Examination Structural Model of Suicidal Behaviors and Perfectionism with the Mediation of Hopelessness, Interpersonal Needs and Suicidal Crisis Syndrome in Women from Culture Perspective

Subject Areas : Psychology

Nazila Hanaei ¹ (Ph.D. Student of Psychology, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran)
Soodabeh Bassak Nejad Bassak Nejad ² (Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran )
Seyed Esmaeil Hashemi ³ (Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran)

Received: 2024-05-21 Accepted : 2024-06-29 Published : 2024-09-14

Keywords: Suicidal behaviors, Perfectionism, Hopelessness, Interpersonal needs, Suicidal crisis syndrome,

Abstract :

The aim of this study was to examine the structural relationship model between suicidal behaviors (suicide ideation, committing suicide) and perfectionism with the mediation of hopelessness, interpersonal needs (perceived burdensomeness, thwarted belongingness) and suicidal crisis syndrome of from cultural perspective. The statistical population included all the women living in Bastak city in 2022. 317 females who refereed to Health Centers were selected as the sample by a convenience sampling procedure. The research method was descriptive of correlation one.   Data were collected through implementing the Multidimensional Perfectionism Scale (MPS) of Hewitt & Flett (1991), Interpersonal Needs Questionnaire of Hill & Pettit (2014), Hopelessness Scale (Beck & Steer, 1988), Suicide Crisis Inventory of Bloch-Elkouby et al. (2021) and Osman et al. (2001). Suicide Behaviors Questionnaire-Revised. Data was analyzed via applying structural equation modeling procedure and using SPSS-24 and AMOS-24 software. The results showed that the proposed model had an acceptable goodness of fit. The findings also indicated existence of direct and significant relationships between perfectionism and hopelessness, perceived burdensomeness and thwarted belongingness; hopelessness with suicidal crisis syndrome; perceived burdensomeness with suicidal crisis syndrome; and thwarted belongingness with suicidal crisis syndrome. In addition, the suicidal crisis syndrome had a positive and significant relationship with suicidal ideation and committing suicide. The results of indirect paths analysis also revealed that there existed  positive and significant relationship between perfectionism and suicidal crisis syndrome, through hopelessness, perceived burdensomeness and thwarted belongingness and also between hopelessness and suicidal ideation  through suicidal crisis syndrome; between the perceived burdensomeness and suicidal ideation through suicidal crisis syndrome; between the thwarted belongingness and suicidal ideation through suicidal crisis syndrome; and also between hopelessness and committing suicide through suicidal crisis syndrome; between the perceived burdensomeness and committing suicide through suicidal crisis syndrome; between thwarted belongingness and committing suicide through suicidal crisis syndrome.

References:

