Suicidal behavior is a massive global problem. Not only does suicide affect those who depart life in that manner, but also every single person who they have known, loved and impacted. The World Health Organization (WHO) estimates that approximately one million people die by suicide; that works out to about one death every 40 seconds. Unfortunately, the numbers only seem to be increasing.
However, when there is any major problem, especially a heavily devastating issue such as increasing suicidal behavior, people begin desperately searching for answers, reasons, a cause to explain such a traumatic tragedy.
The large looming question to those left stricken from the grief of sudden and unfair loss, is why.
Why do people attempt suicide? What drives someone to willingly leave this world and everything in it behind? William Styron, an author who dealt with depression stated, “though suicide has not one cause, but many, they all flow together into one river whose overwhelming current, mental pain, carries everything before it.
Those doomed to it choose death over intolerable suffering that to them seems interminable”. There is not one single cause to explain suicidal behavior and that can be frustrating for those searching for answers trying to understand.
In an attempt to address the frustration of the ever-lingering question “why,” the Interpersonal Needs Questionnaire (INQ), a self-report measure, was developed and derived from the Interpersonal Theory of Suicide; specifically created to measure thwarted belonging and perceived burdensomeness, the two traits are believed to be the leading factors in suicidal behavior (Van Orden , et al.
, April 2010).
Thwarted belonging is feeling alienated from family and friends. A person then typically turns to isolation despite the want for social connection. Perceived burdensomeness refers to viewing one’s existence as a burden and leads to the idea that “my death will be worth
more than my life”, or “it would be better if I was dead” to family, friends, society etc (Van Orden & Joiner, 2011). In addition to the INQ being developed to further study the root of suicidal behavior, it has also been put into use by clinicians as part of risk assessment protocol for suicidal behavior to explain and improve accuracy in suicide prediction (Van Orden , et al., April 2010).
Using the INQ in the clinical setting as a risk assessment resource allows clinicians to implement intervention strategies to address the risk factors expressed and potentially decrease the ever growing epidemic of suicidal behavior.
Because that’s exactly what it is, an invisible epidemic; untouchable, unbearable pain that leaves hollow husks of people that have suffered in silence. Given the intense nature of the problem, there is no question that the Interpersonal Needs Questionnaire has a true and meaningful purpose.
The Interpersonal Needs Questionnaire has five different self-reporting forms of varying lengths; 10-item, 12-item, 15-item, 18-item and 25-item (Hill, et al., 2015). The 25-item set contains the original questions on thwarted belonging and perceived belongingness, the other forms are condensed versions of the original 25-item questionnaire.
In the original 25-item version, ten items measure thwarted belongingness; example, “these days other people care about me (Van Orden & Joiner, 2011).” Fifteen items measure perceived burdensomeness; example, “these days I feel like a burden to the people in my life” (Van Orden & Joiner, 2011). Items were chosen from the hypotheses of the Interpersonal-Psychological Theory.
The INQ is measured on a 7-point Likert scale, respondents answer by indicating to what degree the item is true or untrue for them. Higher scoring numbers (7) reflect higher levels of thwarted belongingness and perceived burdensomeness.
The Interpersonal Needs Questionnaire was tested on five samples; however, the first two samples at Florida State University offer the most pertinent information to this paper. Sample 1 consisted of 312 undergraduate general psychology students who received credit for their participation (A., 2009).
Females made up the majority of the sample with 74% and the mean age was approximately 19 with participants ranging from 17-51 years old (A., 2009). For the first sample, data on race and ethnicity was unavailable. However, researchers determined the sample was likely similar to Florida State’s Psychology Department subject pool which contained: 64% White, 28% Black or African American, 5% American Indian/Alaska Native and 3% Asian. Of the participants, 26% of which qualified for financial need status.
The second sample differed in comparison to the first. Sample 2 contained a larger number of Florida State University undergraduates; 912 (A., 2009). The percentage of women was more equal to men at 64% (A., 2009). The mean age was slightly lower at 18.83 but the range of ages was also more condensed ranging from 18-29 years of age (A., 2009). The participants also self-identified their race resulting in 80% White, 9% Black or African American, 5% Asian and 6% other race. Of the sample regarding ethnicity, 20% self-identified as Hispanic/Latino (A., 2009).
Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) was performed on the samples to determine a proper form of measurement for the INQ. The EFA looks at interpretability of the items, eliminates poorly defined items and drops items that consist of too much overlap with other factors or are redundant.
While analyzing the data, two subcategories were found in the 25-item test, loneliness and giving/receiving support for thwarted belongingness (Teo, Su?rez, & Oei, 2018). It was determined through the EFA that those particular questions be dropped from the model as to better grasp thwarted belonging and perceived burdensomeness with fewer more direct questions (Teo, Su?rez, & Oei, 2018).
The CFA confirmed that the shortened version with more parsimonious questions better grasped the uniqueness of both perceived burdensomeness and thwarted belongingness and consistently predicted suicidal ideation; however, only on the 10-item INQ (Teo, Su?rez, & Oei, 2018).
The content of the Interpersonal Needs Questionnaire is absolutely relevant. Items included in the INQ directly address what their trying to measure; thwarted belonging and perceived burdensomeness. The 10 and 15-item versions demonstrate the most consist and pure questions that address perceived burdensomeness and thwarted belonging (Hill, et al., 2015).
