their potential utility as intervention targets in this at-risk population. Thus, although the current results are the first to show the basic IPTS risk factors generalize across race/ethnicity and offense type, they also failed to support that those factors were interactive, a primary IPTS claim. The absense of an interaction between thwarted belongingness and perceived burdensomeness suggests their role in suicide ideation for juvenile offenders may be more parsimonious than the IPTS proposes.
*Spitzer, E. G., *Zuromski, K. L., *Davis, M. T., Witte, T. K., & Weathers, F. W. (in press). PTSD symptom clusters and acquired capability for suicide: A re-examination using DSM-5 criteria. Suicide and Life Threatening Behavior.
The current study used the interpersonal-psychological theory of suicide to explore the relationships among DSM-5 PTSD symptom clusters derived from the six-factor anhedonia model and facets of the acquired capability for suicide (ACS). In a sample of 373 trauma-exposed undergraduates, most PTSD symptom clusters were negatively associated with facets of ACS in bivariate correlations, but the anhedonia cluster was positively associated with ACS in regression models. Structure coefficients and commonality analysis indicated that anhedonia served as a suppressor variable for the other symptom clusters. Our findings further elucidate the complex relationship between specific PTSD symptom clusters and ACS.
†Witte, T. K., †Holm-Denoma, J. M., *Zuromski, K. L., *Gauthier, J. M., & Ruscio, J. (2017). Individuals at high risk for suicide are categorically distinct from those at low risk. Psychological Assessment, 29, 382-393. †Joint first authorship.
Though suicide risk is often thought of as existing on a graded continuum, its latent structure (i.e., whether it is categorical or dimensional) has not been empirically determined. Knowledge about the latent structure of suicide risk holds implications for suicide risk assessments, targeted suicide interventions, and suicide research. Our objectives were to determine whether suicide risk can best be understood as a categorical (i.e., taxonic) or dimensional entity, and to validate the nature of any obtained taxon. We conducted taxometric analyses of cross-sectional, baseline data from 16 independent studies funded by the Military Suicide Research Consortium. Participants (N = 1,773) primarily consisted of military personnel, and most had a history of suicidal behavior. The Comparison Curve Fit Index (CCFI) values for MAMBAC (.85), MAXEIG (.77), and L-Mode (.62) all strongly supported categorical (i.e., taxonic) structure for suicide risk. Follow-up analyses comparing the taxon and complement groups revealed substantially larger effect sizes for the variables most conceptually similar to suicide risk compared to variables indicating general distress. Pending replication and establishment of the predictive validity of the taxon, our results suggest the need for a fundamental shift in suicide risk assessment, treatment, and research. Specifically, suicide risk assessments could be shortened without sacrificing validity, the most potent suicide interventions could be allocated to individuals in the high-risk group, and research could generally be conducted on individuals in the high-risk group.
*Zuromski, K. L., *Cero, I., Witte, T. K., & Zeng, P. (2017). The quadratic relationship between body mass index and suicide ideation: A non-linear analysis of indirect effects. Suicide and Life Threatening Behavior, 47, 155-167.
The current study applied a non-linear indirect effects framework to investigate potential interpersonal indirect effects (i.e., perceived burden and thwarted belonging) accounting for the non-linear relationship between body mass index (BMI) and suicide ideation. Using a sample of 338 undergraduates, results revealed a significant quadratic effect of BMI on suicide ideation via perceived burden only, which became significant as BMI fell below 18.00 kg/m2 and above 28.00 kg/m2. Our results provide novel information relevant for suicide risk screening in the context of weight- and health-related interventions, and provide justification for future longitudinal trials assessing suicide risk across the BMI spectrum.
*Gauthier, J. M., Witte, T. K., & Correia, C. J. (2017). Suicide ideation, alcohol consumption, motives, and related problems: Exploring the association in college students. Suicide and Life Threatening Behavior, 47, 142-154.
Previous findings on the relationship between suicide ideation (SI) and alcohol misuse among college students are inconsistent, leading to conflicting clinical implications. We aimed to clarify this relationship, in order to determine the utility of regarding alcohol misuse as a risk factor for SI in this population. Unselected college students (N = 545) completed an online survey including measures of alcohol consumption, problems, drinking motives, SI, and related variables. Our results suggest alcohol misuse is not a correlate of SI among college students; therefore, one should not assume that students who misuse alcohol are necessarily at increased risk for SI.
