(PS11-31) Evaluating the 3-step Theory of Suicide and Modifications: A Structural Equation Modeling Approach

Suicide is a leading cause of death and disability worldwide and represents a major public health concern. Given the complex nature of suicidal thoughts and behaviors, precise and comprehensive theories are needed in order to inform prediction and prevention efforts. One that has received much recent uptake is the Three-Step Theory of Suicide (3ST). The 3ST is a concise, parsimonious, and evidence-based theory that considers suicide in an “ideation-to-action” framework. The first two steps consider suicidal desire as arising from a combination of pain and hopelessness and that desire will escalate when pain overwhelms connectedness. In other words, connectedness, a broad construct defined as sources of connection that gives an individual a sense of purpose and meaning in life, safeguards an individual against intensifying suicidal ideation. The aim of this study was to use structural equation modeling to test and replicate parts of the 3ST and explore relationships between pain, hopelessness, connectedness, and suicidal desire. Participants were 340 adults from the ages of 19-79 (Mage = 39, female = 51%, white = 75%) collected from CloudResearch, an online crowdsourcing platform. Data was collected using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Recovery Evaluation and Suicide Support Tool (RESST), the Future Self-Continuity Questionnaire (FSCQ), and the Depression, Anxiety and Stress Scale (DASS). Preliminary analyses showed borderline acceptable fit to the model (χ2 p< 0.05, comparative fit index = 0.95, Tucker–Lewis index = 0.95, root mean square error of approximation = 0.11, and standardized root mean square residual = 0.08). Further, while local fit indices were considered acceptable for the factor analysis and that both pain and connectedness significantly predicted suicidal desire, hopelessness did not, revealing a discrepancy between the theoretical framework and the observed data. In light of these results, we will explore and offer alternative theoretical models that better fit our observed data. Findings can offer more comprehensive understandings of how constructs behind suicide influence suicidal desire, thereby advancing and refining existing theoretical models of suicide and improving suicide  assessment and prevention efforts.