Archives of Suicide Research, 18:282–294, 2014 Copyright # International Academy for Suicide Research ISSN: 1381-1118 print=1543-6136 online DOI: 10.1080/13811118.2013.824839
Basic Need Satisfaction and Suicidal Ideation: A Self-Determination Perspective on Interpersonal Suicide Risk and Suicidal Thinking Raymond P. Tucker and LaRicka R. Wingate This study investigated the relationship between the basic psychological needs, as outlined by self-determination theory, and the interpersonal predictors of suicidal desire, as outlined by the interpersonal-psychological theory of suicidal behavior. It was hypothesized that basic need satisfaction (collective feeling of autonomy, relatedness, and competence) would be related to suicidal ideation through thwarted belongingness and perceived burdensomeness. Mediation analyses demonstrated that thwarted belongingness and perceived burdensomeness both individually mediated the relationship between basic need satisfaction and suicidal ideation. Relatedness also predicted variance of the interaction of thwarted belongingness by perceived burdensomeness while controlling for depression. The clinical utility of assessing need satisfaction as an indication of suicide risk is discussed. Future research to investigate the temporal relationship of the study variables is recommended. Keywords basic psychological needs, interpersonal relationships, self-determination theory, suicidal ideation, suicide
to die by suicide is present (clinically referred to as suicidal ideation) and the capability to enact lethal self-harm has been developed. The interpersonal dysfunctions of thwarted belongingness and perceived burdensomeness promote the development of the desire for suicide. The capability to enact lethal self-harm develops through repeated exposure to painful and provocative experiences (i.e., death of others, physical injury to self, and previous suicide attempts) which habituates individuals to the painful
Over 38,000 Americans died by suicide in 2010, making it the tenth ranked cause of American deaths that year (Mcintosh & Drapeau, 2012). With an estimated 959,100 Americans who attempted in the same year, suicide continues to be a legitimate public health concern. Joiner’s (2005) interpersonal-psychological theory of suicidal behavior is a recent theoretical framework of suicidal risk aimed at explaining why individuals die by suicide. Within this theory, death by suicide is most imminent when both the desire
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R. P. Tucker and L. R. Wingate
consequences of enacting self-harm and enables people to physically follow through with their desire for death by suicide (Joiner, 2005; Van Orden et al., 2010). Thus, the interpersonal-psychological theory of suicidal behavior contains three central risk factors for severe suicidal risk: (1) feelings of social isolation (thwarted belongingness), (2) beliefs that one is a burden to others (perceived burdensomeness), and (3) the acquired capability to enact lethal self-harm through an increase in pain tolerance and a reduced fear of death (acquired capability). Risk factors (1) and (2) facilitate the development of suicidal desire, and (3) creates the ability to physically carry out lethal selfharm. Although the interpersonal-psychological theory of suicidal behavior has received empirical support, little research has investigated the relationship between the theory’s interpersonal risk factors and a key component of the self-determination theory—basic psychological need satisfaction. Previous research has indicated that the satisfaction of the basic psychological needs of autonomy, relatedness, and competence, are intimately related to symptoms of depression Wei, Shaffer, Young et al., 2005), and it is possible that the basic psychological needs play an important role in the development of suicidal ideation as well as the interpersonal predictors of suicidal behavior. This inquiry is significant as it investigates constructs that may contribute to the desire for suicide, and could be potential antecedents to interpersonal predictors of suicide. Self-determination theory (Deci & Ryan, 1985; 2000; 2008) offers a possible understanding of the role of basic psychological needs in the experience of interpersonal risk factors of suicide. Self-determination theory is rooted in positive psychology and it asserts that well-being occurs when the basic psychological needs are met. This macrotheory of human motivation asserts that there are three inherent psychological needs: (1) autonomy, (2) relatedness, (3) competence,
and that these are integral antecedents for proper growth and adjustment (Deci & Ryan, 2000). Some of the research on basic psychological needs has focused on mental health outcomes in relation to basic need satisfaction (the collective satisfaction of all three basic needs). Other research has examined mental health outcomes in relation to individual need satisfaction (i.e., the satisfaction of only autonomy, relatedness, or competence). Findings have generally demonstrated that when these needs are not satisfied, a wide variety of physical and psychological disturbances manifest, including depression, anxiety, insomnia, low self-esteem, and negative affect, among others (Baard, Deci, & Ryan, 2004; Kasser & Ryan, 1999; Sheldon & Niemiec, 2006; Sheldon, Ryan, & Reis, 1996; Wei, Shaffer, Young et al., 2005). Self-determination theory asserts that the need for autonomy is theoretically similar to self-governance in that individuals demonstrate autonomy by acting willingly on whole-heartedly endorsed beliefs and decisions (Chirkov, Ryan, Kim et al., 2003; Ryan & Deci, 2000). People’s actions are not influenced by social norms or expectations of others that the individual does not validate. Failed satisfaction of the need for autonomy has been related to feelings of depression in nursing home residents, bank employees, and adolescents (Baard, Deci, & Ryan, 2004; Kasser & Ryan, 1999; Noom, Dekovic´, & Meeus, 1999; O’Connor & Vallerand, 1994). A similar relationship has been found utilizing the Basic Psychological Needs Scale (BPNS; Deci, Ryan, Gagne´ et al., 2001), a measure of general basic need satisfaction developed specifically for testing need satisfaction as it relates to selfdetermination theory. Wei and colleagues (2005) illustrated a negative relationship between the satisfaction of the need for autonomy and self-reported symptoms of depression and loneliness in an undergraduate sample. The need for relatedness was influenced by early work on attachment. This basic
