Thwarted Belongingness Mediates Interpersonal Stress and Suicidal Thoughts: An Intensive Longitudinal Study with High-risk Adolescents

ABSTRACT

Objective

Interpersonal negative life events (NLEs) have been linked to risk for suicidal thoughts and behaviors. However, little is known about how this risk is conferred over the short term and the mechanisms linking interpersonal NLEs to suicide risk, particularly in adolescents. This study used an intensive longitudinal design to examine thwarted belongingness with family and friends as potential mechanisms linking interpersonal NLEs to suicidal thoughts.

Method

Forty-eight adolescents (M_age = 14.96 years; 64.6% female, 77.1% White), who recently received acute psychiatric care for suicide risk, were followed intensely for 28 days after discharge. Smartphone-based ecological momentary assessment was used to measure presence of interpersonal NLEs at the day level, fluctuations in thwarted belongingness with family and friends (separately) within day, and fluctuations in suicidal thoughts within day. A multi-level structural equation model was utilized to examine family thwarted belongingness and friend thwarted belongingness as parallel mediators in the relationship between interpersonal NLEs and next-day suicidal thoughts.

Results

Significant direct effects were observed between interpersonal NLEs and family thwarted belongingness, family thwarted belongingness and suicidal thoughts, and friend thwarted belongingness and suicidal thoughts. In addition, family, but not friend, thwarted belongingness significantly mediated the association between interpersonal NLEs and next-day suicidal thoughts.

Conclusions

Interpersonal NLEs predicted greater suicidal thoughts over the short term (next day) in high-risk adolescents. Findings suggest how interpersonal NLEs may confer risk for suicidal thoughts – by reducing feelings of family belongingness. Future research is needed to examine how modifying belongingness may reduce suicide risk in adolescents.

Acknowledgments

The authors would like to thank the following members of the research team for their assistance with this project: Linda Alpert-Gillis PhD, Yeates Conwell MD, Wilfred Pigeon PhD, Jaclyn Kearns MA, John (Kai) Kellerman, Angela Santee, and all the research assistants who helped with data collection and risk monitoring. In addition, the authors thank Kim Van Orden PhD for assistance modifying the belongingness measure for the current study. Finally, the authors would like to thank the adolescents and their families who volunteered to participate in this research, as well as Michael Scharf, MD, Claudia Blythe, and the clinical team in Pediatric Behavioral Health & Wellness at the University of Rochester Medical Center for their support with this research.

Disclosure statement

Author CG receives royalties from UpToDate, and RL is a consultant for Relmada Therapeutics. The other authors have no conflicts of interest to disclose.

Supplementary Material

Supplemental material for this article can be accessed online at https://doi.org/10.1080/15374416.2021.1969654

Notes

¹ At the time of eligibility screening, only adolescents’ age and gender were available. Enrolled and unenrolled adolescents did not differ in age (t[80] = −0.12, p = .902) or gender (χ²[2, N = 82] = 1.05, p = .591).

² Because the number of total SC prompts varied across adolescents depending on the number of days enrolled in the study and number of daily prompts (based on each adolescent’s availability), survey completion is reported as raw numbers instead of percentages.

³ When testing alternative models with only one mediator at a time, the interpretation was the same: family thwarted belongingness was a significant mediator, but friend thwarted belongingness was not.

Additional information

Funding

This research was supported in part by a grant from the American Foundation for Suicide Prevention (YIG-1-054-16), funding from the National Institute of Mental Health (L30 MH101616), and pilot funding from the University of Rochester Medical Center. This study was approved by the University of Rochester’s Institutional Review Board (RSRB00066408).