The Emergence of Suicidal Ideation: Testing the Three-Step Theory in Iranian Adolescents.

Objective: Suicide is a global public health problem with significant adverse effects on individuals and society, especially among adolescents. Klonsky's three-step theory (3ST) of suicide explains suicidal ideation through three factors, namely hopelessness, psychological pain, and connectedness in two steps. No study has investigated connectedness (step 2) in combination with psychological pain and hopelessness (step 1) in prediction of suicidal ideation among adolescents. Thus, we empirically tested the first two steps of the 3ST in a sample of Iranian adolescents. Method : A total of 466 adolescents aged 12 to 20 years (356 females and 110 males) were recruited using convenience sampling. This cross-sectional study was conducted between September to November 2024. The participants completed self-report questionnaires on suicidal ideation, hopelessness, psychological pain, and connectedness. Hierarchical linear regression analysis was conducted to explore the impact of the interaction of hopelessness and psychological pain on suicidal ideation. In addition, we explored whether connectedness reduced the escalation of suicidal ideation in adolescents experiencing high psychological pain and hopelessness levels. Results: The findings showed that the interaction of hopelessness and psychological pain accounted for 59% of the variance in suicidal ideation (P < 0.001). Connectedness was found as a protective factor for suicidal ideation in adolescents who experience high levels of both psychological pain and hopelessness (r = 0.24, P < 0.001). Conclusion: These findings support the applicability of the first two steps of the 3ST for Iranian adolescents. Future research should examine all three steps of this theory in a clinical sample of adolescents.