Perceived burdensomeness and thwarted belongingness in text messages of suicide attempt survivors

Objective: Perceived burdensomeness and thwarted belongingness are considered interpersonal risk factors for suicide. Examining these themes in personal text messages may help identify proximal suicide risk.

Method: Twenty-six suicide attempt survivors provided personal text messages and reported dates for past periods characterized by positive mood, depressed mood, suicidal ideation (with no attempt), or the two-week period leading up to suicide attempt(s). Texts were then classified into the applicable period based on matching dates. Texts (N = 194,083; including n = 86,705 outgoing texts) were coded for perceived burdensomeness and thwarted belongingness by masked trained raters. Multilevel models were fit to examine whether the target themes (combined into one overall interpersonal risk variable due to low base rate) were more prevalent in texts sent during higher risk episodes (e.g., suicide attempt vs. depressed mood episodes).

Results: 0.57% of outgoing texts contained either target theme. As hypothesized, logistic models showed participants were more likely to send texts containing the target themes during suicide attempt episodes relative to suicidal ideation (with no attempt) episodes, depressed mood episodes, and positive mood episodes, and during suicidal ideation (with no attempt) episodes relative to positive mood episodes. All contrasts were robust to post-hoc correction except for suicide attempt episodes vs. ideation (with no attempt) episodes. No other significant pairwise differences for episode type emerged.

Conclusions: Despite the small sample size and low base rate of target themes in the texts, perceived burdensomeness and thwarted belongingness were associated with intra-individual suicide risk severity in personal text messages.

Keywords: Perceived burdensomeness; suicide; text messages; thwarted belongingness.