Mediating Effect of Hopelessness between Thwarted Belongingness, Perceived Burdensomeness, and Non-Suicidal Self-Injury in Spanish Adolescents

Ansiedad y Estrés, (2025), 31(1), 23-29
https://doi.org/10.5093/anyes2025a4
https://www.ansiedadyestres.es
Bibliography reference

Mediating Effect of Hopelessness between Thwarted Belongingness, Perceived Burdensomeness, and Non-Suicidal Self-Injury in Spanish Adolescents

INFO ARTICLE

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Received 17 December 2024
Accepted 26 March 2025

 

ABSTRACT

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Introduction: Given the strong connection between non-suicidal self-injury (NSSI) and suicidal behaviour, recent research has explored the relationship between this type of behaviour and thwarted belongingness (TB), perceived burdensomeness (PB), and hopelessness (HS) in adolescent populations. This study aimed to analyse the relationship between TB, PB, HS, and NSSI, as well as the mediating role of HS between these variables using path analyses. Design: The final sample included N = 1733 adolescents (48.11% male, 51.89% female), aged 12-19 years (M = 14.87, SD = 1.58), residing in several regions of Spain and assessed transversally at school. Results: PB was positively associated with the frequency of NSSI (r = .394, p < .01) and HS (r = .618, p < .01). Moreover, HS was significantly and positively associated with the frequency of NSSI (r = .353, p < .01). Path analyses confirmed that PB had direct and indirect effects on NSSI, with HS acting as a mediator. The final structural model showed a good fit to the data (SB?²(3) = 5.15, p = .161, CFI = .996, RMSEA = .020), explaining 38% of the variance in HS and 18% of the variance in NSSI. Conclusion/Discussion: PB is a strong predictor of NSSI, exerting both direct and indirect effects through the mediation of HS. Conversely, TB does not seem to predict NSSI in Spanish adolescents.

 

KEYWORDS

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Non-Suicidal Self-Injury
Perceived Burdensomeness
Thwarted Belongingness
Hopelessness
Spanish adolescents

Ansiedad y Estrés, (2025), 31(1), 23-29
https://doi.org/10.5093/anyes2025a4
https://www.ansiedadyestres.es
Bibliography reference

RESUMEN

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Introducción: Dada la estrecha relación entre las autolesiones no suicidas (ANS) y la conducta suicida, investigaciones recientes han explorado la relación entre este tipo de conductas y la pertenencia frustrada, la carga percibida y la desesperanza en poblaciones adolescentes. Este estudio tuvo como objetivo analizar la relación entre estas variables, así como el papel mediador de la desesperanza entre estas variables. Método: La muestra final incluyó N = 1733 adolescentes (48.11% hombres, 51.89% mujeres), con edades entre 12 y 19 años (M = 14.87, SD = 1.58), residentes en diversas regiones de España y evaluados transversalmente en el ámbito escolar. Resultados: La carga percibida se asoció positivamente con la frecuencia de las ANS (r = .394, p < .01) y con la desesperanza (r = .618, p < .01). Además, la desesperanza se asoció positiva y significativamente con la frecuencia de las ANS (r = .353, p < .01). Los path analysis confirmaron que la carga percibida tuvo efectos directos e indirectos sobre las ANS, con la dessperanza actuando como variable mediadora. El modelo estructural final mostró un buen ajuste a los datos (SB?²(3) = 5.15, p = .161, CFI = .996, RMSEA = .020), explicando el 38% de la varianza de la dessperanza y el 18% de la varianza de las ANS. Conclusión/Discusión: la carga percibida es un fuerte predictor de las ANS, con efectos tanto directos como indirectos a través de la mediación de deseseperanza. Por el contrario, la pertenencia frustrada no parece predecir las ANS en adolescentes españoles.