*Corbitt-Hall, D. J., *Gauthier, J. M., *Davis, M. T., & Witte, T. K. (2016). College students' responses to suicidal content on social networking sites: An examination using a simulated Facebook newsfeed. Suicide and Life Threatening Behavior, 46, 609-624.
Although Facebook has a peer-initiated suicide prevention protocol, little is known about users' abilities to notice, recognize, and appropriately interpret suicidal content or about their willingness to intervene. In this study, 468 college students were randomly assigned to interact with a simulated Facebook newsfeed containing content reflecting various suicide risk levels. A larger proportion of those exposed to content reflecting moderate and severe suicide risk noticed, recognized, appropriately interpreted, and endorsed taking action to intervene, as compared to those exposed to content representing no or low risk. Overall, results indicate that college students are responsive to suicidal content on Facebook.
Witte, T. K., *Zuromski, K. L., *Gauthier, J. M., Smith, A. R., Bartlett, M., Siegfried, N., Bodell, L., & Goodwin, N. (2016). Restrictive eating: Associated with suicide attempts but not acquired capability in residential patients with eating disorders. Psychiatry Research, 235, 90-96.
Research within the framework of the Interpersonal-Psychological Theory of Suicide has suggested that the elevated suicide risk among those with anorexia nervosa (AN) can be explained by the presence of severe restrictive eating, which is proposed to affect an individual's acquired capability for suicide (i.e., heightened physical pain tolerance and fearlessness about death). We investigated this postulation in a sample (N = 100) of women receiving residential treatment for an eating disorder. We hypothesized that several restrictive eating variables would be associated with history of suicide attempts and acquired capability for suicide, even when accounting for presence of non-restrictive disordered eating. Results revealed partial support for our hypotheses. Fasting was robustly associated with history of suicide attempts. In addition, fasting and dietary restraint were associated with one or both facets of acquired capability for suicide. Nevertheless, these associations were weaker compared to self-induced vomiting and laxative use and became non-significant after controlling for self-induced vomiting and laxative use. Taken together, our results, in combination with other recent studies, are inconsistent with the postulation that restrictive eating accounts for the high suicide rate in AN through the mechanism of acquired capability for suicide.
Nett, R. J., Witte, T. K., Holzbauer, S. M., Elchos, B. L., Campagnolo, E. R., Musgrave, K. J...Funk, R. J. (2015). Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among U.S. veterinarians. Journal of the American Veterinary Medical Association, 247, 945-955.
Objective. To evaluate the prevalence of suicide risk factors, attitudes toward mental illness, and practice-related stressors among US veterinarians. Design. Cross-sectional survey. Sample. 11,627 US veterinarians. Procedures. Between July 1 and October 20, 2014, a web-based questionnaire was made available through the Veterinary Information Network (VIN), Vin News Service, JAVMA News, and monthly email messages to US veterinarians sent by the veterinary medical association, agriculture or livestock department, or health department of each state (except Maine) and Puerto Rico. Results. Of 11,627 respondents, 3,628 (31%) were male. Modal age category was 30 to 39 years, and modal range for years practicing veterinary medicine was 10 to 19 years. There were 7,460 (64%) with a primary practice of small animal medicine, and 4,224 (36%) were practice owners. There were 1,075 (9%) respondents with current serious psychological distress. Since leaving veterinary school, 3,655 (31%) respondents experienced depressive episodes, 1,952 (17%) experienced suicdial ideaiton, and 157 (1%) attempted suicide. Currently, 2,225 (19%) respondents were receiving treatment for a mental health condition or emotional problem. Only 32% of respondents somewhat or strongly agreed that people are sympathetic toward persons with mental illness. The most commonly reported practice-related stressor was demands of practie (e.g., long work hours or work overload). Conclusionsa and Clinical Relevance. In this survey, approximately 1 in 11 veterinarians had serious psychological distress and 1 in 6 experienced suicidal ideation since leaving veterinary school. Implementing measures to help veterinarians cope iwth practice-related stressors and reducing barriers veterinarians face in seeking mental health treatment might reduce the risk for suicide among veterinarians.
Witte, T. K., *Domino, J. L., & Weathers, F. W. (2015). Item order effects in the evaluation of posttraumatic stress disorder symptom structure. Psychological Assessment, 27, 852-864.