Beck, A. T., & Steer, R. A. (1988). Manual for the Beck Hopelessness Scale. San Antonio, TX: Psychological Corp. URL: https://www.scirp.org/reference/referencespapers?referenceid=1162622
Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974) The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865. URL: https://doi.org/10.1037/h0037562
Besharat, M. A. (2007). Development and validation of the tehran multidimensional perfectionism scale. Psychological Research, 10(1-2), 49-67. [Persian] URL: https://www.sid.ir/paper/66255/en
Bhargav, M., & Swords, L. (2022). Role of thwarted belongingness, perceived burdensomeness and psychological distress in the association between adverse childhood experiences and suicidal ideation in college students. BJPsych Open, 8(2), e39. URL: https://doi.org/10.1192/bjo.2021.1087
Bibring, E. (1953). The mechanism of depression. In P. Greenacre (Ed.), Affective Disorders; Psychoanalytic Contributions To Their Study (pp. 13-48). International Universities Press. URL: https://psycnet.apa.org/record/1955-01239-001
Bloch-Elkouby, S., Barzilay, S., Gorman, B. S., Lawrence, O. C., Rogers, M. L., Richards, J., Cohen, L. J., Johnson, B. N., Galynker, I. (2021). The revised Suicide Crisis Inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up. Journal of Affective Disorders, 295, 1280-1291. URL: https://doi.org/10.1016/j.jad.2021.08.048
Cerel, J., Brown, M. M., Maple, M., Singleton, M., van de Venne, J., Moore, M., & Flaherty, C. (2018). Suicide exposure in the population: Perceptions of impact and closeness. Suicide and Life-Threatening Behavior, 48(1), 40-51. URL: https://doi.org/10.1111/sltb.12339
Chang, Q., Yip, P. S., & Chen, Y. Y. (2019). Gender inequality and suicide gender ratios in the world. Journal of Affective Disorders, 243, 297-304. URL: https://doi.org/10.1016/j.jad.2018.09.032
Cohen, L. J., Ardalan, F., Yaseen, Z., & Galynker, I. (2018). Suicide Crisis Syndrome Mediates the Relationship Between Long-term Risk Factors and Lifetime Suicidal Phenomena. Suicide & Life-Threatening Behavior, 48(5), 613-623. URL: https://doi.org/10.1111/sltb.12387
Ferrari, M., Yap, K., Scott, N., Einstein, D. A., & Ciarrochi, J. (2018). Self-compassion moderates the perfectionism and depression link in both adolescence and adulthood. PloS One, 13(2), e0192022. URL: https://doi.org/10.1371/journal.pone.0192022
Flett, G. L., & Hewitt, P. L. (2020). Reflections on three decades of research on multidimensional perfectionism: An introduction to the special issue on further advances in the assessment of perfectionism. Journal of Psychoeducational Assessment, 38(1), 3-14. URL: https://doi.org/10.1177/07342829211057640
Flett, G. L., & Hewitt, P. L. (2024). The need to focus on perfectionism in suicide assessment, treatment and prevention. World Psychiatry: Official Journal of the World Psychiatric Association, 23(1), 152-154. URL: https://doi.org/10.1002/wps.21157
Flett, G. L., Hewitt, P. L., Nepon, T., Sherry, S. B., & Smith, M. (2022). The destructiveness and public health significance of socially prescribed perfectionism: A review, analysis, and conceptual extension. Clinical Psychology Review, 93, 102130. URL: https://doi.org/10.1016/j.cpr.2022.102130
Flint, J., Cohen, L., Nath, D., Habib, Z., Guo, X., Galynker, I., & Calati, R. (2021). The association between the suicide crisis syndrome and suicidal behaviors: The moderating role of personality traits. European psychiatry : the journal of the Association of European Psychiatrists, 64(1), e63. URL: https://doi.org/10.1192/j.eurpsy.2021.2235
Galynker, I. (2017). The suicidal crisis: Clinical guide to the assessment of imminent suicide risk. Oxford University Press. URL: https://doi.org/10.1093/med/9780190260859.001.0001
Goudarzi, M.A.. (2002). The study of reliability and validity of beck hopelessness scale in a group of shiraz university students. Journal of Social Sciences and Humanities of Shiraz University, 18(2), 27-39. [Persian] URL: https://www.sid.ir/paper/406194/en
Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology: A Journal of Human Behavior, 15(1), 27-33. URL: https://psycnet.apa.org/record/1979-08598-001
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456-470. URL: https://doi.org/10.1037/0022-3514.60.3.456
Hill, R. M., & Pettit, J. W. (2014). Perceived burdensomeness and suicide-related behaviors in clinical samples: current evidence and future directions. Journal of Clinical Psychology, 70, 631–643. URL: https://doi.org/10.1002/jclp.22071.