 

PALABRAS CLAVE

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Autolesiones no suicidas
Carga percibida
Pertenencia frustrada
Desesperanza
Adolescentes españoles
 

Introduction

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Non-suicidal Self-Injury (NSSI) includes any deliberate harm to the surface of one's body, with no suicidal intent and includes a variety of methods, such as cutting, burning, or hitting oneself (Klonsky et al. 2011). The age of onset is between 12 and 14 years (De Luca et al., 2023; Gandhi et al., 2018), with adolescence being a critical age for the development and perpetuation of this type of behaviour, given that it is a developmental stage that involves great emotional instability (Plener et al., 2015).  With the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR [APA, 2022]), NSSI disorder was included as diagnostic category, excluding self-injury with suicidal intent. Different authors delimit the range of prevalence in adolescent samples between 7% and 25%, with an average of 13% (Brunner et al., 2014; Denton & Alvarez, 2024; Xiao et al., 2022). Regarding prevalence by sex, Bresin and Schoenleber (2015) and Pérez et al. (2021)—the latter conducted in Spain with 1,733 participants aged 12 to 19 years (M = 15.76), 46.7% males and 53.3% females—found no statistically significant differences between genders in the frequency of NSSI. Cutting, scratching, burning, dangerous substance intake, and banging are the most common forms of NSSI, often occurring in combination (Klonsky, 2011; Morey et al., 2004; Nock, 2010).  Regarding gender differences, men seem to become more frequently involved in banging, while women tend to engage more in cutting (Andover et al., 2010).

The Interpersonal Theory of Suicide (IPTS) (Joiner, 2005) is a well-established framework for understanding suicidal behavior, emphasizing two key sociopsychological factors. Thwarted belongingness (TB) refers to the perception of social disconnection and the belief that one is unimportant to others, leading to feelings of alienation. Perceived burdensomeness (PB) is the belief that one is a burden to others, characterized by self-hate and the perception that one’s death would be more valuable than their life. The co-occurrence of these two cognitive states leads to passive ideation. However, when both occur along with hopelessness, they contribute to the emergence of active suicidal ideation. According to the theory, for a person to attempt suicide, they need to acquire the capability to do so. Different factors capable of reducing fear of death and increase pain tolerance may contribute to acquiring or increasing this capability (Andreo-Jover et al., 2024). Joiner (2012) highlighted the importance of NSSI as a factor that contributes to this acquired capability of suicide. Some studies have explored the role of TB and PB as predictors of NSSI in the context of the IPTS. The study by Assavedo and Anestis (2015) analysed TB and PB as predictors of NSSI in an undergraduate student’s sample (N = 999, 17-69 years, Mage = 21.18, 79.8 % female), giving special importance in their results to TB. Chu et al. (2017) found TB and PB to be mediators between NSSI and suicidal ideation in 508 undergraduate students (17-29 tears, Mage = 18.94 years, 67% female). Marco et al. (2021) found that meaning in life mediated the relationship between TB, PB and NSSI in 1531 Spanish adolescents (Mage = 14.85; 48.1% men). Recently, Shen et al. (2024) explored trajectories of suicide ideation and NSSI in 453 Chinese adolescents (Mage = 12.35 years, 48.3% boys), finding that TB and PB, among other variables, predicted group membership of adolescents with low, moderate, and high levels of NSSI and suicide ideation.

Regarding the role of hopelessness in NSSI, Gong et al. (2019) found in a sample of 915 Chinese high school students (405 girls; Mage = 15.85) that self-criticism, a factor related to perceived burdensomeness, was significantly associated with NSSI, with hopelessness mediating this relationship. Similarly, in Spain, Faura-García et al. (2024) identified hopelessness as a key psychological factor linked to NSSI in a sample of 785 adolescents (57.1% girls) aged 13 to 18 years (Mage = 15.64).

