Two Steps Too Far: The Three-Step Theory and Suicidal Ideation in Adolescents Living with Inflammatory Bowel Disease

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Moreau, Julia
inflammatory bowel disease , adolescence , suicidal ideation
Inflammatory bowel disease (IBD) is a painful and chronic gastrointestinal condition with approximately one in four patients diagnosed during adolescence. The debilitating nature of the IBD coupled with the developmental stage of adolescence gives rise to poor psychosocial outcomes. Specifically, concern about suicidal ideation among patients living with the disease is growing and ideation-to-action frameworks have been recently investigated in the IBD literature. In a sample of adolescents living with IBD ,this study examined the prevalence of suicidal ideation and modelled Step One and Step Two of Klonsky and May's (2015) Three Step Theory (3ST) of Suicide. Adolescents, aged 16-21 years, completed an online self-report survey. First, according to the Suicidal Ideation Questionnaire – Junior (SIQ-JR) cut off scores, 20.12% of adolescents living with IBD reported clinically significant suicidal ideation, and 32.32% reported elevated suicidal cognitions. Next, results largely supported Step One and Step Two of the 3ST; multiple regressions demonstrated pain and interpersonal hopelessness interacted to predict greater suicidal ideation and the same relationship was buffered by connectedness. However, IBD symptoms as a source of pain did not substantially contribute to the modelling of suicidal ideation in the context of the 3ST. Specifically, exploratory multiple regression revealed non-significant results apart from fatigue and suicidal ideation moderated by interpersonal hopelessness and thwarted belongingness. Finally, an exploratory commonality analysis suggested suicidal ideation may be best explained by the shared overlap of psychache and interpersonal hopelessness. The current suicidal ideation prevalence rate among adolescents living with IBD highlights the importance of routine screening for poor psychological wellbeing in allied health care settings. Additionally, the modelling of the theory-driven factors, psychache, interpersonal hopelessness, and connectedness, indicate clinical intervention targets for prevention of the development and exacerbation of suicidal ideation.
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