title: The interpersonal theory of suicide and adolescent suicidal behavior.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The cross-sectional design precludes conclusions about causality and directionality. Proxy measures were used to test the interpersonal theory constructs.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Electronic address: shirabarzilay@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Barzilay
authors.affiliation: Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Feldman
authors.affiliation: Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Snir
authors.affiliation: Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Apter
authors.affiliation: National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.
authors.forename: V
authors.initials: V
authors.lastname: Carli
authors.affiliation: Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Hoven
authors.affiliation: Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Wasserman
authors.affiliation: Department of Health Sciences, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy "d'Annunzio University" Foundation, Chieti, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sarchiapone
authors.affiliation: National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Wasserman
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D018912:Arabs / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003863:Depression; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007585:Jews / Q000706:statistics & numerical data; D008297:Male; D011582:Psychological Theory; D012307:Risk Factors; D012309:Risk-Taking; D016728:Self-Injurious Behavior / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Depression; Interpersonal theory; Non suicidal self-injury; Self-harm; Suicide