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need refers to an individual’s desire for frequent interpersonal interactions and significant, unwavering connections to others (Baummeister & Leary, 1995; Bowlby, 1969). The absence of relatedness (the second basic psychological need outlined in self-determination theory) has also been empirically linked to depression utilizing domain specific measures of relatedness. Older adults who feel connected to a social network report lower levels of depression (Gillath, Johnson, Selcuk et al., 2011). In a longitudinal study of high school senior women, Eberhart and Hammen (2006) found that a lack of relatedness to family members and peers predicted depressive symptoms at 6 and 24 months when controlling for baseline depression scores. Wei and colleagues (2005) used the BPNS to demonstrate a negative relationship between the satisfaction of the need for relatedness and symptoms of depression. Competence (the third basic psychological need) has been broadly defined as the feeling of effectiveness and efficiency within one’s own environment and the belief that one can achieve desired outcomes and goals (Deci & Ryan, 1985; White, 1963). A lack of academic and social competency has been shown to be robust predictor of childhood depression (Blechman, McEnroe et al., 1986; Cole, 1990). A lack of perceived competence has similarly been related to adolescent depression (Sma´ri, Pe´tursdo´ttir, & Porsteinsdo´ttir, 2001). Blatt and Zuroff (1992) argued that depressed individuals are likely to fail to reach introjected expectations, self-scrutinize, and develop feelings of worthlessness and depression. The competence subscale of the BPNS has been negatively associated with three different self-report measures of depression (Wei, Shaffer, Young et al., 2005). Self-determination theory and its core components of the basic psychological needs may contain strong implications for understanding the desire to die by suicide. Although there is research that establishes
284
the relationship among depression and both the individual and collective components of basic need satisfaction, there has not been empirical evidence relating basic need satisfaction and suicide risk. More specifically, there is no literature, to our knowledge, that examines how the collective satisfaction of the needs for autonomy, relatedness, and competence relate to suicidal ideation and the interpersonal risk factors of thwarted belongingness and perceived burdensomeness. Research has demonstrated that one way suicidal ideation develops is through perceptions of burdensomeness and disconnection from others (Joiner, Van Orden, Witte et al., 2009). It stands to reason that these feelings—whether accurate or distorted—relate to a lack of autonomy, relatedness, and competence. The aim of this study is to investigate the role of basic needs satisfaction in the development of suicidal ideation, thwarted belongingness, and perceived burdensomeness. This research may shed light upon potential protective factors against suicidal desire. It is hypothesized that the satisfaction of each individual psychological need posited by self-determination theory (i.e., autonomy, relatedness, and competence) will be negatively related to suicidal ideation, thwarted belongingness, and perceived burdensomeness. Similarly, a negative relationship among basic need satisfaction (i.e., the combination of all three needs) and suicidal ideation, thwarted belongingness, and perceived burdensomeness is hypothesized. This study also aims to test whether basic psychological need satisfaction displays a significant relationship to suicidal ideation independent of the interpersonal risk factors outlined by in the interpersonal-psychological theory of suicidal behavior. We predict that both thwarted belongingness and perceived burdensomeness will mediate the relationship between basic need satisfaction (the total satisfaction of all three needs) and suicidal ideation. Specifically, we expect that participants experiencing elevated basic need
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satisfaction would endorse lower levels of thwarted belongingness and perceived burdensomeness, and thus less suicidal ideation.
found to be good (a ¼ .88), however the reliability of the three subscales varied: autonomy .64 (poor), relatedness .85 (good), and competence .74 (acceptable).
METHODS
Interpersonal Needs Questionnaire. The Interpersonal Needs Questionnaire (INQ; Van Orden, Cukrowicz, Witte et al., 2012) is a self-report scale designed to measure feelings of thwarted belongingness and perceived burdensomeness. The scale consists of 15 self-report items with 9 items assessing thwarted belongingness and 6 items assessing perceived burdensomeness. Responses are coded on a 7-point Likerttype scale (ranging from 1 ¼ not at all true for me to 7 ¼ very true for me) with higher scores reflecting increased feelings of thwarted belongingness and perceived burdensomeness. Internal consistencies were found to be excellent in the current sample: a ¼ .92 for the perceived burdensomeness subscale and a ¼ .90 for the thwarted belongingness subscale.