Horney, K. (1939). What is a neurosis?. American Journal of Sociology, 45(3), 426-432. URL: https://doi.org/10.1086/218312
Juwono, I. D., Kun, B., Demetrovics, Z., & Urbán, R. (2023). Healthy and unhealthy dimensions of perfectionism: Perfectionism and mental health in Hungarian adults. International Journal of Mental Health and Addiction, 21(5), 3017-3032. URL: https://doi.org/10.1007/s11469-022-00771-8
Kahn, J. H., Fishman, J. I., Galati, S. L., & Meyer, D. M. (2023). Perfectionism, locus of control, and academic stress among college students. Personality and Individual Differences, 213, 1-6. URL: https://doi.org/10.1016/j.paid.2023.112313
Kiamnesh, P., Dieserud, G., & Haavind, H. (2015). From a cracking facade to a total escape: maladaptive perfectionism and suicide. Death Studies, 39, 316-322. URL: https://doi.org/10.1080/07481187.2014.946625
Kiani Chelmardi, A. R., Rashid, S., & Ramezani Sh. (2019). Validity of the integrated motivational-volitional model of suicidal behavior in students: structural model. Iranian Journal of Psychiatry and Clinical Psychology, 25(2), 194-209.‏ URL: https://doi.org/10.32598/ijpcp.25.2.194
Kirmayer, L.J. (2022). Suicide in cultural context: An ecosocial approach. Trans Cultural Psychiatry, 59(1), 3-12. URL: https://doi.org/10.1177/13634615221076424
Lam, J. S. H., Links, P. S., Eynan, R., Shera, W., Tsang, A. K. T.,Law, S., Fung, W. L. A., Zhang, X., Liu, P., &Zheer, J. (2022). I thought that I had to be alive to repay my parents: Filial piety as a risk and protective factor for suicidal behavior in a qualitative study of Chinese women. Transcultural Psychiatry,59(1), 13-27. URL: https://doi.org/10.1177/13634615211059708
Maharajh, H.D., Abdool, P.S. (2005). Cultural aspects of suicide. The Scientific World Journal, 5, 736–746. URL: https://doi.org/10.1100/tsw.2005.88
Mata-Greve, F., Johnson, M., Brittany, E., & Blanchard, B. E. (2022). A longitudinal examination of cultural risk factors of suicide and emotion regulation. American Journal of Orthopsychiatry, 92(5), 635–645. URL: https://doi.org/10.1037/ort0000629
Melzer, L.,Forkmann,T., &Teismann,T. (2024) Suicide Crisis Syndrome: A systematic review. Suicide and Life-Threatening Behavior, 54(3), 391-615. URL: https://doi.org/10.1111/sltb.13065
Mitelman AM, Bafna A, Rogers ML, et al. (2023). Perceived clinical utility of the suicide crisis syndrome: A multisite pilot study. Psychological Services, 20(Suppl 2), 61-67. URL: https://doi.org/10.1093/epirev/mxn002
Morpeth, J. E. (2018). Perfectionism and interpersonal theory of suicide: thwarted belongingness and perceived burdensomeness as mediators of multidimensional perfectionism and suicide ideation (Master's thesis, The Florida State University). URL: https://repository.lib.fsu.edu/islandora/object/fsu:653474
Mueller, A.S., Abrutyn, S., Pescosolido, B., & Diefendorf, S. (2021). The social roots of suicide: Theorizing how the external social world matters to suicide and suicide prevention. Frontiers in Psychology, 12, 763. URL: https://doi.org/10.3389/fpsyg.2021.621569
O'Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical transactions of the Royal Society of London. Series B, Biological Sciences, 373(1754), 20170268. URL: https://doi.org/10.1098/rstb.2017.0268
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment, 8(4), 443-454. URL: https://doi.org/10.1177/107319110100800409
Pia, T., Galynker, I., Schuck, A., Sinclair, C., Ying, G., & Calati, R. (2020). Perfectionism and Prospective Near-Term Suicidal Thoughts and Behaviors: The Mediation of Fear of Humiliation and Suicide Crisis Syndrome. International Journal of Environmental Research and Public Health, 17(4), 1424. URL: https://doi.org/10.3390/ijerph17041424
Rashid S, Kiani A, Khorramdel K, Mohammadnezhady B, Abdollahy B, Makaremi F. (2016). The relationship between perceived social support, perceived burdensomeness and thwarted belongingness with suicidal behavior in college students (the interpersonal-psychological theory for suicide). Pajoohande, 21(4), 192-198. [Persian] URL: https://pajoohande.sbmu.ac.ir/article-1-2248-fa.html
Robinson, A., Moscardini, E., Tucker, R., & Calamia, M. (2022). Perfectionistic Self-Presentation, Socially Prescribed Perfectionism, Self-Oriented Perfectionism, Interpersonal Hopelessness, and Suicidal Ideation in U.S. Adults: Reexamining the Social Disconnection Model. Archives of suicide research: Official Journal of the International Academy for Suicide Research, 26(3), 1447-1461. URL: https://doi.org/10.1080/13811118.2021.1922108