For example, on perceived burdensomeness an item states, “these days the people in my life would be better off if I’m gone” directly relates to the perceived burdensomeness definition. On thwarted belonging an item states. “these days, I feel disconnected from other people”, clearly stating that someone feels they do not have a sense of belonging or connectedness around other people. Both of those particular example items are utilized in all five versions of the INQ.
When constructing a test of any kind, it is important to keep in mind the appropriate context such as reading level, cultural context, situation in which the test is administered, whether the test is appropriate for broad or specific audiences or both, are the items clear, is the item format a good fit for the construct etc.
With the Interpersonal Needs Questionnaire, there are multiple cases where the test is given to more than one type of sample; adolescents, veterans, college students and the elderly, each resulting in appropriate and explainable results with these different populations.
Not only does the INQ apply to different categories of people but also those in different cultures. There is a German, Spanish and Singapore version of the INQ (Teo, Su?rez, & Oei, 2018). Being adaptable can be useful especially in the case of the INQ as not one group of people can be susceptible to suicidal ideations through perceived burdensomeness and thwarted belonging.
The items on the Interpersonal Needs Questionnaire are clearly presented and straightforward. The longest version of the INQ at 25-items is a clear list from top to bottom with questions addressing thwarted belonging and perceived burdensomeness. Using a Likert measuring scale, participants write how much they agree with the item to the left of the listed statement. Rather plain and simple and utilized in many psychological tests, increasing the familiarity of the scale to the participants.
Reliability evidence is available in the form of internal consistency, as the INQ consistently measures the constructs of thwarted belonging and perceived burdensomeness. The INQs medium and large item correlations of an average of 0.85 in the perceived burdensome category and 0.65 for thwarted burdensomeness indicated that items represented the constructs adequately (Hill, et al., 2015).
The Cronbach’s alpha values for the INQ measured 0.95 for perceived burdensomeness and 0.89 for thwarted belonging (Hill, et al., 2015). Given the statistics of the item correlation and Cronbach’s alpha, both appropriate for measuring the construct, reliability is demonstrated through internal consistency.
Convergent validity was demonstrated in both factors of thwarted belonging and perceived burdensomeness were positively associated with hopelessness, depression, suicide ideation, and low meaning in life (Hill, et al., 2015).
Supporting convergent validity for thwarted belongingness and perceived burdensomeness, the relationship between thwarted belongingness and perceived burdensomeness and the four conceptually similar constructs were statistically significant and in the hypothesized directions.
The average variance extracted of perceived burdensomeness (.77) and thwarted belonging (.49) showed that the items in the two constructs share a decent sized proportion of variance, supporting convergent validity (Hill, et al., 2015).
Discriminant validity was determined by the average variance extracted values, which were rather high at 0.89 perceived burdensomeness and 0.70 for thwarted belongingness indicating the two constructs are distinct and unique from each other (Teo, Su?rez, & Oei, 2018).
The main hypothesis of the INQ is that it wants to get at predicting suicidal ideations through perceived burdensomeness and thwarted belongingness. Regression analysis, an appropriate method of measuring predictive validity for this construct, equaled R2=0.50 for suicidal desire and 0.38 for suicidal planning, predicting suicidal desire much more accurately than actual suicidal plans (Teo, Su?rez, & Oei, 2018).
The main question regarding utility is, does the INQ assess the meaningful constructs of thwarted belonging and perceived burdensomeness in a cost-effective way?
Being that the INQ is a self-report measure that at its highest item version at 25, means that it takes no more than 30 minutes maximum to complete. The measure can also be sent out and completed electronically which means fast feedback and response time for analysis. Both time and cost-effective; maximum utility.
As has been reiterated because of its vast importance in psychological testing, no test is perfect. A weakness of the INQ is that the concepts of thwarted belonging and perceived burdensomeness were initially devised and tested on US samples; which are not equivalent across cultures, specifically Asian (Teo, Su?rez, & Oei, 2018).
Western society places heavy emphasis on independence and individuality that are heavy drivers in behaviors and emotions. On the other hand, Asian societies have more of a collectivist agenda with a strong emphasis on family cohesion and group harmony.
Perceived burdensomeness and thwarted belongingness may perhaps be an especially critical cultural risk factor for suicidal desire in Asians because of the importance of harmonious interpersonal relationships (Teo, Su?rez, & Oei, 2018).
In reviewing the INQ, the most prevalent strengths of the measure are the utility and validity. By having well-written, short, “single barreled” questions that directly address unique and meaningful concepts, the INQ makes for a quick, cost-effective valid suicidal ideation predicting measure.
In the future, I would like to see the INQ given to middle-school-aged adolescents and yearly administered until they are 18. Given the serious nature of the growing tragedy of increasing suicides and suicidal desire, if the INQ can be utilized as a risk-assessment tool for adolescents who are already in a difficult time of their life trying to fit in and figure out who they are, the better.
Give people coping strategies, learn to problem solve, actively address feelings of thwarted belonging and perceived burdensomeness and work at it at an early age so as to lessen the desire for suicide later. Even with its weaknesses, addressed and unaddressed, the INQ has an immense potential to do a truly heavy amount of good.
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