(PS9-20) Perceived Burdensomeness, Thwarted Belongingness, and Suicidality: The Moderating Role of Discrimination

Background:  Perceived burdensomeness (PB), the belief one is a burden on others, and thwarted belongingness (TB), feeling disconnected, are theorized to contribute to suicidal desire (Joiner, 2005). Similarly, interpersonal discrimination can lead to more suicidal thoughts and behaviors (Oh et al., 2019). The associations between PB, TB, discrimination, and suicidality have been researched in the past, but these variables have yet to be analyzed within acute settings. This study examined whether discrimination moderates the association between PB and suicidality and TB and suicidality among patients within a 20-day DBT-adherent partial hospital program. 

Methods:  Our sample included 147 patients aged 13-24 (M = 17.7, SD = 2.4), majority White (84.4%), cisgender female (61.2%), and a sexual minority (57.1%). Participants completed the Suicidal Behaviors Questionnaire, the Interpersonal Needs Questionnaire, and the Youth Discrimination Measure. We examined the discrimination items with yes/no response options in four domains: race, nationality, sexuality, and weight, as a count 0-2 (0 = none, 1 = one domain, 2 = two or more domains). Using cross-sectional data, multivariate regressions were conducted to assess the potential influence of thwarted belongingness and perceived burdensomeness on suicidality and simple slopes tests were used to capture the potential moderating effect of discrimination, covarying for age and gender. 

Results:  Fifty-six (38.1%) participants reported discrimination. There was a significant and positive interaction between perceived burdensomeness and discrimination in the prediction of suicidality (𝛽 = .49, p = .036), such that patients with more PB had higher suicidality at 0, 1, and 2+ discrimination domains (𝛽 = .60, p = .005; 𝛽 = 1.09, p < .001; 𝛽 = 1.58, p < .001). There was also a significant interaction between thwarted belongingness and discrimination (𝛽 = -.54, p = .002). Greater TB predicted higher suicidality at 0 discrimination (𝛽 = .42, p = .029) and lower suicidality at 2+ discrimination domains (𝛽 = -.65, p = .007). 

Conclusions:  Our results suggest when participants do not experience discrimination, thwarted belongingness is positively associated with suicidality, whereas when participants experience discrimination in two or more domains, thwarted belongingness is negatively associated with suicidality. One explanation for this finding is when youth do not feel like they belong and experience discrimination, they are more likely to seek their affinity groups and develop authenticity in their minoritized identity which may buffer the impact of feeling disconnected on their suicidality (Katz et al., 2023; Rogers et al., 2021). Perceived burdensomeness was directly and indirectly positively associated with suicidality, which may be due to participants mostly reporting experiencing discrimination against their sexual identity. Sexual discrimination may be especially pertinent for sexual minority youth who feel deeply invalidated or flawed to such an extent they are a burden (Katz et al., 2023). Future research should assess the frequency and impact of discriminatory events, and analyze discrimination domains separately to understand the possible differential impact of each.