A growing body of research suggests that hopelessness plays a crucial role in the relationship between TB, PB and NSSI. Within the framework of the IPTS (Joiner, 2005), hopelessness has been proposed as a key factor that transforms passive suicidal ideation into active suicidal ideation. Additionally, NSSI has been identified as a factor that facilitates the transition to suicidal behaviour by habituating individuals to pain and reducing their fear of death, thereby increasing their acquired capability for suicide. Given this, we hypothesize that hopelessness would mediate the relationship between PB, TB, and NSSI, considering NSSI as an important precursor to suicidal attempts.

In sum, different studies have documented the relationship between TB, PB and NSSI. However, these studies have placed PB and TB in different positions within their relationship with NSSI or in the IPTS model. In addition, to the best of our knowledge, no previous studies have been conducted with Spanish adolescent samples to investigate the roles of TB, PB, and hopelessness in the occurrence of NSSI. Thus, the aims of this study were, first, to explore the relationships between PB, TB, hopelessness, and NSSI and, second, to test whether PB and TB are directly related to the frequency of NSSI, and whether hopelessness mediates the relationship between TB, PB, and NSSI.

Method

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Procedure

Once the study was approved by the ethics committee of the university, the research group contacted the management teams of 22 schools around Spain in different autonomous communities to ask for access to the study sample. We approached study centres that had previous agreements with the university of the research team. Nine schools (one public and 8 charter schools) expressed their interest in participating, distributed the research information to the families. The study’s inclusion criteria required participants to be aged 12 to 19 years old and to have signed the informed consent. For minors, their parents or legal guardians had to sign the consent. Therefore, the exclusion criterion was that either the students and/or their legal guardians did not agree to participate in the study. All participants received appropriate instructions to complete the assessment protocol in their classes, and all of them understood Spanish.

Initially, 1733 students from different Spanish provinces were recruited between September 2016 and June 2018. Of them, 22 (1.27%) did not want to participate in the project, and 171 (9.89%) did not correctly follow the evaluation guidelines. A total of 25% of participants (n = 384) were from the Valencian Community, 22% (n = 338) from the Basque Country, 17% (n = 261) from la Rioja, 23% (n = 353) from the Community of Madrid, 6% (n = 92) from Castilla la Mancha, 3% (n = 46) from Castilla-León, and 4% (n = 62) from Aragón. Sociodemographic characteristics and psychological variables were evaluated using online questionnaires. The data were collected through the online platform Survey Monkey.

Participants

The final sample included 1536 participants aged between 12 and 19 years old (M = 14.87, SD = 1.58), with a subgroup of male individuals representing 48.11% of the total sample (739 participants) and a subgroup of female individuals representing the remaining 51.89% (797 participants). Regarding their ages, 64.13% (n = 985) were under 15, and 35.87% (n = 551) were between 15 and 19 years old.

Instruments

Inventory of Statements about Self-Injury (ISAS; Klonsky and Glenn, 2009)

The present inventory was used to assess the presence of NSSI. The administration of the ISAS allowed us to know the frequency and methods of NSSI, as well as the number of times the person had self-injured in the past month, past year, and in their lifetime. Similarly, the ISAS provided information on the intrapersonal and interpersonal functions of these behaviours. NSSI responses on the ISAS-I scale were rescaled into ordinal (Likert-type) categories: "no NSSI present at all"; between 1 and 4 times; between 5-50 times; 51-100 times; and more than 100 times. Five Likert categories were chosen for clinical and methodological purposes: to capture two categories under the DSM 5 clinical category that included at least 5 NSSI behaviours (no NSSI, and 1-4), and to capture three categories that grouped NSSI with progressively higher levels of frequency, based on the clinical consensus of the research team members. In addition, we selected a 5-category option for reasons of reliability and validity (Nunnally, 1967; Preston & Colman, 2000). The ISAS has been validated in our sample with Spanish adolescents (Pérez et al., 2021), showing adequate internal consistency, a = .70 for both intrapersonal and interpersonal functions. Since the same sample is used in the present study, these data reflect the reliability of the instrument in the present work.

