Psychological Sex Differences in Suicidal Ideation: Testing the Three-Step Theory in Iranian Adolescents
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Background: Suicide constitutes a global public health crisis with devastating consequences for individuals and society, particularly among adolescents. Klonsky's Three-Step Theory (3ST) of suicide posits that suicidal behavior develops through a three-step process involving pain, hopelessness, connectedness, and capability for suicide. Connectedness is also influenced by gender differences in empathy and systematization between men and women. This study investigated the first two steps of the 3ST, specifically the interplay of psychological pain and hopelessness (Step 1) and connectedness (Step 2), in predicting suicidal ideation within a sample of Iranian adolescents.
Methods: A sample of 456 Iranian adolescents (75.7% female, 24.3% males, ages 12-20, M = 16.44, SD =3.28) completed self-report measures assessing suicidal ideation, hopelessness, psychological pain, connectedness, Empathizing and Systemizing. Cross-sectional regression models were employed to analyze the data.
Results: Hierarchical regression analysis revealed that the interaction of pain and hopelessness explained 59% of the variance in suicidal ideation. Furthermore, connectedness emerged as a protective factor against suicidal ideation, particularly among participants experiencing elevated levels of both psychological pain and hopelessness (r = .29, p < .001).
Conclusions: These findings support the applicability of the first two steps of the 3ST to Iranian adolescents. Future research should examine all three steps of the theory within a clinical adolescent sample.
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Abbasi-Ghahramanloo, A., Jafarzadeh, M., Pourfarzi, F., Afrashteh, S., Azimi, A., Yusuf, M. A., Adham, D., & Moradi-Asl, E. (2024). Characteristics of suicide attempts in Northwestern Iran: a five-year population-based survey. BMC psychiatry, 24(1), 15. https://doi.org/10.1186/s12888-023-05483-4
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Amini‐Tehrani, M., Sadeghi, R., Nasiri, M., Jalali, T., & Zamanian, H. (2021). Suicide‐related interpersonal needs of young Iranian people: A preliminary validation of thwarted belongingness and perceived burdensomeness constructs. Clinical psychology & psychotherapy, 28(2), 422-437. https://doi.org/10.1002/cpp.2507
Balaguer, A., Monforte-Royo, C., Porta-Sales, J., Alonso-Babarro, A., Altisent, R., Aradilla-Herrero, A., Bellido-Pérez, M., Breitbart, W., Centeno, C., & Cuervo, M. A. (2016). An international consensus definition of the wish to hasten death and its related factors. Plos one, 11(1), e0146184. https://doi.org/10.1371/journal.pone.0196754
Bilsen, J. (2018). Suicide and youth: risk factors. Frontiers in Psychiatry, 9, 540. https://doi.org/10.3389/fpsyt.2018.00540
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Esfahani, M., Hashemi, Y., & Alavi, K. (2015). Psychometric assessment of the Beck Scale for suicidal ideation (BSSI) in the general population in Tehran. Medical journal of the Islamic Republic of Iran, 29, 268. https://pmc.ncbi.nlm.nih.gov/articles/PMC4715388/
Fan, Q., Li, Y., Gao, Y., Nazari, N., & Griffiths, M. D. (2023). Self-compassion moderates the association between body dissatisfaction and suicidal ideation in adolescents: A cross-sectional study. International Journal of Mental Health and Addiction, 21(4), 2371-2388. https://doi.org/10.1007/s11469-021-00727-4
Fonseca-Pedrero, E., Al-Halabí, S., Pérez-Albéniz, A., & Debbané, M. (2022). Risk and protective factors in adolescent suicidal behaviour: A network analysis. International Journal of Environmental Research and Public Health, 19(3), 1784. https://doi.org/10.3390/ijerph19031784
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Abramson, L., Alloy, L., Hogan, M., Whitehouse, W., Gibb, B., Hankin, B., & Cornette, B. (2002). The hopelessness theory of suicidality: Suicide science. In: Springer. https://link.springer.com/chapter/10.1007/0-306-47233-3_3
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Amini‐Tehrani, M., Sadeghi, R., Nasiri, M., Jalali, T., & Zamanian, H. (2021). Suicide‐related interpersonal needs of young Iranian people: A preliminary validation of thwarted belongingness and perceived burdensomeness constructs. Clinical psychology & psychotherapy, 28(2), 422-437. https://doi.org/10.1002/cpp.2507
Balaguer, A., Monforte-Royo, C., Porta-Sales, J., Alonso-Babarro, A., Altisent, R., Aradilla-Herrero, A., Bellido-Pérez, M., Breitbart, W., Centeno, C., & Cuervo, M. A. (2016). An international consensus definition of the wish to hasten death and its related factors. Plos one, 11(1), e0146184. https://doi.org/10.1371/journal.pone.0196754
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Dhingra, K., Klonsky, E. D., & Tapola, V. (2019). An empirical test of the three‐step theory of suicide in UK university students. Suicide and Life‐Threatening Behavior, 49(2), 478-487. https://doi.org/10.1111/sltb.12437
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Fan, Q., Li, Y., Gao, Y., Nazari, N., & Griffiths, M. D. (2023). Self-compassion moderates the association between body dissatisfaction and suicidal ideation in adolescents: A cross-sectional study. International Journal of Mental Health and Addiction, 21(4), 2371-2388. https://doi.org/10.1007/s11469-021-00727-4
Fonseca-Pedrero, E., Al-Halabí, S., Pérez-Albéniz, A., & Debbané, M. (2022). Risk and protective factors in adolescent suicidal behaviour: A network analysis. International Journal of Environmental Research and Public Health, 19(3), 1784. https://doi.org/10.3390/ijerph19031784
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187. https://doi.org/10.1037/bul0000084
Gelvez-Gafaro, L.-M., Medina-Duarte, D.-M., Villa-Belluci, I.-P., Rivera-Porras, D., & Bonilla-Cruz, N.-J. (2022). Psychosocial risk factors associated with suicide in youth and adolescents: A systematic review. https://doi.org/10.47307/GMC.2022.130.s3.14
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Klonsky, E. D., Pachkowski, M. C., Shahnaz, A., & May, A. M. (2021). The three-step theory of suicide: Description, evidence, and some useful points of clarification. Preventive medicine, 152, 106549. https://doi.org/10.1016/j.ypmed.2021.106549
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