Biopsychosocial Predictors of Suicide Risk in Inflammatory Bowel Disease

Abstract

Inflammatory Bowel Disease (IBD) is a debilitating chronic medical condition affecting millions of people worldwide. Epidemiological data suggest suicidal behaviour is a persistent concern in IBD populations, but little research examines suicide risk (i.e., ideation and attempts) in this population. This study examined how patient history, biomedical, psychosocial, and theory-driven predictors of suicidal behaviour interact to predict suicide risk in individuals with IBD. Consenting participants completed two online self-report surveys one month apart (NTime 1 = 324, NTime 2 = 147). Based on SBQ-R clinical cut-off scores, over 30% of individuals in this sample were at-risk for suicide. Hierarchical regression analyses (N = 285) explained 48% of the variance in suicide risk, with theory-driven variables (i.e., psychache, perceived burdensomeness and thwarted belongingness from the Interpersonal Theory of Suicide) emerging as the strongest predictors. A parallel mediation (N = 324) revealed that psychache and perceived burdensomeness, but not thwarted belongingness, mediated the relationship between IBD symptoms and suicide risk. A cross-sectional model of the progression of IBD symptomatology to suicide risk was also examined (N = 282). Biomedical variables (i.e., IBD symptoms, average pain) predicted distal mental experiences of suicidal behaviour (i.e., shame, depressive symptoms, hopelessness), which predicted proximal mental experiences of suicidal behaviour (i.e., psychache, perceived burdensomeness), which then predicted suicide risk. The final analysis examined the ability of baseline biopsychosocial variables to predict suicide risk one month into the future (N = 128). Baseline variables were similarly associated in the longitudinal model as in the cross-sectional model. However, after controlling for baseline suicide risk, baseline psychache and perceived burdensomeness were not significant predictors of suicide risk one month later, suggesting that previous suicide risk is the best predictor of future suicide risk. The alarmingly high number of individuals clinically at-risk for suicide in this study may indicate a general trend in IBD populations worldwide. These novel results may be of high clinical and research interest as they suggest variables for possible interventions targeting distal predictors of suicidal behaviour in order to mitigate their downstream effects.