The interpersonal theory of suicide and adolescent suicidal behavior

S. Barzilay, D. Feldman, A. Snir, A. Apter, V. Carli, C. W. Hoven, C. Wasserman, M. Sarchiapone, D. Wasserman

Research output: Contribution to journalArticlepeer-review


Abstract Background Joiner's interpersonal theory of suicide (IPTS) proposes that suicide results from the combination of a perception of burdening others, social alienation, and the capability for self-harm. The theory gained some empirical support, however the overall model has yet to be tested. This study aimed to test the main predictions of IPTS in a large community sample of Israeli adolescents. Method 1196 Israeli Jewish and Arab high-school pupils participating in the SEYLE project completed a self-report questionnaire measuring perceived burdensomeness, thwarted belongingness, health risk behaviors, and non-suicidal self-injury (risk variables), and suicidal ideation and suicide attempts (outcome measures). The data were tested in cross-sectional regression models. Results Consistent with IPTS, perceived burdensomeness was found to interact with thwarted belongingness, predicting suicidal ideation. Depression mediated most of the effect of thwarted belongingness and perceived burdensomeness on suicidal ideation. Acquired capability for self-harm, as measured by health risk behaviors and direct non-suicidal self-injurious behaviors, predicted suicide attempt. However, this mechanism operated independently from ideation rather than in interaction with it, at variance with IPTS-based predictions. Limitations The cross-sectional design precludes conclusions about causality and directionality. Proxy measures were used to test the interpersonal theory constructs. Conclusion The findings support some of the IPTS predictions but not all, and imply two separate pathways for suicidal behavior in adolescents: one related to internalizing psychopathology and the other to self-harm behaviors. This conceptualization has clinical implications for the differential identification of adolescents at risk for suicidal behavior and for the development of prevention strategies.

Original languageEnglish
Article number7424
Pages (from-to)68-74
Number of pages7
JournalJournal of Affective Disorders
StatePublished - 1 Sep 2015
Externally publishedYes

Bibliographical note

Funding Information:
The SEYLE project is supported by the European Union through the Seventh Framework Program (FP7), Grant agreement number HEALTH-F2-2009-223091.

Funding Information:
The SEYLE project is supported by the European Union through the Seventh Framework Program (FP7) , Grant agreement number HEALTH-F2-2009-223091 . The SEYLE Project Leader and Principal Investigator is Danuta Wasserman, Professor in Psychiatry and Suicidology, National Center for Suicide Research and Prevention of Mental Ill-Health (NASP) Karolinska Institute, Stockholm, Sweden. The Executive Committee comprises Professor Danuta Wasserman and Senior Lecturer Vladimir Carli, both from the NASP, Sweden; Professor Marco Sarchiapone, NASP, Italy; and Professor Christina W. Hoven and Anthropologist Camilla Wasserman from Columbia University, New York, NY, USA. The SEYLE Consortium includes sites in 12 European countries. Site leaders are Danuta Wasserman (NASP, coordinating center), Christian Haring (Austria), Airi Varnik (Estonia), Jean-Pierre Kahn (France), Romuald Brunner (Germany), Judit Balazs (Hungary), Paul Corcoran (Ireland), Alan Apter (Israel), Marco Sarchiapone (Italy), Doina Cosman (Romania), Dragan Marusic (Slovenia) and Julio Bobes (Spain). This work was carried out in partial fulfillment of the requirements for the degree of doctor of philosophy of Dr. Shira Barzilay, under the supervision of Prof. Alan Apter, Schneider Children’s Medical Center and Prof. Eshkol Rafaeli, Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.

Publisher Copyright:
© 2015 Elsevier B.V.


  • Depression
  • Interpersonal theory
  • Non suicidal self-injury
  • Self-harm
  • Suicide

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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