Participants
Participants in this study were 336 students (65.5% female, 34.5% male) from a large state university. Participants ranged in age from 18 to 46, with a mean age of 19.74 years. 80.7% of participants selfidentified as Caucasian, 4.8% as AfricanAmerican, 6.8% as Native American, 1.5% as Biracial, 3.0% as Asian-American, 2.4% as Hispanic, and .6% as other. 9.5% of participants reported some level of suicidal ideation in the past 2 weeks. Measures
Basic Psychological Needs Scale. The Basic Psychological Needs Scale (BPNS; Deci, Ryan, Gagne´ et al., 2001) is a self-report scale designed to measure the degree to which individuals experience the satisfaction of the psychological needs of autonomy, relatedness, and competence. The scale consists of 21 questions with 7 questions assessing levels of autonomy, 8 questions assessing levels of relatedness, and 6 questions assessing levels of competence. Participants are asked to think about how the items relate to their everyday lives and indicate how accurate the statements are. Responses are coded on a 7-point Likerttype scale (ranging from 1 ¼ ‘‘not at all true’’ to 4 ¼ ‘‘somewhat true’’ to 7 ¼ ‘‘very true’’) with higher scores representing greater need satisfaction. The three subscales can be averaged to form an index of general need satisfaction which has been used in multiple studies (Deci, Ryan, Gagne´ et al., 2001; Gagne´, 2003). The internal consistency for basic need satisfaction was
Hopelessness Depressive Symptom QuestionnaireSuicidality Subscale. The Hopelessness Depressive Symptom QuestionnaireSuicidality Subscale (HDSQ-SS; Metalsky & Joiner, 1991; Metalsky & Joiner, 1997) is a subscale of the Hopelessness Depression Symptom Questionnaire (HDSQ) developed by Metalsky and Joiner (1991). The subscale is designed to assess selfreported suicidal ideation in the previous 2 weeks. The HQSQ-SS consists of four items (e.g., ‘‘I do not have thoughts of killing myself’’ and ‘‘I am not having impulses to kill myself’’) rated on a scale of 0–3 with the corresponding responses varying depending on the question. Higher scores indicate elevated levels of suicidal thinking and the impulse to end one’s life. The internal consistency of the HDSQ-SS in the current sample was excellent, a ¼ .91. Center for Epidemiologic Studies Depression Scale. The Center for Epidemiologic
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Studies Depression Scale (CES-D; Radloff, 1977) was developed to assess self-reported symptoms of depression over the past week and was developed to use in the general population. The scale consists of 20 Likert-type items with scores ranging from 0 ¼ Rarely or none of the time (less than 1 day) to 3 ¼ Most or all of the time (5–7 days). Total scores range from 0–40. Radloff (1977) demonstrated that the CES-D has strong psychometric properties including good internal consistency and test-retest reliability. The internal consistency of the scale in this sample was excellent, a ¼ .92. Procedure
Participants completed self-report measures through an online research system. Most participants completed the study in approximately 30 to 40 minutes. This study was approved by the University’s human subjects review board. As some of the information assessed during the study may have been considered personal and sensitive, referral resources indicating local
and national counseling services were provided to all participants. The referral resources also included contact information to local emergency services and national suicide hotlines. RESULTS
Means, standard deviations, and correlation coefficients of study variables are presented in Table 1. Zero-order correlations revealed that increased basic need satisfaction (the aggregate of the satisfaction of the needs of autonomy, relatedness, and competence) was negatively associated with suicidal ideation and the interpersonal risk factors of thwarted belongingness and perceived burdensomeness. Similarly, each individual need was significantly negatively correlated to suicidal ideation, thwarted belongingness, and perceived burdensomeness. Mediation Analyses
To test for the hypothesized mediational effect of the thwarted belongingness
TABLE 1. Means, Standard Deviations, and Correlation Coefficients of Study Variables Variable 1. Need Sat. 2. Autonomy 3. Relatedness 4. Competence 5. Depression 6. Burden 7. Belong 8. Ideation M SD
1
2
3
4
5
6
7
8
– .84 .89 .91 .54 .51 .68 .27 5.24 .80
– .62 .66 .46 .40 .50 .19 4.31 .74
– .71 .40 .46 .63 .22 6.16 .94
– .55 .49 .65 .29 5.25 1.03
– .65 .64 .41 12.94 10.31
– .66 .49 8.87 5.29
– .38 22.23 7.22
– .26 .60
Note. p < .001. Need Sat. ¼ Basic Psychological Need Satisfaction Total; Autonomy ¼ Basic Psychological Need Satisfaction—Autonomy Subscale; Relatedness ¼ Basic Psychological Need Satisfaction—Relatedness Subscale; Competence ¼ Basic Psychological Need Satisfaction—Competence Subscale; Depression ¼ Center for Epidemiologic Studies Scale Total; Burden ¼ Interpersonal Need Questionnaire—Burdensomeness Subscale; Belong ¼ Interpersonal Need Questionnaire—Thwarted Belongingness Subscale; Ideation ¼ Hopelessness Depressive Symptom Questionnaire—Suicidality Subscale.
