Lauren N Forrest1, Lindsay P Bodell2, Tracy K Witte3, Natalie Goodwin4, Mary L Bartlett5, Nicole Siegfried5, Kamryn T Eddy6, Jennifer J Thomas6, Debra L Franko7, April R Smith8. 1. Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States. 2. University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, United States. 3. Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL 36849, United States. 4. Eating Recovery Center of Washington, 1231 116th Ave NE, Bellevue, WA 98004, United States. 5. Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States. 6. Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States. 7. Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Bouvé College of Health Sciences and Department of Counseling and Applied Educational Psychology, Northeastern University, 123 Behrakis Health Sciences Center, Boston, MA 02115, United States. 8. Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States. Electronic address: aprilsmith@miamioh.edu.
Abstract
BACKGROUND: Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal-Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations. METHOD: We tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome. RESULTS: The first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. LIMITATIONS: The sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation. CONCLUSIONS: Results underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.
BACKGROUND: Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal-Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations. METHOD: We tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome. RESULTS: The first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. LIMITATIONS: The sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation. CONCLUSIONS: Results underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.
Authors: Carol Chu; Melanie A Hom; Ian H Stanley; Anna R Gai; Matthew K Nock; Peter M Gutierrez; Thomas E Joiner Journal: J Consult Clin Psychol Date: 2017-11-27
Authors: April R Smith; Shelby N Ortiz; Lauren N Forrest; Elizabeth A Velkoff; Dorian R Dodd Journal: Curr Psychiatry Rep Date: 2018-08-09 Impact factor: 5.285
Authors: Carol Chu; Jennifer M Buchman-Schmitt; Ian H Stanley; Melanie A Hom; Raymond P Tucker; Christopher R Hagan; Megan L Rogers; Matthew C Podlogar; Bruno Chiurliza; Fallon B Ringer; Matthew S Michaels; Connor H G Patros; Thomas E Joiner Journal: Psychol Bull Date: 2017-10-26 Impact factor: 17.737
Authors: Shirley B Wang; Christopher J Mancuso; Jenny Jo; Ani C Keshishian; Kendra R Becker; Franziska Plessow; Alyssa M Izquierdo; Meghan Slattery; Debra L Franko; Madhusmita Misra; Elizabeth A Lawson; Jennifer J Thomas; Kamryn T Eddy Journal: Int J Eat Disord Date: 2019-12-30 Impact factor: 4.861