Exploring the Construct of Perceived Burdensomeness Among Suicidal Adolescents: An Intervention Development Study

The Interpersonal Psychological Theory of Suicide has a growing base of empirical support for use with adolescents. Of the two interpersonal constructs that make up the theory, perceived burdensomeness demonstrates a stronger relationship with suicidal ideation and appears more resistant to change over the course of treatment than thwarted belongingness. Despite this, there are few clinical interventions directly informed by theoretical models of suicide. Qualitative methodology is currently underutilized in better understanding the manifestation of theoretical constructs among suicidal youth and may shed light on how to harness this information during intervention development. Qualitative interviews about perceived burdensomeness were conducted with adolescents with a history of suicidality (n = 10), their parents (n = 10), and clinicians administering care to this population (n = 10). Perceived burdensomeness was widely recognized and described as relevant by all participants. Parents and clinicians expressed limited success when trying to directly address these cognitions with adolescents. Results from this exploratory study elucidated a close relationship with thwarted belongingness, especially in regard to how burden cognitions can lead to behaviors that damage social connectedness. An enhanced clinical model of perceived burdensomeness is proposed that identifies possible mechanisms of change when targeting this construct in a clinical setting. Potential interventions informed by these results are also outlined.