The three-step theory of suicide: Description, evidence, and some useful points of clarification

Klonsky, E. David; Pachkowski, Mikayla C.; Shahnaz, Arezoo; May, Alexis M.

doi:10.1016/j.ypmed.2021.106549

Cited by 96 publications

(87 citation statements)

References 42 publications

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“…Individuals who also experience disrupted connectedness will have strong suicidal ideation and this will progress to a suicide attempt if the individual has the dispositional, acquired, and practical capacity to do so. Empirical research has demonstrated support for all three of these theories, although it has relied heavily on student samples [ 12 – 14 ]. These theories were also developed to account for suicidal ideation and behaviour in the general population but have not been tested specifically using pregnant and/or postpartum samples.…”

Section: Introductionmentioning

confidence: 99%

What makes a perinatal woman suicidal? A grounded theory study

et al. 2022

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Background Suicide is a leading cause of maternal death during pregnancy and up to a year after birth. Psychological and psychosocial risk factors for maternal suicide ideation and behaviour have been identified but do not account for why mothers begin to experience suicidal thoughts. Qualitative research offers a way of identifying what might drive mothers to initially consider suicide and then go on to act on such thoughts; crucial for the development of assessments to identify, and interventions to target, maternal suicide ideation and behaviour. We aimed to develop a grounded theory outlining what makes women think about suicide and/or engage in suicidal behaviour during pregnancy and the first 12 months following birth? Method Semi-structured interviews were conducted with 12 mothers in the UK who had suicidal thoughts during pregnancy and/or the first year following birth. A constructivist approach to grounded theory was adopted which guided the data collection and analysis processes. Results We developed a model outlining the theorised process of psychological factors that culminates in mothers experiencing suicidal thoughts and then making a suicide attempt during the perinatal period. The process was initiated when mothers felt attacked by motherhood which led to feeling like a failure, self-identifying as a “bad mother” and subsequent appraisals of entrapment and/or defeat. When nothing resolved the distress and as mothers collated reasons for why they perceived they needed to die, suicidal behaviour became a viable and appealing option. We theorised that mothers might make a suicide attempt when they entered a state of intense “darkness” brought on by a trigger, followed by a temporary lapse in the conflict between the desire to live and desire to die and an opportunity to attempt. Conclusions Participants stressed the rapid onset of suicidal thoughts. We suggest that healthcare professionals enquire about the mother’s feelings towards the baby and of isolation, how she views herself as a mother, feelings of entrapment and defeat during routine contacts to aid identification and prevention of suicidal ideation/behaviour. Suggested interventions to prevent suicidal thoughts and behaviour include helping women manage their expectations for pregnancy and the postpartum period.

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Section: Introductionmentioning

confidence: 99%

What makes a perinatal woman suicidal? A grounded theory study

et al. 2022

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“…The Three-step Theory (3ST), one of the newer theories of suicidal behavior within the ideation-toaction framework, postulates three crucial steps: pain and hopelessness are necessary for the development of suicidal thoughts; if pain exceeds connectedness, these thoughts may settle and escalate; and high levels of SI will only give way to an attempt if the individual has the capability for it. 4,5 Impulsivity was previously considered as a factor that should account for an individual's chances of death by suicide, and has been included in clinical guidelines. 6,7 Counterintuitively, longitudinal studies have found weak or no associations between trait-impulsivity and SAs.…”

Section: Introductionmentioning

confidence: 99%

“…The Three-step Theory (3ST), one of the newer theories of suicidal behavior within the ideation-to-action framework, postulates three crucial steps: pain and hopelessness are necessary for the development of suicidal thoughts; if pain exceeds connectedness, these thoughts may settle and escalate; and high levels of SI will only give way to an attempt if the individual has the capability for it. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

Suicide attempt, impulsivity, and exposure to trauma in college students

Lira

Vieira

Cavalcanti

et al. 2022

Braz. J. Psychiatry

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Objectives: Past suicide attempt (SA) is one of the most important risk factors for suicide death. An ideation-to-action framework posits that impulsivity, potentially traumatic events, and mental disorders also play a role in increasing suicide risk. This study aimed to assess the association between trait impulsivity, lifetime exposure to trauma, and post-traumatic stress disorder (PTSD) with SA in a sample of Brazilian college students. Methods: A total of 2,137 participants filled self-reported questionnaires consisting of a sociodemographic and clinical questionnaire, Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist -Civilian version, and Barratt Impulsiveness Scale. Results: Our findings suggest that trait impulsivity may be interpreted as exerting a distal effect on SA, even in the presence of other variables -such as trauma history, psychological neglect, and PTSDwhich also increase the odds of SA. High and medium levels of impulsivity, history of trauma, and PTSD increased the likelihood of SA. Conclusions: Intervention strategies to prevent SA may target trait impulsivity and exposure to traumatic experiences.

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“…Individuals who also experience disrupted connectedness will have strong suicidal ideation and this will progress to a suicide attempt if the individual has the dispositional, acquired, and practical capacity to do so. Empirical research has demonstrated support for all three of these theories, although it has relied heavily on student samples (12)(13)(14). These theories were also developed to account for suicidal ideation and behaviour in the general population but have not been tested speci cally using pregnant and/or postpartum samples.…”

Section: Introductionmentioning

confidence: 99%

What Makes A Perinatal Woman Suicidal? A Grounded Theory Study

Reid

Pratt

Edge

et al. 2022

Preprint

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Background: Suicide is a leading cause of maternal death during pregnancy and up to a year after birth. Psychological and psychosocial risk factors for maternal suicide ideation and behaviour have been identified but do not account for why mothers begin to experience suicidal thoughts. Qualitative research offers a way of identifying what might drive mothers to initially consider suicide and then go on to act on such thoughts; crucial for the development of assessments to identify, and interventions to target, maternal suicide ideation and behaviour. We aimed to develop a grounded theory outlining what makes women think about suicide and/or engage in suicidal behaviour during pregnancy and the first 12 months following birth?Method: Semi-structured interviews were conducted with 12 mothers in the UK who had suicidal thoughts during pregnancy and/or the first year following birth. A constructivist approach to grounded theory was adopted which guided the data collection and analysis processes. Results: We developed a model outlining the theorised process of psychological factors that culminates in mothers experiencing suicidal thoughts and then making a suicide attempt during the perinatal period. The process was initiated when mothers felt attacked by motherhood which led to feeling like a failure, self-identifying as a “bad mother” and subsequent appraisals of entrapment and/or defeat. When nothing resolved the distress and as mothers collated reasons for why they perceived they needed to die, suicidal behaviour became a viable and appealing option. We theorised that mothers might make a suicide attempt when they entered a state of intense “darkness” brought on by a trigger, followed by a temporary lapse in the conflict between the desire to live and desire to die and an opportunity to attempt.Conclusions: Participants stressed the rapid onset of suicidal thoughts. We suggest that healthcare professionals enquire about the mother’s feelings towards the baby and of isolation, how she views herself as a mother, feelings of entrapment and defeat during routine contacts to aid identification and prevention of suicidal ideation/behaviour. Suggested interventions to prevent suicidal thoughts and behaviour include helping women manage their expectations for pregnancy and the postpartum period.

show abstract

The three-step theory of suicide: Description, evidence, and some useful points of clarification

Cited by 96 publications

References 42 publications

What makes a perinatal woman suicidal? A grounded theory study

What makes a perinatal woman suicidal? A grounded theory study

Suicide attempt, impulsivity, and exposure to trauma in college students

What Makes A Perinatal Woman Suicidal? A Grounded Theory Study

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