Beck Hopelessness Scale (BHS; Beck et al., 1974; Viñas et al., 2004)

The BHS was designed to assess negative expectations about the future and has been used in the present research. It is a 20-item self-administered scale that includes three subscales: a) feelings about the future, associated with the analysis of hopelessness, hope, and enthusiasm; b) loss of motivation, related to hopelessness, motivation, and feelings of abandonment; and c) expectations about the future, linked to what is expected and anticipated from future life. Since its creation, it has been translated into different languages. It was validated in the Spanish population by Viñas et al. (2004) and in Spanish adolescents (Batlle-Viñas et al., 2015), showing good internal consistency (a =.93). In this study, the total scale showed a high internal consistency of w = .82.

Interpersonal Needs Questionnaire-15 (INQ-15; Van Orden et al., 2012; Pérez et al., 2022)

 The INQ-15 is a self-report measure composed of 15 items that evaluate the main constructs of the interpersonal theory of suicide (Joiner, 2005) and has been validated in Spanish adolescents (Pérez et al., 2022): PB (Items 1 to 6) and TB (Items 7 to 15). The original version of the questionnaire (Van Orden et al., 2009) consisted of 25 items that were subsequently reduced in order to achieve a shorter questionnaire with greater consistency. The 15-item version, used in this study, is the one most frequently used in research. The items are answered on a 1- to 7-point Likert scale. In light of the results presented by Glaesmer et al. (2014), the INQ-15 offers a high internal consistency of a = .83 for TB and a =.88 for PB. In this study, both the PB and TB dimensions showed high and acceptable internal consistency, ? = .88 and ? = .78, respectively.

Data analyses

Descriptive statistics and frequencies were calculated to analyse the characteristics of the sample and Pearson correlations were conducted to explore the relationships between the variables included in this study. These analyses were carried out with the SPSS 26.0 programme (IBM Statistics, 2021). Path analyses were conducted to test the direct and indirect effects between TB and BP, as well as the frequency of NSSI, through hopelessness (Model 1), using the EQS6 software program (Bentler & Hu, 2005). The estimation method used was maximum similarity parameter estimation, and the root mean squared error of approximation (RMSEA), non-normalised fit index (NNFI), incremental fit index (IFI), and comparative fit index (CFI) were used to test the model fit.

Given that the first proposed model did not fit the data a second model was specified in which hopelessness would act as a mediating factor between PB and NSSI. Given that Mardia's coefficient was greater than 5 (Mardia = 83.30), robust methods were used to calculate goodness-of-fit indexes. The goodness of fit was acceptable and set at NNFI, NFI, and CFI values over .95 and RMSEA results under .06 (90% CI [.00, .05]) (Hu & Bentler, 1995). In addition, we calculated effect sizes using Cohen’s f2 (Cohen, 2013).

Results

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Correlations

Table 1 presents means, standard deviations, and correlations for the analysed variables. The findings suggest that PB was positively and significantly associated with the frequency of NSSI (r = .394, p < .01) and hopelessness (r = .618, p < .01). Moreover, hopelessness was significantly and positively associated with the frequency of NSSI (r = .353, p < .01). However, no association was found between TB and hopelessness (r = -.016, p = .494), TB and NSSI (r = .01, p = .967), and PB and TB (r = -.040, p = .092).

Structural Equation Model

The path analysis tested the theoretical model of the ITPS, including TB and PB as direct and indirect predictors of NSSI, and considering hopelessness as a mediator between these variables. A path analysis was conducted in two steps. First, the hypothesized model (Figure 1) was specified, which included the direct and indirect effects of both the TB and PB scales on NSSI (Figure 2). Because the model did not fit the data, SB?²(2) = 47.28, p = .000, CFI = .91, IFI = .91; NNFI = .72; RMSEA = .115 (90% CI [.088, .144]), the model was re-specified, and nonsignificant paths (i.e., the path from TB interaction to hopelessness and to NSSI, ? = .042 and ? = .01, respectively) were removed from the model.