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on the relationship between basic need satisfaction (the aggregate of all three needs) and suicidal ideation, the multiple regression steps outlined by Baron and Kenny (1986) and Judd and Kenny (1981) were followed. In step 1, the relationship between the initial variable and outcome variable is tested. As predicted, a linear regression revealed that basic need satisfaction negatively predicted suicidal ideation (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001). The second step of the mediation analysis is conducted to demonstrate the relationship between the initial variable and the mediating variable. As predicted, basic need satisfaction negatively predicted thwarted belongingness (b ¼ .68, SE ¼ .36, t(334) ¼ 17.16, p < .001), such that higher levels of need satisfaction was associated with lower levels of thwarted belongingness. To test the third step and fourth steps, a hierarchical regression analysis was conducted to determine if basic need satisfaction (the predictor variable) predicted suicidal ideation (the outcome variable) while controlling for the effects of thwarted belongingness (the mediator). Results indicated that the thwarted belongingness positively predicted suicidal ideation (b ¼ .39, SE ¼ .01, t(334) ¼ 7.62, p < .001) and basic need satisfaction dropped out as a meaningful predictor of suicidal ideation when the effects of the mediator were controlled
(b ¼ .01, SE ¼ .11, t(333) ¼ .09, p ¼ .927; see Figure 1). This significant mediation suggests that basic need satisfaction does not share significant variance with suicidal ideation above and beyond thwarted belongingness. The steps above were repeated with perceived burdensomeness as the mediator variable in order to determine if the interpersonal risk factor of suicide mediated the relationship between basic need satisfaction and suicidal ideation. Regressions demonstrated that basic need satisfaction negatively predicted suicidal ideation (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001), basic need satisfaction negatively perceived burdensomeness (b ¼ .51, SE ¼ .31, t(334) ¼ 10.92, p < .001), perceived burdensomeness positively predicted suicidal ideation (b ¼ .55, SE ¼ .01, t(334) ¼ 11.96, p < .001), and basic need satisfaction dropped out as a meaningful predictor of suicidal ideation when perceived burdensomeness was controlled (b ¼ .03, SE ¼ .08, t(333) ¼ .36, p ¼ .721; see Figure 2). Results demonstrate that perceived burdensomeness mediated the relationship between basic need satisfaction and suicidal ideation. Reverse Direction Models
In order to test other potential sequencing of variables in the hypothesized
FIGURE 1. Model of relationship among basic psychological need satisfaction, thwarted belongingness, and suicidal ideation. Note: Numerical values are the standardized regression coefficients. The standardized regression coefficient between basic need satisfaction and suicidal ideation controlling for thwarted belongingness is in parentheses. p < .001.
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FIGURE 2. Model of relationship among basic psychological need satisfaction, perceived burdensomeness, and suicidal ideation. Note: Numerical values are the standardized regression coefficients. The standardized regression coefficient between basic need satisfaction and suicidal ideation controlling for perceived burdensomeness is in parentheses. p < .001.
model, the outcome variables and mediator variables were switched in each model. This tested whether thwarted belongingness and perceived burdensomeness affect suicidal ideation through basic need satisfaction. In the first model, thwarted belongingness positively predicted suicidal ideation (b ¼ .39, SE ¼ .01, t(334) ¼ 7.62, p < .001). In step two, thwarted belongingness negatively predicted basic need satisfaction (b ¼ .68, SE ¼ .00, t(334) ¼ 17.16, p < .001). Basic need satisfaction negatively predicted suicidal ideation in step 3 (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001), however thwarted belongingness remained a meaningful predictor of suicidal ideation when the effects of basic need satisfaction were controlled (b ¼ .38, SE ¼ .01, t(334) ¼ 5.48, p < .001). A non-significant Sobel’s test demonstrated that the relationship was not partially mediated (z ¼ .10, p > .05). This result suggests that the relationship between thwarted belongingness and suici-
dal ideation is not mediated by basic need satisfaction. A similar relationship was found when testing the reverse direction model of perceived burdensomeness related to suicidal ideation through basic need satisfaction. Perceived burdensomeness positively predicted suicidal ideation (b ¼ .55, SE ¼ .01, t(334) ¼ 11.96, p < .001). In step two, perceived burdensomeness negatively predicted basic need satisfaction (b ¼ .51, SE ¼ .01, t(334) ¼ 10.92, p < .001). Basic need satisfaction negatively predicted suicidal ideation in step 3 (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001), however perceived burdensomeness remained a meaningful predictor of suicidal ideation when the effects of basic need satisfaction were controlled (b ¼ .56, SE ¼ .01, t(334) ¼ 10.43, p < .001). A non-significant Sobel’s test demonstrated that the relationship was not partially mediated (z ¼ .36, p > .05). This result suggests that the relationship between perceived burdensomeness
TABLE 2. Hierarchical Regression Analysis of Depressive Symptoms and Basic Need Satisfaction as Predictors of Thwarted Belongingness X Perceived Burdensomeness Interaction
Step 1 Depression Step 2 Basic Need Satisfaction
288
DR2
df
F
.240
1, 334
105.23
.006
2, 333
2.66
B
SE B
b
t
p
2.85
.28
.49
10.26
