The role of perceived burdensomeness and thwarted belongingness in suicide disclosure likelihood: a social network perspective.

BACKGROUND: Suicide prevention frequently hinges on disclosure of suicidal ideation (SI), yet half of suicide deaths are not preceded by disclosure. Interpersonal beliefs, including perceived burdensomeness and thwarted belongingness predict suicide risk, but little is known about how those beliefs influence SI disclosure likelihood. This study employed a social network approach to investigate the role of PB and TB in likelihood to disclose future SI. METHODS: N = 111 adults (mean age=54.7 years, 78.2% women) with an affective or psychotic disorder completed a social network survey assessing network structure, quality, support, and likelihood to disclose future suicidal thoughts to each social network member. Participants were also assessed for perceived burdensomeness and thwarted belongingness, depressive symptoms, and current/lifetime SI. Correlations evaluated relationships among social network features, perceived burdensomeness and thwarted belongingness, and likelihood to disclose future suicidal thoughts. Multilevel mediation models evaluated whether perceived burdensomeness and thwarted belongingness explained the relationship between social network features and likelihood to disclose future suicidal thoughts, before and after adjusting for depression and current SI. RESULTS: Social network structure, quality, and support were associated with perceived burdensomeness and thwarted belongingness. Perceived burdensomeness and thwarted belongingness were negatively correlated with likelihood to disclose future suicidal thoughts. Adjusting for depression and current SI, thwarted belongingness explained the relationship between closeness, satisfaction, and practical support received, and likelihood to disclose future suicidal thoughts (standardized indirect effects β ≈.19 -.45). Perceived burdensomeness did not account for the relationship between social network features and likelihood to disclose future suicidal thoughts after adjusting for depression and SI. DISCUSSION: Thwarted belongingness, but not perceived burdensomeness, explained the relationship between social network features and likelihood to disclose future suicidal thoughts after adjusting for depression and SI. Our findings highlight the independent role of thwarted belongingness in anticipated suicide disclosure decisions and suggest that interventions that strengthen social networks could improve thwarted belongingness and suicide disclosure.