Rogers, M. L., Chiurliza, B., Hagan, C. R., Tzoneva, M., Hames, J. L., Michaels, M. S., Hitschfeld, M. J., Palmer, B. A., Lineberry, T. W., Jobes, D. A., & Joiner, T. E. (2017). Acute suicidal affective disturbance: Factorial structure and initial validation across psychiatric outpatient and inpatient samples. Journal of Affective Disorders, 211, 1-11. URL: https://doi.org/10.1016/j.jad.2016.12.057
Rogers, M. L., Richards, J. A., Cao, E., Krumerman, M., Barzilay, S., Blum, Y., ... & Galynker, I. (2023). Associations between long-term and near-term stressful life events, suicide crisis syndrome, and suicidal ideation. International Journal of Stress Management, 30(2), 209. URL: https://doi.org/10.1037/str0000272
Sand, L., Bøe, T., Shafran, R., Stormark, K. M., & Hysing, M. (2021). Perfectionism in Adolescence: Associations With Gender, Age, and Socioeconomic Status in a Norwegian Sample. Frontiers in Public Health, 9, 688811. https://doi.org/10.3389/fpubh.2021.688811
Schuck A, Calati R, Barzilay S, Bloch-Elkouby S, Galynker I. (2019). Suicide Crisis Syndrome: A review of supporting evidence for a new suicide-specific diagnosis. Behavioral Sciences & The Law, 37(3), 223-239. URL: https://doi.org/10.1002/bsl.2397
Shahnaz, A., Saffer, B. Y., & Klonsky, E. D. (2018). The relationship of perfectionism to suicide ideation and attempts in a large online sample. Personality and Individual Differences, 130, 117-121. URL: https://doi.org/10.1016/j.paid.2018.04.002
Sherry, S. B., Mackinnon, S. P., & Gautreau, C. M. (2016). Perfectionists don't play nicely with others: Expanding the social disconnection model. In F. M. Sirois, & D. S. Molnar (Eds.), Perfectionism, health, and well-being (pp. 225-243). New York: Springer. URL: https://doi.org/10.1007/978-3-319-18582-8_10
Sherry, S. B., Mackinnon, S. P., & Nealis, L. J. (2017). Perfectionism and interpersonal problems: Narcissistic and self-critical perfectionism. In The psychology of perfectionism (pp. 177-199). Routledge. URL: https://doi.org/10.4324/9781315536255-13
Smith, M. M., Sherry, S. B., Chen, S., Saklofske, D. H., Mushquash, C., Flett, G. L., & Hewitt, P. L. (2018). The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship. Journal of Personality, 86(3), 522-542. URL: https://doi.org/10.1111/jopy.12333
Smith, M. M., Sherry, S. B., Ge, S. Y. J., Hewitt, P. L., Flett, G. L., & Baggley, D. L. (2022). Multidimensional perfectionism turns 30: A review of known knowns and known unknowns. Canadian Psychology/Psychologie Canadienne, 63(1), 16-31. URL: https://doi.org/10.1037/cap0000288
Sommerfeld, E., & Malek, S. (2019). Perfectionism moderates the relationship between thwarted belongingness and perceived burdensomeness and suicide ideation in Adolescents. The Psychiatric Quarterly, 90(4), 671-681. URL: https://doi.org/10.1007/s11126-019-09639-y
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575-600. URL: https://doi.org/10.1037/a0018697
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner Jr, T. E. (2008). Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72. URL: https://doi.org/10.1037/0022-006X.76.1.72
Ventriglio, A., Castaldelli-Maia, J. M., Bellomo, A., & Torales, J. (2023). Culture and mental health: Focus on suicide. World Society Psychiatry, 5, 132-134. URL: https://doi.org/10.4103/wsp.wsp_48_23
Wastler, H. M., Moe, A. M., Pine, J. G., & Breitborde, N. J. (2021). Perceived burdensomeness, thwarted belongingness and suicidal ideation among individuals with first‐episode psychosis. Early Intervention in Psychiatry, 15(4), 1033-1037. URL: https://doi.org/10.1111/eip.13023
Wetherall, K., Robb, K. A., & O'Connor, R. C. (2019). An examination of social comparison and suicide ideation through the lens of the integrated motivational-volitional model of suicidal behavior. Suicide and Life‐Threatening Behavior, 49(1), 167-182. URL: https://doi.org/10.1111/sltb.12434
WHO Mortality Database. (2024). 15-19 years [dataset]. With minor processing by Our World in Data. Retrieved from [link to the dataset]. URL: https://www.who.int/data/data-collection-tools/who-mortality-database
Yaseen, Z. S., Hawes, M., Barzilay, S., & Galynker, I. (2019). Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. Suicide & life-Threatening Behavior, 49(4), 1124-1135. URL: https://doi.org/10.1111/sltb.12495