Factor analytic research has demonstrated consistently that the 3-factor DSM-IV model of posttraumatic stress disorder (PTSD) symptom structure provides a poorer fit than alternative 4- and 5-factor models. In the current study we examined whether order of item presentation accounts for these findings. IN a large sample (N = 1,311) of trauma-exposed undergraduates we conducted a series of confirmatory factor analyses using the PTSD Checklist and Posttraumatic Stress Diagnostic SCale, which present symptom items in the same order as DSM-IV, and the Detailed Assessment of Posttraumatic Stress, which presents items in a different order. Across all 3 measures, the 3-factor DSM-IV model provided a relatively worse fit and the 5-factor dysphoric arousal model provided a relatively better fit compared with other tested models. We also examined the distinctiveness of 2 pairs of symptom clusters that appear in the dysphoric arousal model -- avoidance versus numbing and dysphoric arousal versus anxious arousal -- by comparing their patterns of associations with external correlates. Avoidance and numbing demonstrated differential associations wtih external correlates, as did dysphoric arousal and anxious arousal. Taken together, results indicate that order effects are unlikely to account for differences in relative fit between leading models of PTSD symptom structure. We discuss the need for future research in this area, especially studies designed to evaluate order effects more directly.
*Cero, I., *Zuromski, K. L., Witte, T. K., Ribeiro, J. D., & Joiner, T. E. (2015). Burdensomeness, belongingness, and suicide ideation: Re-examination of the interpersonal-psychological theory of suicide in two samples. Psychiatry Research, 228, 544-550.
The interpersonal-psychological theory of suicide (IPTS) proposes that suicide ideaiton is caused by the interaction of perceived burdensomeness and thwarted belongingness, in which each predictor amplifies the harm of the other. Though several studies support this synergy hypothesis, research has not considered potential quadratic effects of perceived burdensomeness and thwrated belongingness, which can distort the sign, size, and significance of interactions, if mistakenly neglected in a model. This investigation examined the synergy hypothesis in samples of university undergraduates and psychaitric inpatients, this time controlling for quadratic effects. Despite adequate power, results showed no interaction between perceived burdensomeenss and thwarted belongingness in either sample, regardless of the presence of quadratic effects. Additionally, no quadratic effects were observed. The lower-order, linear perceived burdensomeness term was positively associated with suicide ideation in both samples, but the thwarted belongingness term was not associated with suicide ideation in either sample. The discussion considers implications of current findings for the IPTS, highlighting the need to formally test the impact of sample characteristics on the estimation of theory parameters. Recommendations for systematic evaluation of such sample and theory parameters are offered and their clinical implications are discussed.
*Zuromski, K. L., & Witte, T. K. (2015). Fasting and acquired capability for suicide: A test of the interpersonal-psychological theory of suicide in an undergraduate sample. Psychiatry Research, 226, 61-67.
Though some preliminary research within the framework of the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005) has postulated that restrictive eating may contribute to increased risk for suicide through its effect on the acquired capability for suicide (ACS; i.e., increased fearlessness about death and heightened pain tolerance), existing studies have not conducted direct tests of this relationship. To enhance understanding of this relationship, we compared undergraduates who endorsed one form of restrictive eating, fasting (n = 99) to controls endorsing no form of eating pathology over the lifetime (n = 94). We hypothesized that the fasting group would have higher ACS and higher likelihood of suicide attempt history. Contrary to hypotheses, no differences emerged between groups on ACS, and frequency of fasting within the fasting group was not significantly associated with ACS. Consistent with hypotheses, the fasting group was more likely to have suicide attempt history. Though results were not entirely consistent with hypotheses, the current study represents the first attempt at isolating and examining one form of restrictive eating (i.e., fasting) within the context of the IPTS. Results suggest that, in isolation, fasting may not be directly contributing to increases in ACS.
*Diulio, A. R., *Dutta, N. M., *Gauthier, J. M., Witte, T. K., Correia, C. J., & Angarano, D. (2015). Associations among depressive symptoms, drinking motives, and risk for alcohol related problems in veterinary students. Journal of Veterinary Medical Education, 42, 11-17.
