Evaluating a motivational interviewing-based communication program for nurses in advance care planning: a quasi-experimental study.

Suicide is the second leading cause of death in the United States for individuals between the ages of 10 and 34 and the fourth leading contributor of years of potential life lost before 65 []. In addition to the gravity of suicide mortality, each year, more than 13 million adults in the United States suffer from thoughts of suicide []. Suicidal ideation and lower-lethality suicide-related behaviors (e.g., deliberate self-harm) are established predictors of future suicide attempts and mortality [, , ]. Thus, studying suicidal thoughts and lower-lethality suicidal behaviors has been an important component of understanding why people die by suicide [, ]. Despite the availability of both evidence-based interventions [, , ] and community resources [, , ] aimed at reducing suicidal ideation, suicide rates have continued to rise in recent years []. This underscores a need for a more comprehensive understanding of the factors that contribute to suicidal ideation and lower-lethality suicidal behaviors. Recognizing that suicide results from multiple psychiatric, cognitive, interpersonal, and circumstantial factors, the interpersonal psychological theory of suicide (IPTS; [, ]) emerged as an influential and empirically supported model for understanding suicide risk. The IPTS proposes that unmet interpersonal needs, specifically thwarted belongingness and perceived burdensomeness, are two proximal predictors of suicidal desire. Within this framework, it is believed that other, distal factors can confer increased risk of suicide by exacerbating feelings of thwarted belongingness and perceived burdensomeness []. Although initially developed to explain lethal and near-lethal suicidal behavior, the IPTS has since been widely applied to the study of suicidal ideation [, , , ]. Conceptually, thwarted belongingness reflects a more intense and distressing form of social isolation than loneliness, representing a deeply felt, enduring lack of belonging, or the “sense that sustaining [social] connections are obliterated” [], p. 120). Perceived burdensomeness is believed to emerge from unmet needs for social competence, [], such as when one is unable to fulfill expected social roles (e.g., contributing to collective goals in one’s family or another group). If thwarted belongingness and perceived burdensomeness are regarded as global, enduring evidence of low social efficacy, a person may begin to view their existence as a liability to others. According to the IPTS, the co-occurrence of thwarted belongingness and perceived burdensomeness is considered the strongest proximal predictor of the desire to die by suicide [, ].