title: Associations between eating disorder symptoms and suicidal ideation through thwarted belongingness and perceived burdensomeness among eating disorder patients.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States.
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Forrest
authors.affiliation: University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, United States.
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Bodell
authors.affiliation: Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL 36849, United States.
authors.forename: Tracy K
authors.initials: TK
authors.lastname: Witte
authors.affiliation: Eating Recovery Center of Washington, 1231 116th Ave NE, Bellevue, WA 98004, United States.
authors.forename: Natalie
authors.initials: N
authors.lastname: Goodwin
authors.affiliation: Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Bartlett
authors.affiliation: Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States.
authors.forename: Nicole
authors.initials: N
authors.lastname: Siegfried
authors.affiliation: 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.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: 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.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.affiliation: 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.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Franko
authors.affiliation: Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States. Electronic address: aprilsmith@miamioh.edu.
authors.forename: April R
authors.initials: AR
authors.lastname: Smith
mesh_terms: D000328:Adult; D001828:Body Image; D015992:Body Mass Index; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005215:Fasting / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008960:Models, Psychological; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012919:Social Behavior; D059020:Suicidal Ideation; D055815:Young Adult
keywords: Body dissatisfaction; Burdensomeness; Eating disorders; Fasting; Suicidal ideation