Hazardous alcohol consumption among medical students appears to occur at a level comparable to the general population; however, among this population, it has been found that the motivation to use alcohol partially stems from unique stressors related to their professional training. Although veterinary students may also experience psychological distress in association with their training, little work has focused on the way that these students use alcohol to cope with their distress. The current study sought to examine the severity of depressive symptoms and alcohol consumption among veterinary students, as well as students' specific motives for drinking alcohol. The majority of our sample reported experiencing at least one depressive symptom, and a significant proportion engage in high-risk drinking, wtih men reporting more harmful alcohol use patterns. Drinking motives related to managing internal bodily and emotional states accounted for variance in drinking patterns. Further, the relationship between psychological distress and high-risk drinking was partially accounted for by drinking to ameliorate negative emotions. The results of this study suggest that depressive symptoms among veterinary students may be related to harmful drinking patterns, due to alcohol being used as a coping mechanism to regulate emotions. The findings from this study can be used to develop targeted interventions to promote psychological wellbeing among veterinary students.
*Gauthier, J. M., *Zuromski, K. L., Gitter, S. A., Witte, T. K., *Cero, I. J., Gordon, K. H., Ribeiro, J. D., Anestis, M. D., & Joiner. T. E., Jr. (2014). The interpersonal-psychological theory of suicide and exposure to video game violence. Journal of Social and Clinical Psychology, 33, 512-535.
According to the Interpersonal-Psychological Theory of Suicide (IPTS), individuals become capable of withstanding the pain and fear associated with a suicide attempt through habituation to painful and/or frightening stimuli. This capability, referred to as the acquired capability for suicide, is composed of both pain tolerance and fearlessness about death. Although most often these two components have been confounded in the literature, recent investigations utilizing the IPTS have found differential relationships between these components and specific life experiences. In the current study, we investigated the relationship between exposure to violent video games and both components of acquired capability. Given that a limited number of studies have found relationships between suicide ideation and excessive video game play, we also investigated the relationships among violent video game exposure, thwarted belongingness, perceived burdensomeness, and passive suicide ideation. We hypothesized that exposure to violent video games would be positively associated with fearlessness about death, but not pain tolerance; additionally we explored the notion that violent video game exposure is associated with the other constructs of the IPTS. In a sample of 781 undergraduate students, we found an association between violent video game exposure and fearlessness about death; no other meaningful significant results were found.
*Zuromski, K., *Davis, M. T., Witte, T. K., Weathers, F. W., & Blevins, C. (2014). PTSD symptom clusters are differentially associated with components of the acquired capability for suicide. Suicide and Life Threatening Behavior, 44, 682-697.
Previous research has established the link between posttraumatic stress disorder (PTSD) and suicidal behavior. In the current study, constructs pro- posed to explain this relationship were examined, applying the framework of the interpersonal-psychological theory of suicide (IPTS). Relationships between acquired capability for suicide (ACS; i.e., fearlessness about death [FAD] and pain tolerance) and specific PTSD symptom clusters were explored. In a sample of 334 trauma-exposed undergraduates, anxious arousal and FAD were nega- tively associated, and numbing and pain tolerance were positively associated. Results establish a foundation for investigating the role of ACS in understand- ing observed relationships between suicidal behavior and PTSD symptoms.
*Davis, M.T., Witte, T. K., Weathers, F. W., & *Blevins, C. A. (2014). The role of posttraumatic stress disorder symptom clusters in the prediction of passive suicidal ideation. Psychological Trauma: Theory, Research, Practice, and Policy, 6, S82-S91.
This study examined the relationship between posttraumatic stress disorder symptom clusters and passive suicidal ideation in a sample of trauma-exposed college students (N = 334), using the interpersonal-psychological theory of suicide as a framework. All symptom clusters had indirect relationships with passive suicidal ideation, partially mediated by perceived burdensomeness and thwarted belongingness. Further, the numbing cluster had the strongest bivariate relationship with passive suicidal ideation, and both numbing and reexperiencing were directly related to passive suicidal ideation in structural models. Results are consistent with the interpersonal-psychological theory of suicide and suggest a unique relationship between numbing and passive suicidal ideation.
*Davis, M. T., Witte, T. K., & Weathers, F. W. (2014). Posttraumatic stress disorder and suicidal ideation: The role of specific symptoms within the framework of the interpersonal-psychological theory of suicide. Psychological Trauma: Theory, Research, Practice, & Policy, 6, 610-618.
