Exploring the relationship between thwarted belongingness and perceived burdensomeness with experiential avoidance in suicide in a sample of Spanish psychiatric outpatients

Introduction: Suicide is a major global health problem. Within the framework of acceptance and commitment theory (ACT) suicide could be understood as an extreme form of experiential avoidance. On the other hand the Interpersonal-Psychological Theory of Suicide proposes perceived burdensomeness and thwarted belongingness as two indispensable distal variables for an individual to develop suicidal thoughts. This study examines the relation between the variables thwarted belongingness and perceived burdensomeness and experiential avoidance. Methods: A parallel mediation model was carried out in a sample of Spanish outpatients who exhibited suicidal ideation or behavior (N=131) collected from the psychiatric department and the emergency department. Results: Perceived burdensomeness, but not thwarted belongingness, mediated the relation between experiential avoidance and suicidal ideation, with both variables examined as parallel mediators. Following the initial analysis, in a subsequent model, each mediator was tested independently. In these analyses, thwarted belongingness and perceived burdensomeness were statistically significant. Contrary to expectations, only perceived burdensomeness was found to be statistically significant in a parallel model. Discussion: There might be a therapeutic relation between experiential avoidance patterns and the interpersonal variables proposed in Interpersonal-Psychological Theory of Suicide.