Basic Need Satisfaction and Suicidal Ideation: A Self-Determination Perspective on Interpersonal Suicide Risk and Suicidal Thinking Raymond P. Tucker and LaRicka R. Wingate This study investigated the relationship between the basic psychological needs, as outlined by self-determination theory, and the interpersonal predictors of suicidal desire, as outlined by the interpersonal-psychological theory of suicidal behavior. It was hypothesized that basic need satisfaction (collective feeling of autonomy, relatedness, and competence) would be related to suicidal ideation through thwarted belongingness and perceived burdensomeness. Mediation analyses demonstrated that thwarted belongingness and perceived burdensomeness both individually mediated the relationship between basic need satisfaction and suicidal ideation. Relatedness also predicted variance of the interaction of thwarted belongingness by perceived burdensomeness while controlling for depression. The clinical utility of assessing need satisfaction as an indication of suicide risk is discussed. Future research to investigate the temporal relationship of the study variables is recommended. Keywords basic psychological needs, interpersonal relationships, self-determination theory, suicidal ideation, suicide
to die by suicide is present (clinically referred to as suicidal ideation) and the capability to enact lethal self-harm has been developed. The interpersonal dysfunctions of thwarted belongingness and perceived burdensomeness promote the development of the desire for suicide. The capability to enact lethal self-harm develops through repeated exposure to painful and provocative experiences (i.e., death of others, physical injury to self, and previous suicide attempts) which habituates individuals to the painful
Over 38,000 Americans died by suicide in 2010, making it the tenth ranked cause of American deaths that year (Mcintosh & Drapeau, 2012). With an estimated 959,100 Americans who attempted in the same year, suicide continues to be a legitimate public health concern. Joiner’s (2005) interpersonal-psychological theory of suicidal behavior is a recent theoretical framework of suicidal risk aimed at explaining why individuals die by suicide. Within this theory, death by suicide is most imminent when both the desire
282
R. P. Tucker and L. R. Wingate
consequences of enacting self-harm and enables people to physically follow through with their desire for death by suicide (Joiner, 2005; Van Orden et al., 2010). Thus, the interpersonal-psychological theory of suicidal behavior contains three central risk factors for severe suicidal risk: (1) feelings of social isolation (thwarted belongingness), (2) beliefs that one is a burden to others (perceived burdensomeness), and (3) the acquired capability to enact lethal self-harm through an increase in pain tolerance and a reduced fear of death (acquired capability). Risk factors (1) and (2) facilitate the development of suicidal desire, and (3) creates the ability to physically carry out lethal selfharm. Although the interpersonal-psychological theory of suicidal behavior has received empirical support, little research has investigated the relationship between the theory’s interpersonal risk factors and a key component of the self-determination theory—basic psychological need satisfaction. Previous research has indicated that the satisfaction of the basic psychological needs of autonomy, relatedness, and competence, are intimately related to symptoms of depression Wei, Shaffer, Young et al., 2005), and it is possible that the basic psychological needs play an important role in the development of suicidal ideation as well as the interpersonal predictors of suicidal behavior. This inquiry is significant as it investigates constructs that may contribute to the desire for suicide, and could be potential antecedents to interpersonal predictors of suicide. Self-determination theory (Deci & Ryan, 1985; 2000; 2008) offers a possible understanding of the role of basic psychological needs in the experience of interpersonal risk factors of suicide. Self-determination theory is rooted in positive psychology and it asserts that well-being occurs when the basic psychological needs are met. This macrotheory of human motivation asserts that there are three inherent psychological needs: (1) autonomy, (2) relatedness, (3) competence,
and that these are integral antecedents for proper growth and adjustment (Deci & Ryan, 2000). Some of the research on basic psychological needs has focused on mental health outcomes in relation to basic need satisfaction (the collective satisfaction of all three basic needs). Other research has examined mental health outcomes in relation to individual need satisfaction (i.e., the satisfaction of only autonomy, relatedness, or competence). Findings have generally demonstrated that when these needs are not satisfied, a wide variety of physical and psychological disturbances manifest, including depression, anxiety, insomnia, low self-esteem, and negative affect, among others (Baard, Deci, & Ryan, 2004; Kasser & Ryan, 1999; Sheldon & Niemiec, 2006; Sheldon, Ryan, & Reis, 1996; Wei, Shaffer, Young et al., 2005). Self-determination theory asserts that the need for autonomy is theoretically similar to self-governance in that individuals demonstrate autonomy by acting willingly on whole-heartedly endorsed beliefs and decisions (Chirkov, Ryan, Kim et al., 2003; Ryan & Deci, 2000). People’s actions are not influenced by social norms or expectations of others that the individual does not validate. Failed satisfaction of the need for autonomy has been related to feelings of depression in nursing home residents, bank employees, and adolescents (Baard, Deci, & Ryan, 2004; Kasser & Ryan, 1999; Noom, Dekovic´, & Meeus, 1999; O’Connor & Vallerand, 1994). A similar relationship has been found utilizing the Basic Psychological Needs Scale (BPNS; Deci, Ryan, Gagne´ et al., 2001), a measure of general basic need satisfaction developed specifically for testing need satisfaction as it relates to selfdetermination theory. Wei and colleagues (2005) illustrated a negative relationship between the satisfaction of the need for autonomy and self-reported symptoms of depression and loneliness in an undergraduate sample. The need for relatedness was influenced by early work on attachment. This basic
ARCHIVES OF SUICIDE RESEARCH
283
Need Satisfaction and Suicide Risk
need refers to an individual’s desire for frequent interpersonal interactions and significant, unwavering connections to others (Baummeister & Leary, 1995; Bowlby, 1969). The absence of relatedness (the second basic psychological need outlined in self-determination theory) has also been empirically linked to depression utilizing domain specific measures of relatedness. Older adults who feel connected to a social network report lower levels of depression (Gillath, Johnson, Selcuk et al., 2011). In a longitudinal study of high school senior women, Eberhart and Hammen (2006) found that a lack of relatedness to family members and peers predicted depressive symptoms at 6 and 24 months when controlling for baseline depression scores. Wei and colleagues (2005) used the BPNS to demonstrate a negative relationship between the satisfaction of the need for relatedness and symptoms of depression. Competence (the third basic psychological need) has been broadly defined as the feeling of effectiveness and efficiency within one’s own environment and the belief that one can achieve desired outcomes and goals (Deci & Ryan, 1985; White, 1963). A lack of academic and social competency has been shown to be robust predictor of childhood depression (Blechman, McEnroe et al., 1986; Cole, 1990). A lack of perceived competence has similarly been related to adolescent depression (Sma´ri, Pe´tursdo´ttir, & Porsteinsdo´ttir, 2001). Blatt and Zuroff (1992) argued that depressed individuals are likely to fail to reach introjected expectations, self-scrutinize, and develop feelings of worthlessness and depression. The competence subscale of the BPNS has been negatively associated with three different self-report measures of depression (Wei, Shaffer, Young et al., 2005). Self-determination theory and its core components of the basic psychological needs may contain strong implications for understanding the desire to die by suicide. Although there is research that establishes
284
the relationship among depression and both the individual and collective components of basic need satisfaction, there has not been empirical evidence relating basic need satisfaction and suicide risk. More specifically, there is no literature, to our knowledge, that examines how the collective satisfaction of the needs for autonomy, relatedness, and competence relate to suicidal ideation and the interpersonal risk factors of thwarted belongingness and perceived burdensomeness. Research has demonstrated that one way suicidal ideation develops is through perceptions of burdensomeness and disconnection from others (Joiner, Van Orden, Witte et al., 2009). It stands to reason that these feelings—whether accurate or distorted—relate to a lack of autonomy, relatedness, and competence. The aim of this study is to investigate the role of basic needs satisfaction in the development of suicidal ideation, thwarted belongingness, and perceived burdensomeness. This research may shed light upon potential protective factors against suicidal desire. It is hypothesized that the satisfaction of each individual psychological need posited by self-determination theory (i.e., autonomy, relatedness, and competence) will be negatively related to suicidal ideation, thwarted belongingness, and perceived burdensomeness. Similarly, a negative relationship among basic need satisfaction (i.e., the combination of all three needs) and suicidal ideation, thwarted belongingness, and perceived burdensomeness is hypothesized. This study also aims to test whether basic psychological need satisfaction displays a significant relationship to suicidal ideation independent of the interpersonal risk factors outlined by in the interpersonal-psychological theory of suicidal behavior. We predict that both thwarted belongingness and perceived burdensomeness will mediate the relationship between basic need satisfaction (the total satisfaction of all three needs) and suicidal ideation. Specifically, we expect that participants experiencing elevated basic need
VOLUME 18 NUMBER 3 2014
R. P. Tucker and L. R. Wingate
satisfaction would endorse lower levels of thwarted belongingness and perceived burdensomeness, and thus less suicidal ideation.
found to be good (a ¼ .88), however the reliability of the three subscales varied: autonomy .64 (poor), relatedness .85 (good), and competence .74 (acceptable).
METHODS
Interpersonal Needs Questionnaire. The Interpersonal Needs Questionnaire (INQ; Van Orden, Cukrowicz, Witte et al., 2012) is a self-report scale designed to measure feelings of thwarted belongingness and perceived burdensomeness. The scale consists of 15 self-report items with 9 items assessing thwarted belongingness and 6 items assessing perceived burdensomeness. Responses are coded on a 7-point Likerttype scale (ranging from 1 ¼ not at all true for me to 7 ¼ very true for me) with higher scores reflecting increased feelings of thwarted belongingness and perceived burdensomeness. Internal consistencies were found to be excellent in the current sample: a ¼ .92 for the perceived burdensomeness subscale and a ¼ .90 for the thwarted belongingness subscale.
Participants
Participants in this study were 336 students (65.5% female, 34.5% male) from a large state university. Participants ranged in age from 18 to 46, with a mean age of 19.74 years. 80.7% of participants selfidentified as Caucasian, 4.8% as AfricanAmerican, 6.8% as Native American, 1.5% as Biracial, 3.0% as Asian-American, 2.4% as Hispanic, and .6% as other. 9.5% of participants reported some level of suicidal ideation in the past 2 weeks. Measures
Basic Psychological Needs Scale. The Basic Psychological Needs Scale (BPNS; Deci, Ryan, Gagne´ et al., 2001) is a self-report scale designed to measure the degree to which individuals experience the satisfaction of the psychological needs of autonomy, relatedness, and competence. The scale consists of 21 questions with 7 questions assessing levels of autonomy, 8 questions assessing levels of relatedness, and 6 questions assessing levels of competence. Participants are asked to think about how the items relate to their everyday lives and indicate how accurate the statements are. Responses are coded on a 7-point Likerttype scale (ranging from 1 ¼ ‘‘not at all true’’ to 4 ¼ ‘‘somewhat true’’ to 7 ¼ ‘‘very true’’) with higher scores representing greater need satisfaction. The three subscales can be averaged to form an index of general need satisfaction which has been used in multiple studies (Deci, Ryan, Gagne´ et al., 2001; Gagne´, 2003). The internal consistency for basic need satisfaction was
Hopelessness Depressive Symptom QuestionnaireSuicidality Subscale. The Hopelessness Depressive Symptom QuestionnaireSuicidality Subscale (HDSQ-SS; Metalsky & Joiner, 1991; Metalsky & Joiner, 1997) is a subscale of the Hopelessness Depression Symptom Questionnaire (HDSQ) developed by Metalsky and Joiner (1991). The subscale is designed to assess selfreported suicidal ideation in the previous 2 weeks. The HQSQ-SS consists of four items (e.g., ‘‘I do not have thoughts of killing myself’’ and ‘‘I am not having impulses to kill myself’’) rated on a scale of 0–3 with the corresponding responses varying depending on the question. Higher scores indicate elevated levels of suicidal thinking and the impulse to end one’s life. The internal consistency of the HDSQ-SS in the current sample was excellent, a ¼ .91. Center for Epidemiologic Studies Depression Scale. The Center for Epidemiologic
ARCHIVES OF SUICIDE RESEARCH
285
Need Satisfaction and Suicide Risk
Studies Depression Scale (CES-D; Radloff, 1977) was developed to assess self-reported symptoms of depression over the past week and was developed to use in the general population. The scale consists of 20 Likert-type items with scores ranging from 0 ¼ Rarely or none of the time (less than 1 day) to 3 ¼ Most or all of the time (5–7 days). Total scores range from 0–40. Radloff (1977) demonstrated that the CES-D has strong psychometric properties including good internal consistency and test-retest reliability. The internal consistency of the scale in this sample was excellent, a ¼ .92. Procedure
Participants completed self-report measures through an online research system. Most participants completed the study in approximately 30 to 40 minutes. This study was approved by the University’s human subjects review board. As some of the information assessed during the study may have been considered personal and sensitive, referral resources indicating local
and national counseling services were provided to all participants. The referral resources also included contact information to local emergency services and national suicide hotlines. RESULTS
Means, standard deviations, and correlation coefficients of study variables are presented in Table 1. Zero-order correlations revealed that increased basic need satisfaction (the aggregate of the satisfaction of the needs of autonomy, relatedness, and competence) was negatively associated with suicidal ideation and the interpersonal risk factors of thwarted belongingness and perceived burdensomeness. Similarly, each individual need was significantly negatively correlated to suicidal ideation, thwarted belongingness, and perceived burdensomeness. Mediation Analyses
To test for the hypothesized mediational effect of the thwarted belongingness
TABLE 1. Means, Standard Deviations, and Correlation Coefficients of Study Variables Variable 1. Need Sat. 2. Autonomy 3. Relatedness 4. Competence 5. Depression 6. Burden 7. Belong 8. Ideation M SD
1
2
3
4
5
6
7
8
– .84 .89 .91 .54 .51 .68 .27 5.24 .80
– .62 .66 .46 .40 .50 .19 4.31 .74
– .71 .40 .46 .63 .22 6.16 .94
– .55 .49 .65 .29 5.25 1.03
– .65 .64 .41 12.94 10.31
– .66 .49 8.87 5.29
– .38 22.23 7.22
– .26 .60
Note. p < .001. Need Sat. ¼ Basic Psychological Need Satisfaction Total; Autonomy ¼ Basic Psychological Need Satisfaction—Autonomy Subscale; Relatedness ¼ Basic Psychological Need Satisfaction—Relatedness Subscale; Competence ¼ Basic Psychological Need Satisfaction—Competence Subscale; Depression ¼ Center for Epidemiologic Studies Scale Total; Burden ¼ Interpersonal Need Questionnaire—Burdensomeness Subscale; Belong ¼ Interpersonal Need Questionnaire—Thwarted Belongingness Subscale; Ideation ¼ Hopelessness Depressive Symptom Questionnaire—Suicidality Subscale.
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on the relationship between basic need satisfaction (the aggregate of all three needs) and suicidal ideation, the multiple regression steps outlined by Baron and Kenny (1986) and Judd and Kenny (1981) were followed. In step 1, the relationship between the initial variable and outcome variable is tested. As predicted, a linear regression revealed that basic need satisfaction negatively predicted suicidal ideation (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001). The second step of the mediation analysis is conducted to demonstrate the relationship between the initial variable and the mediating variable. As predicted, basic need satisfaction negatively predicted thwarted belongingness (b ¼ .68, SE ¼ .36, t(334) ¼ 17.16, p < .001), such that higher levels of need satisfaction was associated with lower levels of thwarted belongingness. To test the third step and fourth steps, a hierarchical regression analysis was conducted to determine if basic need satisfaction (the predictor variable) predicted suicidal ideation (the outcome variable) while controlling for the effects of thwarted belongingness (the mediator). Results indicated that the thwarted belongingness positively predicted suicidal ideation (b ¼ .39, SE ¼ .01, t(334) ¼ 7.62, p < .001) and basic need satisfaction dropped out as a meaningful predictor of suicidal ideation when the effects of the mediator were controlled
(b ¼ .01, SE ¼ .11, t(333) ¼ .09, p ¼ .927; see Figure 1). This significant mediation suggests that basic need satisfaction does not share significant variance with suicidal ideation above and beyond thwarted belongingness. The steps above were repeated with perceived burdensomeness as the mediator variable in order to determine if the interpersonal risk factor of suicide mediated the relationship between basic need satisfaction and suicidal ideation. Regressions demonstrated that basic need satisfaction negatively predicted suicidal ideation (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001), basic need satisfaction negatively perceived burdensomeness (b ¼ .51, SE ¼ .31, t(334) ¼ 10.92, p < .001), perceived burdensomeness positively predicted suicidal ideation (b ¼ .55, SE ¼ .01, t(334) ¼ 11.96, p < .001), and basic need satisfaction dropped out as a meaningful predictor of suicidal ideation when perceived burdensomeness was controlled (b ¼ .03, SE ¼ .08, t(333) ¼ .36, p ¼ .721; see Figure 2). Results demonstrate that perceived burdensomeness mediated the relationship between basic need satisfaction and suicidal ideation. Reverse Direction Models
In order to test other potential sequencing of variables in the hypothesized
FIGURE 1. Model of relationship among basic psychological need satisfaction, thwarted belongingness, and suicidal ideation. Note: Numerical values are the standardized regression coefficients. The standardized regression coefficient between basic need satisfaction and suicidal ideation controlling for thwarted belongingness is in parentheses. p < .001.
ARCHIVES OF SUICIDE RESEARCH
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Need Satisfaction and Suicide Risk
FIGURE 2. Model of relationship among basic psychological need satisfaction, perceived burdensomeness, and suicidal ideation. Note: Numerical values are the standardized regression coefficients. The standardized regression coefficient between basic need satisfaction and suicidal ideation controlling for perceived burdensomeness is in parentheses. p < .001.
model, the outcome variables and mediator variables were switched in each model. This tested whether thwarted belongingness and perceived burdensomeness affect suicidal ideation through basic need satisfaction. In the first model, thwarted belongingness positively predicted suicidal ideation (b ¼ .39, SE ¼ .01, t(334) ¼ 7.62, p < .001). In step two, thwarted belongingness negatively predicted basic need satisfaction (b ¼ .68, SE ¼ .00, t(334) ¼ 17.16, p < .001). Basic need satisfaction negatively predicted suicidal ideation in step 3 (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001), however thwarted belongingness remained a meaningful predictor of suicidal ideation when the effects of basic need satisfaction were controlled (b ¼ .38, SE ¼ .01, t(334) ¼ 5.48, p < .001). A non-significant Sobel’s test demonstrated that the relationship was not partially mediated (z ¼ .10, p > .05). This result suggests that the relationship between thwarted belongingness and suici-
dal ideation is not mediated by basic need satisfaction. A similar relationship was found when testing the reverse direction model of perceived burdensomeness related to suicidal ideation through basic need satisfaction. Perceived burdensomeness positively predicted suicidal ideation (b ¼ .55, SE ¼ .01, t(334) ¼ 11.96, p < .001). In step two, perceived burdensomeness negatively predicted basic need satisfaction (b ¼ .51, SE ¼ .01, t(334) ¼ 10.92, p < .001). Basic need satisfaction negatively predicted suicidal ideation in step 3 (b ¼ .27, SE ¼ .08, t(334) ¼ 5.06, p < .001), however perceived burdensomeness remained a meaningful predictor of suicidal ideation when the effects of basic need satisfaction were controlled (b ¼ .56, SE ¼ .01, t(334) ¼ 10.43, p < .001). A non-significant Sobel’s test demonstrated that the relationship was not partially mediated (z ¼ .36, p > .05). This result suggests that the relationship between perceived burdensomeness
TABLE 2. Hierarchical Regression Analysis of Depressive Symptoms and Basic Need Satisfaction as Predictors of Thwarted Belongingness X Perceived Burdensomeness Interaction
Step 1 Depression Step 2 Basic Need Satisfaction
288
DR2
df
F
.240
1, 334
105.23
.006
2, 333
2.66
B
SE B
b
t
p
2.85
.28
.49
10.26