A second more parsimonious model (Figure 3) showed a good fit to the data: SB?²(3) = 5.15, p = .161, CFI = .996, RMSEA = .020 (90% CI [.000, .049]). All parameters were statistically significant at the .05 level. This model showed direct and indirect effects from PB to NSSI through hopelessness. In the model, PB explained 38% of the variance in hopelessness (f2 = .616) and 18% of the variance in NSSI (f2 = .212) (Figure 3). According to Cohen’s (2013) guidelines, f2 = 0.02, f2 = 0.15, and f2 = 0.35 represent small, medium, and large effect sizes respectively.

Discussion

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The objectives of the present study were twofold: 1) to explore the relationships between PB, TB, hopelessness, and NSSI; and 2) to analyse whether PB and TB were directly related to the frequency of NSSI and to test the mediating effect of hopelessness between TB and PB and NSSI.         

Regarding the first objective, our results indicate that there are positive and significant correlations between PB, hopelessness, and NSSI. Previous literature supports the relationship between NSSI and PB (Chu et al., 2017; Marco et al., 2021) and between PB and hopelessness (i.e., Gray et al., 2020; Hagan et al., 2015). Perceived burdensomeness to family or friends has been found to be related to emotional dysregulation and NSSI. In this case, NSSI could act as a way of managing the frustration and negative affect derived from these types of negative cognitions. Other authors have linked NSSI to emotional dysregulation, interpersonal difficulties, and impulsivity, variables that lead to perceived burdensomeness to one’s family (Chu et al., 2017; Wolff et al., 2019). Similarly, Dunlop et al. (2020) and Taylor et al. (2018) indicate that people who have experienced some form of bullying lose a sense of belonging to the group and, in turn, exhibit a higher frequency of NSSI than others who have not been victims of those behaviours.

Unlike adolescents from more individualistic cultures, Spanish adolescents may be more affected by the perception of burdening their family due to the cultural value placed on familial interdependence. In collectivist cultures, interdependence among family members is more pronounced, which can amplify feelings of guilt or inadequacy in adolescents (Dwairy & Achoui, 2010). Additionally, socio-cultural factors such as academic stress and social media use may further contribute to these dynamics, potentially distinguishing Spanish adolescents from peers in other countries. These findings suggest that future research should explore how cultural and socio-demographic variables influence NSSI across different populations.

As for the second objective, our results revealed that the initial model proposed, in which both TB and PB predicted the frequency of NSSI mediated by hopelessness, did not fit the data. Instead, in the final model, PB predicted NSSI, mediated by hopelessness. The importance of both PB and hopelessness in the model and in the present study population is of great interest given how it is related to the presence of NSSI. In line with this result, Gray et al. (2020) found that hopelessness was positively related to the frequency of NSSI below the age of 65, and Gong et al. (2019) concluded that hopelessness was a strong risk factor for NSSI in adolescents, with a high predictive power of NSSI. Furthermore, the study by Pérez et al. (2017) supported the relationship between PB and NSSI in a clinical sample.

Based on the objectives of the present study and the results obtained in the SEM analysis, the mediating role of hopelessness between PB and NSSI is noteworthy. In this regard, Edwards (2019) described how depression and related symptoms were associated with PB, showing that greater PB produces an increase in the severity of depressive symptoms, and more severe depressive symptoms increase the frequency and use of NSSI methods. Thus, it is possible that people with PB who engage in NSSI seek to satisfy the intrapersonal function by appeasing negative emotions (e.g., guilt, shame, anger, hopelessness) (Chu et al., 2017), or they may engage in NSSI to seek affirmation and external validation to facilitate a decrease in PB (Hames et al., 2015). Both explanations may support the relationship between hopelessness, PB, and NSSI because hopelessness can increase the negative emotions experienced towards oneself and the loss of social reinforcement.

