Examining Components of the Interpersonal Theory of Suicide Among Children With Suicide Ideation or Attempts

Abstract

Introduction

Limited research has examined the circumstances surrounding childhood suicidal thoughts and behaviors. The interpersonal psychological theory of suicide proposes that suicidal desire arises from perceived burdensomeness and thwarted belongingness, and that suicide attempts result from an acquired capability for suicide. No published study, of which we are aware, has tested whether this theory applies to children’s suicidal thoughts or behaviors. The present study examined whether components of the interpersonal psychological theory of suicide would be present in the narratives of children who presented for clinical care with suicide ideation or attempts.

Methods

Thirty-nine children, ages 7–12 years, recruited from two public hospitals and one outpatient clinic, completed semi-structured interviews assessing the circumstances surrounding their recent suicide ideation or attempts. Interviews were analyzed thematically using a hybrid inductive-deductive approach.

Results

Findings indicated that thwarted belongingness stemmed from loneliness, perceived rejection, and a lack of reciprocal care. Themes reflecting perceived burdensomeness included internalized criticism, low self-esteem, and perceived liability. Children described experiences, such as physical punishment, that may contribute to acquired capability for suicide.

Discussion

These findings support the relevance of the interpersonal psychological theory of suicide in childhood and underscore the critical role caregivers play in protecting children from suicide-related risk.

Plain Language Summary

There is very little research that has tried to understand what leads children to think about and attempt suicide. Our study tried to fill this gap in the literature. We interviewed children who went to a hospital after having suicidal thoughts or behaviors to better understand whether how they described what led them to think about or attempt suicide was consistent with one of the most prominent theories of suicide -- the Interpersonal Theory of Suicide. This theory was developed with and has been studied primarily with adults, and to a lesser degree, with adolescents. However, its relevance to children is unknown. By analyzing children’s descriptions of their recent suicidal crises, we found that children described what led to their suicidal thoughts or attempts in ways consistent with this theory. Specifically, themes that arose in their descriptions reflected feeling like a burden to others, lack of belonging, hopelessness about the future, and experiences that reflected being capable of suicide. For example, children who seemed to see themselves as a burden to others described feeling that others would be better off without them, seemed to internalize others’ criticisms of them, and experienced low self-esteem. Children who described lack of belonging did so in ways that suggested they were lonely, felt rejected by others, and saw themselves as caring more about others than others cared about them. Our results suggested that the Interpersonal Theory of Suicide can be used to understand children’s suicidal thoughts and behavior, although with some differences from older age groups.