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Cited by 267Suicide and Self-Harm StudiesDeath Anxiety and Social ExclusionHomicide, Infanticide, and Child Abuse

Perceived burdensomeness and suicide ideation in older adults

Open access
Cukrowicz, Kelly C., Cheavens, Jennifer S., Van Orden, Kimberly A., Ragain, R. Michael, Cook, Ronald L.·2011·Psychology and Aging
DOI 10.1037/a0021836PMC PMC3699192
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Abstract

Older adults have the highest risk of death by suicide in the United States. Improving our understanding of the factors that lead to increased risk of suicide in older adults will greatly inform our ability to prevent suicide in this high-risk group. Two studies were conducted to test the effect of perceived burdensomeness, a component of the interpersonal-psychological theory of suicide (Joiner, 2005), on suicide ideation in older adults. Further, gender was examined as a moderator of this association to determine if perceived burdensomeness exerted a greater influence on suicide ideation in males. The results of these studies suggest that perceived burdensomeness accounts for significant variance in suicide ideation, even after predictors such as depressive symptoms, hopelessness, and functional impairment are controlled. Gender did not moderate the association. The implications of these findings for treatment of older adults with suicide ideation and elevated suicide risk are discussed.

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Registry

Crossref · 10.1037/a0021836

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 25 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In Study 1, the model adding perceived burdensomeness fit better than the covariates-only model.

    “The second regression model including perceived burdensomeness was significant with likelihood ratio chi-square equal to 42.78, df = 5, p < .001, suggesting better model fit than the model with only the covariates.”
    Quote in the paperSubstantial claim
  • Findingown data

    In Study 1, male gender was associated with a GSIS-SI score 2.94 times greater than female gender.

    “The exponentiated value of this was 2.94, which means male gender is associated with a 2.94 times greater GSIS-SI score than for female gender.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Gender does not moderate the link between perceived burdensomeness and suicide ideation.

    “Gender did not moderate the association.”
    • Also stated in: § Results and Discussion · plain
      “The coefficient for this interaction (.008) was not significant.”
    Quote in the paperSubstantial claim
  • Findingown data

    In Study 1, the model adding the perceived burdensomeness by gender interaction fit worse than the model without it.

    “This model was significant with a likelihood ratio chi square of 42.79, df = 6, p < .001, indicating poorer fit to the data than the model without this interaction.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In Study 1, perceived burdensomeness predicted suicide ideation after age, gender, depressive symptoms, and loneliness were controlled.

    “Perceived burdensomeness was significant in this model when all covariates were held constant (Wald χ2 = 7.21, p = .007).”
    • Also stated in: § Results and Discussion · plain
      “The coefficient for perceived burdensomeness was 0.11 (p = .007) with an exponentiated value of 1.11.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 21
  • May combine two claims. 17

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In Study 1, loneliness had a coefficient of .07 and an exponentiated value of 1.06.

    “The coefficient for loneliness was .07 (p = .05) with an exponentiated value of 1.06.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both samples were largely Caucasian, female, and highly educated.

    “First, both samples were largely Caucasian, female, and highly educated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The Study 2 sample included older adults from primary care, many with low perceived burdensomeness and few suicide thoughts.

    “This study included older adults recruited from a primary care environment, many of whom had few perceptions of burdensomeness and few thoughts of suicide.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In Study 1, perceived burdensomeness had a coefficient of 0.11 and an exponentiated value of 1.11.

    “The coefficient for perceived burdensomeness was 0.11 (p = .007) with an exponentiated value of 1.11.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The participation rate in Study 2 was 24%.

    “The rate of agreement to participate in this study was 24%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The first negative binomial regression model with only covariates was significant.

    “The first negative binomial regression model with only the covariates was significant with likelihood ratio chi-square equal to 72.06, df = 6, p < .001.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Study 2 recruited 26% men, lower than the 37% men in the primary care clinic.

    “The gender distribution of the Study 2 sample reflected the gender ratio of patients in a primary care clinic (63% women, 37% men); however, our recruitment of 26% men suggests a lower rate of participation by men than women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The GSIS-SI distribution in Study 1 was positively skewed and overdispersed.

    “The distribution of the GSIS-SI variable in these data was positively skewed (skew = 2.67 [SE = .32]) with significant overdispersion (M = 2.65 [SE = .60], σ2 = 19.71, K = 7.65 [SE = .63]; range = 0 to 21); therefore, negative binomial regression was selected as the most appropriate data analytic strategy”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    In Study 2, suicide ideation scores were positively skewed and overdispersed, so negative binomial regression was used.

    “The distribution of the suicide ideation variable in these data was also positively skewed (skew = 2.75 [SE = .24]) with significant overdispersion (M = 2.90 [SE = .49], σ2 = 23.76, K = 8.59 [SE = .48]; range = 0 to 25); therefore negative binomial regression was again used for data analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In Study 1, gender and loneliness had significant effects in the covariate model.

    “Examination of included variables (Table 2) indicated significant effects for gender (Wald χ2 = 8.40, p = .004) and loneliness (Wald χ2 = 3.97, p = .042).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In Study 1, the perceived burdensomeness by gender interaction coefficient was .008 and not significant.

    “The coefficient for this interaction (.008) was not significant.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Perceived burdensomeness may be more common among older adults during the retirement transition.

    “Perceptions of burdensomeness may be more likely to occur in many older adults during the transition to retirement years.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Perceived burdensomeness and thwarted belongingness are proximal mental causes of suicidal desire.

    “They suggested that perceived burdensomeness and thwarted belongingness are mental states that are proximal causes of suicidal desire.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The perceived burdensomeness subscale had internal reliability of .90 in Study 1.

    “In this sample, internal reliability was .90 for the perceived burdensomeness subscale.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The GSIS-SI subscale had internal consistency of .90 in Study 1.

    “The internal consistency for the GSIS-SI subscale in this sample was .90.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Some older adults may see themselves as a burden and view that burden as permanent and stable, leading them to consider suicide as a solution.

    “In this case, some older adults may perceive themselves a burden and may perceive that this state is permanent and stable, resulting in contemplation of suicide, with death as a solution to the problem of ongoing burdensomeness.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Many older adults feel distress when they begin needing more care from family or friends.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The capability for lethal self-injury must be present for suicide ideation to become suicidal intention and action.

    “According to these theorists, a third variable, the capability to enact lethal self-injury, which involves decreased fear of suicide and increased physical pain tolerance, must be present in order for thoughts of suicide to progress to intention to engage in suicidal behavior and to act on these intentions.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    When both perceived burdensomeness and thwarted belongingness are present at the same time, the most serious form of suicide ideation is expected to develop.

    “This theory predicts that the simultaneous presence of feeling like a burden on others and feeling a thwarted sense of belongingness is associated with the development of the most serious form of suicide ideation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The Study 2 sample broadly represents the area's ethnic distribution, with some overrepresentation of White participants.

    “Therefore, this sample is broadly representative of the ethnic distribution of this area, with some overrepresentation of White participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Study 1 had a relatively small, highly educated sample of healthy older volunteers.

    “The sample was relatively small, highly educated, and included healthy older adults who had volunteered to be repeatedly contacted to participate in research.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The interpersonal-psychological theory of suicide holds that perceived burdensomeness and thwarted belongingness are key causal factors in the emergence of suicidal desire.

    “Joiner (2005) and colleagues (Van Orden et al., 2010) recently proposed the interpersonal-psychological theory of suicide, which posits that two interpersonal constructs are key causal factors in the development of desire for suicide (i.e., suicide ideation)—perceptions of burdensomeness on loved ones and/or society and feelings of not belonging to valued groups or relationships.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Joiner, 2005

      Not checked in the free run.

    • cites Van Orden et al., 2010

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Study 1 results replicated and extended prior findings from samples aged 18 to 65.

    “In addition, our results replicated and extended findings from previous studies with samples aged 18 to 65 years (Van Orden et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Van Orden et al., 2008

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The Study 1 sample overrepresented White participants and underrepresented Black participants relative to census data for Chapel Hill and Durham.

    “The recruited included an over-representation of White participants and an under-representation of Black participants compared with census data for Chapel Hill and Durham, NC.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior research indicates that Beck Hopelessness Scale scores predict death by suicide even after controlling for depressive symptoms.

    “Previous studies have supported the psychometric properties of this instrument in multiple populations and have indicated that scores on the BHS are a predictor of death by suicide, even after controlling for depressive symptoms (Beck & Steer, 1988; Beck, Brown, Berchick, Stewart, & Steer, 1990; Brown, Beck, Steer, & Grisham, 2000).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Beck & Steer, 1988

      Not checked in the free run.

    • cites Beck, Brown, Berchick, Stewart, & Steer, 1990

      Not checked in the free run.

    • cites Brown, Beck, Steer, & Grisham, 2000

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The UCLA Loneliness Scale had internal consistency of .90 in Study 1.

    “internal consistency was .90 in this sample.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Cognitive-behavioral therapy has been shown successful in treating geriatric depression.

    “Although these strategies remain untested, researchers have demonstrated success in treating geriatric depression with cognitive-behavioral therapy (e.g., Pinquart, Duberstein, & Lyness, 2006); thus, perceptions of burden on others may also be treated successfully in psychotherapy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pinquart, Duberstein, & Lyness, 2006

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The CESD had internal consistency of .95 in Study 1.

    “The internal consistency for the CESD was .95 in this sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this sample, the Beck Hopelessness Scale had an internal consistency of .86.

    “The internal consistency for the BHS in this sample was .86.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Study 2 improved on Study 1 by using a larger sample, recruiting in primary care, and adding measures of cognitive and physical functioning and hopelessness.

    “The design of Study 2 has several methodological improvements over Study 1, including increased sample size, recruitment in a primary care setting, inclusion of measures of cognitive and physical functioning, as well as a measure of hopelessness, a construct known to predict suicide and suicide ideation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Study 2, all assessment instruments had internal consistency values above .78.

    “Internal consistency values were greater than .78 for all instruments in Study 2.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    One GSIS-SI item was removed because its content concerned perceived burdensomeness.

    “In this study, one item was removed due to item content related to perceived burdensomeness (“I frequently think that my family will be better off when I am dead.”).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Both studies used cross-sectional, self-report data.

    “The data presented in both studies are cross-sectional and rely on self-report.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Prior studies support the content and construct validity and test-retest reliability of the SF-8.

    “Previous studies have provided positive support for the content and construct validity of this scale as well as test-retest reliability (Lefante, Harmon, Ashby, Barnard, & Webber, 2005; Turner-Bowker, Bayliss, Ware, & Kosinski, 2003; Ware, Loskinski, Dewey, & Gandek, 2001).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Lefante, Harmon, Ashby, Barnard, & Webber, 2005

      Not checked in the free run.

    • cites Turner-Bowker, Bayliss, Ware, & Kosinski, 2003

      Not checked in the free run.

    • cites Ware, Loskinski, Dewey, & Gandek, 2001

      Not checked in the free run.

33 of 33

  • The paper relies on this without support.

    There is a gap in identifying specific interpersonal factors that are differentially linked to suicide ideation in older men.

    “however, there exists a gap in identification of specific interpersonal factors that are differentially associated with suicide ideation in older men.”

  • The paper relies on this without support.

    Many older adults feel distress when they begin needing more care from family or friends.

    “Specifically, many older adults experience distress when they begin to require more care from members of their family or friendship networks.”

  • The paper relies on this without support.

    Few studies have identified factors differentially linked to the higher suicide death rate in older males.

    “To date, few studies have identified factors that are differentially associated with the higher rate of suicide deaths in older males (CDC, 2010); therefore, we aimed to determine if perceived burdensomeness was more associated”

  • The paper relies on this without support.

    Physical and cognitive functioning likely influence both perceived burdensomeness and suicide ideation.

    “Physical and cognitive functioning indices were not formally assessed, although it is likely that these variables affect both the predictor variable (i.e., perceived burdensomeness) and the criterion variable (i.e., suicide ideation).”

  • The paper relies on this without support.

    Loneliness is a strong predictor of suicide ideation.

    “These covariates were chosen as they were either theoretically associated with perceived burdensomeness (i.e., health) or have been identified as a strong predictors of suicide ideation (i.e., depression, hopelessness, loneliness).”

  • The paper relies on this without support.

    Health is theoretically associated with perceived burdensomeness.

    “These covariates were chosen as they were either theoretically associated with perceived burdensomeness (i.e., health) or have been identified as a strong predictors of suicide ideation (i.e., depression, hopelessness, loneliness).”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Recent U.S. research examining the Interpersonal Theory of Suicide with older adults indicates that perceived burdensomeness is associated with more severe suicidal ideation above and beyond the contribution of belongingness.

    “Recent U.S. research examining the theory with older adults indicates that perceived burdensomeness is associated with more severe suicidal ideation above and beyond the contribution of belongingness [73,74].”

    From A systematic review of social factors and suicidal behavior in older adulthood (2012) · cites this paper as [73]

  • Financial- and employment-related stress may be most relevant for predicting suicide in middle adulthood, while health-related events and difficulties may play a more central role in suicide for older adults.

    “In contrast, financial- and employment-related stress may be most relevant for predicting suicide in middle adulthood (DeJong et al. 2010; Innamorati et al. 2008), while health-related events and difficulties may play a more central role in suicide for older adults, particularly through their effects on cognitive-affective states like perceived burdensomeness (e.g., Cukrowicz et al. 2011).”

    From Life stress and suicide in adolescents (2019) · cites this paper as Cukrowicz et al. 2011

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Suicide-ideation score is described as an item count

    Minor

    After one item was removed, the scale had nine items and a centered score ranging from 0 to 36. The number of items reported could not range as high as 36, so the regression outcome is misdescribed as an item count.

1 of 1

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Authors
Cukrowicz, K. C., Cheavens, J. S., Van Orden, K. A., Ragain, R. M., & Cook, R. L.
Affiliations
  • Texas Tech University (US)
  • The Ohio State University (US)
ORCID
Venue
Psychology and Aging
Publisher
American Psychological Association (APA)
Published
2011
Volume
26
Issue
2
Pages
331-338
ISSN
  • 0882-7974 (ISSN-L)
  • 1939-1498
DOI
10.1037/a0021836
PMC
PMC3699192
OpenAlex
W2067819534
Semantic Scholar
75ccbb1e2ef71251dfe18e08865ae222cce8e6f5
Cited by
267
References
38
Citations by year
2026: 12 · 2025: 13 · 2024: 12 · 2023: 13 · 2022: 16 · 2021: 24 · 2020: 20 · 2019: 27 · 2018: 13 · 2017: 22 · 2016: 20 · 2015: 26 · 2014: 20 · 2013: 12 · 2012: 13
FWCI
16.56
Type
journal article
Language
en
Open access
Locations
  • Psychology and Aging (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (T32AG000029)
  • American Foundation for Suicide Prevention
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
perceived burdensomeness, suicidal ideation, older adults, interpersonal theory of suicide, gender differences, suicide risk, suicide prevention, depressive symptoms, hopelessness, functional disability
MeSH terms
Activities of Daily Living, Aged, Depression, Female, Health Status, Humans, Interpersonal Relations, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Surveys and Questionnaires, Self Concept, Suicidal Ideation

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