Posttraumatic stress disorder (PTSD) has been linked consistently with suicidal ideation (SI). However, research in this area has focused on PTSD at the diagnostic or syndrome level rather than at the symptom level. In the present study we examined the relationship between individual PTSD symptoms and SI, deriving hypotheses from the interpersonal-psychological theory of suicide (IPTS) as well as the conceptual and empirical literature regarding the nature and factor structure of PTSD symptoms. We predicted that the strongest relationship between PTSD symptoms and SI would be found for the emotional numbing symptoms, especially detachment or estrangement from others. Trauma-exposed female undergraduates (N = 434) completed a battery of self-report measures, including the PTSD Checklist and Personality Assessment Inventory. As hypothesized, detachment/estrangement had the highest zero-order correlation with SI. Further, in regression analysis, detachment/estrangement was the only PTSD symptom that was positively associated with SI after controlling for negative response bias, depression, type of trauma, and all other PTSD symptoms. These results are consistent with the IPTS and highlight the relationship between detachment/estrangement and SI among those with PTSD.
Ribeiro, J. D., Witte, T. K., Van Orden, K. A., Selby, E. A., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2014). Fearlessness about death: The psychometric properties and construct validity of the revision to the Acquired Capability for Suicide Scale. Psychological Assessment, 26, 115-126.
The Interpersonal Theory of Suicide proposes that suicidal behavior is so frightening that in order for an individual to engage in suicidal behavior, desire for suicide must be accompanied by the capability to do so. The capability for suicide is characterized by both a sense of fearlessness about death and elevated physiological pain tolerance. The primary aim of the current project was to reevaluate and revise the Acquired Capability for Suicide Scale (ACSS) and offer a revision to the scale. Expert review of the scale items resulted in retaining seven items assessing fearlessness about death. The recommendation is made to refer to the revised scale as the ACSS-Fearlessness about Death (ACSS-FAD) to reflect its content more specifically. A model with the 7 retained items provided good fit to the data across three independent samples of young adults. Multiple group analyses examining measurement invariance across men and women found that the latent structure of the scale is comparable across gender. Data are also presented demonstrating convergent and discriminant validity for the scale in young adults and an inpatient psychiatric sample. Findings support the viability of the ACSS-FAD, indicating the scale has a replicable factor structure that generalizes across males and females and is substantively related to the construct of fearlessness about death. Taken together, the present work extends our knowledge of the psychometrics of the ACSS-FAD in particular and the nature of fearlessness about death in general.
Witte, T. K., Correia, C., & Angarano, D. (2013). Experience with euthanasia is associated with fearlessness about death in veterinary students. Suicide and Life Threatening Behavior, 43, 125-138.
Veterinarians have an increased risk for suicide compared with the general population, yet there is little consensus regarding why this might be. We hypothesized that veterinarians become relatively fearless about death due to their repeated exposure to euthanasia. Accordingly, we predicted that there would be a positive relationship between experience with euthanasia and fear- lessness about death, due to emotional habituation to the process of euthanasia. In a sample of 130 veterinary students, results conformed to expectation and indicated that the relationship with fearlessness about death was specific to euthanasia and did not generalize to experience with surgery or necropsy.
Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24, 197-215.
The present study examines the psychometric properties and construct validity of scores derived from the Interpersonal Needs Questionnaire (INQ) using latent variable modeling with five independent samples varying in age and level of psychopathology. The INQ was derived from the Interpersonal Theory of Suicide and was developed to measure thwarted belongingness and perceived burdensomeness—both proximal causes of desire for suicide. Results support that thwarted belongingness and perceived burdensomeness are distinct, but related constructs and that they can be reliably measured. Further, multiple group analyses were consistent with invariance for younger vs. older adults and non-clinical versus clinical populations thereby supporting the relevance of these constructs to diverse populations. Finally, both constructs demonstrated convergent associations with related interpersonal constructs—including loneliness and social support for belongingness and social worth and death ideation for burdensomeness—as well as prospective associations with suicidal ideation.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575-600.
Suicidal behavior is a major problem worldwide and at the same time has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current paper presents the Interpersonal Theory of Suicidal Behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states)—and further, that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current paper, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses.
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T.E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72-83.
The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that an individual will not die by suicide unless he/she has both the desire to die by suicide and the ability to do so. Three studies test the theory's hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed.