• Type :#article
  • Date read: 2023-07-05
  • Bibtex: @lieberman2023
  • Bibliography: Lieberman, A., Gai, A. R., Rogers, M. L., Jobes, D. A., David Rudd, M., Chalker, S. A., Brenner, J. T., & Joiner, T. E. (2023). Targeting Perceived Burdensomeness to Reduce Suicide Risk. Behavior Therapy, 54(4), 696–707. https://doi.org/10.1016/j.beth.2022.12.002

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My notes

  • Pretty small effect sizes.
  • This intervention is based on Joiner’s interpersonal theory of suicide. He’s also a co-author.
  • They argue that perceived burdensomeness is an important mediator between depression and suicide, and that the construct is fairly malleable and thus open for intervention.
    • Some studies to date, but they are often small or involve multiple treatment components (not isolating perceived burdensomeness).

Further still, across various kinds of intervention studies targeting SI in general, a fairly common pattern of results unfolds such that regardless of condition, all trial participants substantially improve.

  • Data is from a larger RCT with Collaborative Assessment and Management of Suicidality (CAMS) versus enhanced TAU.


Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one’s death is worth more than one’s life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches—including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals—explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from .07–.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts. PDF: lieberman_2023_targeting_perceived_burdensomeness_to_reduce_suicide_risk.pdf