This dissertation does not contain text, graphics, or tables copied and pasted from the Internet, unless specifically acknowledged, and the source is detailed in the dissertation and in the references section. Joiner's (2005) Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) is a comprehensive theory that focuses on intra- and interpersonal influences on the development of suicidal behavior while acknowledging neurobiological correlates. The purpose of this study was to explore demographic and mental health predictors of IPTS constructs and outcomes.
Standard multiple linear regression and binary logistic regression analyzes were conducted to determine which demographic variables and mental health conditions were predictors of the theory's constructs and outcomes. A low level of education was significantly associated with all three outcomes, while being unemployed was significantly associated with thoughts of death, being black or colored was significantly associated with suicidal thoughts and being younger was significantly associated with the risk of suicide. Finally, borderline personality disorder and substance abuse disorder were significantly associated with all three outcomes, while bipolar mood disorder, major depressive disorder, schizophrenia, and grief were also significantly associated with thoughts of death and bipolar mood disorder was also significantly associated with suicide risk.
These findings advance our understanding of the role that demographic variables and mental disorders play in the development of suicidal behavior in the unique South African context, where the study has the potential to inform both the assessment of suicide risk and the development of prevention and intervention initiatives . to minimize the risk of suicide.
Background
Although some theories of suicidal behavior have been proposed (i.e. psychodynamic, sociological and biological theories), few studies have looked at models that are more integrative, that pay attention to the interaction between the dynamic systems that exist intrapersonally and interpersonally (Prinstein, 2008; Van Orden et al., 2010). It is essential that a theory of suicidal behavior distinguishes between suicidal ideation, suicide attempts, and fatal suicide, rather than simply viewing suicidal behavior as a unitary construct, as this is primarily consistent with the taxonomy of suicidal behavior, and in second place is consistent. with the fact that suicidal thoughts and attempts are much more common than fatal suicides (Van Orden et al., 2010). The IPTS is therefore much more comprehensive than previous theories of suicidal behavior, because it is both sensitive in predicting suicidal behavior, because it is able to identify a large number of people at risk for suicidal desire, and specific, because it is also able to identify those at risk for suicide attempts (Bender et al., 2008).
Having a theory that is consistent with and able to account for empirically documented risk factors for suicide (and how they relate to suicidal behavior) is essential in advancing our understanding of suicidal behavior and improving prevention strategies (Van Orden et al., 2010; Bender et al., 2008). Furthermore, a comprehensive theory of suicidal behavior must be able to account for demographic differences in suicidal behavior that are well documented, such as gender differences in suicide rate and behavior, as well as variation in suicide rates by age and breed. Van Orden et al., 2010). The IPTS is supposed to provide such a framework for understanding the universal but distinct relationships between risk factors (such as mental illness), demographic variables, and suicidal behavior, yet the existing literature is inconsistent in this regard (Silva et al., 2015). .
Kessler, Borges & Walters, 1999), but it is possible that within low- and middle-income countries, such as South Africa, there may be different predictors of suicidal behavior (Ndosi, Mbonde & Lyamuya, 2004).
Research Aim
Gaining deeper insight into the mechanisms by which demographic variables and mental illness act as risk factors for suicidal behavior can help develop effective screening, prevention, and intervention strategies (Khasakhala et al., 2011) in the country.
Outline of the Dissertation
Chapter five presents a discussion of the results in relation to the existing literature and considers the implications of the findings as well as the limitations and strengths of the study.
Introduction
Global Picture
Suicide in South Africa
Dysregulation of the HPA axis has been found to be associated with an increased risk for suicide in individuals with psychiatric disorders. Furthermore, in light of the increased risk for suicidal behavior associated with mental illness (Cavanagh et al., 2003), it is also the aim of this study to explore which mental illnesses are associated with the theory's constructs and outcomes. To explore demographic and mental health predictors of the IPTS constructs of thwarted belongingness (TB), perceived burdensomeness (PB), interpersonal hopelessness (IH), and acquired competence (AC) for suicidality.
To explore the demographic and mental health predictors of the IPTS outcomes of thoughts of death, suicidal ideation, and suicidal risk. What are the demographic variables and mental illnesses associated with the constructs of IPTS. What are the demographic variables and mental illnesses associated with the theory's findings.
Four of the DSM diagnoses (a trauma-related disorder, adjustment disorder, personality disorder not specified, and not specified) were excluded from the regression analyzes because their sample size was too small (n < 8). The central purpose of this study was to identify the demographic variables and mental illnesses associated with the constructs and outcomes of the IPTS. Results from the regression analysis showed that none of the demographic variables explored in the study were significantly associated with thwarted belongingness (TB).
All the examined mental illnesses, with the exception of impulse control disorders, were found to be significantly associated with PB. None of the mental illnesses were found to be significantly associated with the IH construct. Findings from the regression analyzes indicated that none of the mental illnesses were significantly associated with AC.
Contrary to expectations, suicidal ideation was significantly associated only with SUD and BPD, and not with any of the other mental illnesses. Of the mental illnesses included in the present study, only SUD and BPD were significantly associated with all three IPTS scores. Therefore, this may explain why only a small number of mental illnesses were significantly associated with the outcomes of suicidal ideation and suicide risk.
None of the mental illnesses were significantly associated with IH and AC (contrary to expectations). A possible explanation for why only a small number of mental illnesses were significantly associated with the outcomes of suicidal ideation and suicide risk could be that due to the high comorbidity of mental. Suicide risk factor predictors defined by the interpersonal-psychological theory of suicidal behavior.
Definition of Suicide
Demographic Variables
Family conflict is an additional interpersonal risk factor and one of the greatest risk factors for fatal suicidal behavior across the lifespan (Van Orden, et al., 2010). The central aim of this study is to explore demographic and mental health predictors of IPTS constructs and outcomes. The second demographic variable that was significantly associated with suicidal ideation was race, specifically being of the black or colored race group.
Findings that none of the mental illnesses were significantly associated with AC were inconsistent with findings from previous studies and contrary to expectations.
Risk and Protective Factors
Theoretical Framework
It is therefore assumed that an individual's degree of cohesion varies over time (Van Orden et al., 2010). PB consists of two components, self-loathing and feelings of accountability (Van Orden et al., 2010). There are a number of observable indicators of liability, the first being the distress caused by unemployment (Van Orden et al., 2010).
PB is viewed as a dynamic cognitive-affective state, in addition to a dimensional phenomenon (Van Orden et al., 2010). The acquired capacity (AC) for suicide is a multidimensional, emergent latent variable and consists of two minor factors: reduced fear of death and increased physical pain tolerance (Van Orden et al., 2010). The former is conceptualized as a dimensional construct, and thus an individual's fear of death can range from very high levels to negligible levels (Van Orden et al., 2010).
Thus, it is proposed that for a person's desire for suicide to develop into a serious suicide risk, their fear of death must be reduced to no fear of suicidal acts (Van Orden et al., 2010).
Rationale for the Present Study
A binary logistic regression analysis was performed to assess the impact of the demographic variables and mental health conditions on the suicide risk outcome. None of the demographic variables were significantly associated with IH, while younger age, being male, and working were significantly associated with AC. Mental Health Conditions Associated with Thoughts of Death, Suicidal Ideation, and Risk of Suicide The findings of this study indicated that of the mental health conditions examined, addiction and BPD were significantly associated with all three outcomes of the IPTS.
In addition to these disorders, BPMD, MDD, schizophrenia, and bereavement were significantly associated with ideation of death, whereas none of the other mental illnesses were significantly associated with suicidal ideation (which was contrary to expectations). The primary aim of this study was to explore demographic and mental health predictors of the constructs (impeded belonging, perceived burden, interpersonal hopelessness, and acquired suicidality) and outcomes (death ideation, suicidal ideation, and suicide risk) of IPTS. Finally, regarding the relationship between the demographic variables included in the study and the IPTS constructs, the results from this study showed that none of the demographic variables were significantly related to thwarted belongingness (TB) and interpersonal hopelessness (IH). while being female, being unemployed, and having a lower level of education were significantly related to perceived burden (PB), and being younger, male, and being employed were significantly related with the acquired ability (AC) for suicide.