As can be observed, the results and the model in the present study partially support the IPTS (Joiner, 2005) in the prediction of NSSI in adolescents, given that TB is excluded from the model. Some research suggests that PB plays a role in suicidal ideation prediction in the university population (Li et al., 2019) and the review by Chu et al. (2017) found that PB had consistent cross-sectional support while the support for TB was mixed. In an adolescent population, Czyz et al. (2015) also highlighted PB and NSSI as key variables in the IPTS, decreasing the importance of TB.

As described above, an unexpected result was that there was no association between TB and NSSI. However, these results have been found and explained in previous studies. For example, based on the theory of social contagion, the presence of NSSI would give rise to a sense of belonging to a group, especially in adolescents (Brechwald & Prinstein, 2011; Jarvi et al., 2013). Thus, the mere occurrence of NSSI could act as a sign of identity in the group of adolescents, thus reducing the relevance of frustrated belongingness in this age group. In the same way, Prinstein et al. (2010) described that the need to socialise and the behavioural selection effect are two key aspects related to the occurrence of NSSI in adolescents. In other words, NSSI would constitute a mode of social interaction, given that many of the patients involved in NSSI know people who also engage in NSSI, thus reducing the importance of TB in the prediction of NSSI. In addition, Roeder and Cole (2019) concluded that PB was more strongly related to NSSI and suicide ideation than TB, perhaps indicating that adolescents may find a connection with their peers through academic and extracurricular activities that are characteristic of that stage. In the present sample, perceived birdensomeness to others might include the perception of separation from the group, both at the family and peer level, thus decreasing the statistical relevance of TB.

Finally, an alternative explanation for these could be the social and family-oriented nature of Spanish society, which is related to a high level of social support (Rokach et al., 2001). This familism seems to reduce the levels of TB and PB and suicide ideation in other studies (Acosta et al., 2017). Therefore, this variable could act as a mechanism underlying our results.  Spanish society places significant emphasis on the importance of family bonds and social support, particularly among adolescents. Spanish adolescents are more likely to rely on family support, which can serve as a protective factor against NSSI (Mendez et al., 2022). This robust social support system may help buffer the impact of TB on NSSI, as the strong family ties and social networks in Spain could alleviate feelings of social exclusion or the burden that typically drive NSSI.

In conclusion, the model tested in the present research supports the roles of PB and hopelessness in the frequency of NSSI, positioning hopelessness as a mediator between the two variables. Similarly, the connection between the variables explored and the increased risk of suicide is also noteworthy in light of the available literature (Li et al., 2019; Roeder & Cole, 2019).

Limitations and future directions

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The present study has some limitations that should be taken into consideration. First, this is a cross-sectional and retrospective study so conclusions cannot be drawn about directionality and causality between the variables explored. Second, only self-report measures were used to assess the variables, which could introduce biases in answering the questionnaires. This might make it challenging to obtain objective data and could impact the honesty of responses, potentially leading to underestimation or overstatement of answers. Third, the results can only be generalised to Spanish adolescent community samples. It is necessary to test our results in samples with other age ranges and nationalities, using longitudinal data. Additionally, it is important to evaluate these results in clinical samples with different mental disorder diagnosis, to analyse the role of these variables as predictors of psychopathology.

Clinical Implications

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The findings of this study underscore the need for clinicians to consider perceived burdensomeness and hopelessness as key factors in the development and maintenance of NSSI in adolescents. Therapeutic interventions that focus on addressing and modifying these cognitive patterns may be particularly effective in preventing and treating NSSI. Cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), for example, could be particularly useful in helping adolescents reframe negative thoughts related to burdensomeness and hopelessness. Moreover, fostering stronger social support systems, particularly within family and peer networks, could also mitigate these cognitive vulnerabilities. Clinicians should focus on creating safe environments where adolescents feel heard and understood, thereby reducing feelings of isolation and perceived burdensomeness, which are often linked to NSSI behaviors.

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