Targeting Perceived Burdensomeness to Reduce Suicide Risk

• Published in: Behavior therapy 2023-07, Vol.54 (4), p.696-707
• Main Authors: Lieberman, Amy, Gai, Anna R., Rogers, Megan L., Jobes, David A., David Rudd, M., Chalker, Samantha A., Brenner, Joshua T., Joiner, Thomas E.
• Format: Article
• Language: English
• Subjects: behavior change; Humans; Interpersonal Relations; Interpersonal Theory of Suicide; military; Military Personnel; perceived burdensomeness; Psychological Theory; Risk Factors; Suicidal Ideation; Suicide
• ISSN: 0005-7894; 1878-1888
• DOI: 10.1016/j.beth.2022.12.002

•Perceived burdensomeness (PB) is a salient risk factors for suicide.•PB is fluid in nature and may serve as a corrective target for intervention.•Decreased PB may mediate decreases in baseline to follow-up suicidal ideation. Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one’s death is worth more than one’s life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches—including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals—explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from .07–.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts.