Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2018 Interpersonal suicide risk for Latino/a Americans: Investigating thwarted belongingness, perceived burdensomeness, and cultural factors of relevance Kelsey E. Engel Iowa State University Follow this and additional works at: https://lib.edu/etd Part of the Counseling Psychology Commons Recommended Citation Engel, Kelsey E., "Interpersonal suicide risk for Latino/a Americans: Investigating thwarted belongingness, perceived burdensomeness, and cultural factors of relevance" (2018). Graduate Theses and Dissertations.edu/etd/16348 This Thesis is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository.
For more information, please contact digirep@iastate. Interpersonal suicide risk for Latino/a Americans: Investigating thwarted belongingness, perceived burdensomeness, and cultural factors of relevance by Kelsey E. Engel A thesis submitted to the graduate faculty in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Major: Psychology Program of Study Committee: Loreto Prieto, Major Professor Karen Scheel Carolyn Cutrona The student author, whose presentation of the scholarship herein was approved by the program of study committee, is solely responsible for the content of this thesis. The Graduate College will ensure this thesis is globally accessible and will not permit alterations after a degree is conferred.
Iowa State University Ames, Iowa 2018 ii TABLE OF CONTENTS Page LIST OF TABLES…………………………………………………………………. vi CHAPTER 1 INTRODUCTION. 1 CHAPTER 2 LITERATURE REVIEW. 13 Definition of Suicidal Risk and Associated Constructs.
13 General Incidence and Prevalence of Suicide in the US. 14 The Interpersonal-Psychological Theory of Suicide. 20 The Present Study. 68 Brief Summary of Findings.
68 The Interpersonal-Psychological Theory of Suicide. 70 Cultural Factors of Relevance. 75 Implications for Future Research. 77 Implications for Clinical Practice.
EMAIL INVITATION TO PARTICIPATE. FOLLOW UP EMAIL INVITATION TO PARTICIPATE. INTEPERSONAL NEEDS QUESTIONNAIRE (INQ-15). SUICIDAL RISK QUESTIONNAIRE.
BIDIMENSIONAL ACCULTURATION SCALE. SAFE-R ACCULTURATIVE STRESS SCALE. 110 iv LIST OF TABLES Page Table 1. Sample Means, Standard Deviations, and Ranges of Study Measures.
Inter-correlations and Alpha Coefficients of Study Measures. Summary of Hierarchical Regression for IPTS Variables Predicting Suicidal Risk….65 v ACKNOWLEDGMENTS I would like to express my gratitude to Dr. Loreto Prieto, my graduate advisor and committee chair, for his continual guidance and patience throughout this research project. I would also like to thank Dr.
Karen Scheel and Dr. Carolyn Cutrona, my committee members, for their excellent advice and willingness to answer questions and generate solutions. My committee’s continual encouragement and belief in my ability to complete my thesis was so appreciated. I would also like to communicate appreciation for the support and guidance of several colleagues in my graduate cohort, research lab, and counseling practice, whose compassion and wisdom throughout my graduate career have been essential to the completion of this research project.
Thank you, Meredith, Mary, Julio, Patrick, Rachel, and Kaitlyn. I am so grateful for Iowa State University’s Department of Psychology, as a whole. Most importantly, I would like to express my endless gratitude to my family. To my mother, for her boundless love, modeling of strength, and for always communicating her confidence in me, even when I failed to see it in myself.
To my partner, whose patience, love, and humor brought laughter and warmth to many long days of research, and supported my self-care and positivity throughout this process. Lastly, to Hemingway, my loyal shadow, I give my love and care. vi ABSTRACT There is evidence that different racial groups not only complete suicide at different rates, but conceptualize suicidal behavior differently (American Association of Suicidology [AAS], 2016; Brownson, Becker, Shadick, Jaggers, & Nitkin-Kaner, 2014; Maris, Berma, & Silverman, 2000; Shadick, Backus, & Babot, 2015). Evidence also exists indicating that key culture-based variables such as acculturation, enculturation, and acculturative stress are important variables to explore in research using Latino/a samples (Bernal, 1990; Del Pilar, 2009; Padilla & Lindholm, 1984), and may be related to the suicidal behavior of Latino/as (Fortuna, Perez, Canino, Sribney, & Alegria, 2007; Perez-Rodriguez, Baca-Garcia, Oquendo, Wang, Wall, et al., 2014), especially Latino/a college students (Gomez, Miranda, & Polanco, 2011; Hovey & King, 1996; Saldana, 1994; Walker, Wingate, Obasi, & Joiner, 2008).
The Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005; Van Orden, Cukrowicz, Witte, & Joiner, 2012; Van Orden, Witte, Gordon, Bender, & Joiner, 2008; Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, 2010), a recent theory in suicidology that has generated a significant amount of research, does not include culture-based factors within its model, and has not been shown to fit well when used to explain the suicidal behavior of racially diverse people (Davidson, Wingate, Slish, & Rasmussen, 2010; O’Keefe, Wingate, Tucker, Thoades-Kerswill, Slish, & Davidson, 2014; Wong, Koo, Tran, Chiu, & Mok, 2011; Garza & Pettit, 2010). In my study, I tested and expanded upon IPTS, by applying Joiner’s construct of suicidal desire (as measured by the sub-constructs of thwarted belongingness and perceived burdensomeness) to Latino/a American college students, to examine the ways in which the IPTS theory can predict their past, current, and future suicidal behavior. In addition, I gave vii consideration to Latino/a cultural factors by examining the moderating effects of acculturation and enculturation, as well as the potential mediation effects of acculturative stress, on the relation between primary IPTS constructs and past, present, and future suicidal risk. In a sample of 147 Latino/a American college students, results indicate that the IPTS, and perceived burdensomeness in particular, is useful in predicting suicidal risk.
Acculturation, enculturation, and acculturative stress were not found to significantly moderate or mediate the relations of the IPTS model. However, enculturation was found to be a particularly salient cultural variable in the explanation of Latino/a American college student’s experience of perceived burdensomeness and its relation to their suicidal risk. Implications for continued examination of the role that relevant cultural factors play in the context of thwarted belongingness, perceived burdensomeness, and Latino/a American college student suicidal risk, as well as implications for utilizing the IPTS in future research and clinical work, are discussed. Keywords: Suicidal behavior; Latino/a Americans; college students; acculturation; enculturation; acculturative stress 1 CHAPTER 1 INTRODUCTION In the United States, suicide continues to be among the top ten leading causes of death (American Association of Suicidology [AAS], 2016).
More specifically, in the United States, in 2015, more than 40,000 people committed suicide (AAS, 2016), translating to an incidence of approximately 1 person committing suicide every 11.9 minutes and a prevalence ratio of 13.8: 100,000 suicides every year in the general population. For college-aged persons (aged 18 - 24), suicide is the second leading cause of death, only behind deaths categorized as a result of unintentional injury (Centers for Disease Control [CDC], 2015). Suicide base rates have remained proportionately constant for over the past hundred years (Maris, in press), yet the field of suicidology and the working theories used to understand suicide have remained stagnant. Investigators still strive to understand who commits suicide and why (Rogers & Lester, 2010).
The overwhelming majority of completed suicides in the US are committed by European Americans (AAS, 2016), and the majority of extant knowledge surrounding suicide is representative of that same racial group. This reality means that the field of suicidology continues to fail to comprehensively advance theoretically our understanding regarding racial group differences in suicide behavior for non-European Americans. Further, modern suicidologists have acknowledged an existing paradox of racial group differences in suicide; that is, most US cultures of color evince lower incidence and prevalence rates for suicide than European Americans, despite the fact that persons of color face far more social, economic, and psychological adversity on average than do European Americans. Despite working theories in the area of suicidology, which largely adopt a diathesis-stress perspective (cf.
Lester & Gunn, 2 2016), the overwhelming body of empirical research in suicidology has been atheoretical and has not paid due attention to specific culture-based factors that can increase the risk for suicide. This is problematic as when theory does not drive empirical investigations, it becomes difficult (if not impossible) to reconcile inconsistent and non-integrative findings that emerge among various studies. This, in turn, hampers investigators' efforts to achieve clarity concerning what data truly indicate across studies. In the next section, I will briefly lay out the theory that guided my research.
The Interpersonal-Psychological Theory of Suicide A recent theory that has emerged in the field of suicidology is Joiner's Interpersonal- Psychological Theory of Suicide (IPTS; 2005). The IPTS has gained widespread attention and use among researchers since its development as a way to investigate suicide in a theory-driven manner. Assertions in the IPTS suggest that individuals who attempt suicide must have the desire to do so, and the model lays out primary constructs and associated variables suspected of contributing to individuals' desire to take their own lives. To date, the IPTS theory has been largely tested using the fifteen-question Interpersonal Needs Questionnaire (INQ-15), a measure that captures the IPTS theoretical constructs of thwarted belongingness and perceived burdensomeness, which are seen as the primary variables directly influencing suicidal behavior.
This measure was created by Joiner and colleagues to directly assess constructs in the IPTS and has been validated on primarily European American samples (Van Orden et al., 2008; Hill, Rey, Marin, Sharp, Green, & Pettit, 2015). However, neither the IPTS theory nor the INQ-15 measure have been validated using samples of people of color, neither does the theory or measure consider ways in which culture-based variables can affect suicidal behavior. 3 Van Orden et al. (2008a) highlighted the need for theory driven research on the proximal, causal, and interactive factors involved with suicidal behavior, so that clinicians and researchers may more accurately and comprehensively detect and intervene in cases of suicidal behavior to prevent suicide.
Joiner's theory has spurred significant research efforts in the field, and is often cited within current research in suicide for its operationalization of suicidal desire, specifically through combining a wide array of empirically supported suicide risk factors into the measurable constructs of thwarted belongingness and perceived burdensomeness. As described by Van Orden et al., thwarted belongingness represents a lack of reciprocal care, social withdrawal, neglect, abuse, or loss felt by individuals, and spans both personal and public dimensions (Joiner, 2005; Van Orden et al. Van Orden et al. found relations of this construct to negative physical and mental health outcomes, biological stress responses, and elevations of negative affect.
The second component of 'suicidal desire' is the belief, held by people contemplating suicide, that others would be better off without them. Past research has found family conflict, unemployment, and physical illness to be strong predictors of suicidal ideation (Van Orden et al., 2010; Waern, Rubenowitz, Wilhelmson, 2003; Bastia & Kar, 2009), which underscores the idea that those contemplating suicide may perceive themselves as a burden upon others. Joiner argues that perceiving oneself as a burden, to others as well as society, is a common thread of several interpersonal risk factors and includes elements of self-hate and feelings of being a liability for others (Joiner, 2005; Van Orden et al. Studies have shown that perceived 4 burdensomeness is strongly related to suicidal ideation (e., Filiberti, Ripamonti, Totis, Ventafridda, De Conno, et al., 2001; Joiner, Pettit, Walker, Voelz, Cruz, Rudd, & Lester, 2002).
Joiner argues that both thwarted belongingness and perceived burdensomeness are proximal and causal factors in individuals’ desire to commit suicide. He maintains that each construct is a significant independent predictor of suicidal ideation, and that the interactive effect of thwarted belongingness and perceived burdensomeness is more strongly determinant of suicidal ideation (Van Orden et al. In the IPTS model, both thwarted belongingness and perceived burdensomeness must be present for individuals to 'desire' to commit suicide. However, these two constructs and the IPTS model have found only mixed empirical support, especially in samples of racially diverse populations, an issue that I will discuss further in the next section.