Psychological Sex Differences in Suicidal Ideation: Testing the Three-Step Theory in Iranian Adolescents
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Objective: Suicide is a major adolescent public-health concern. Klonsky’s Three-Step Theory (3ST) posits that suicidal ideation emerges when psychological pain co-occurs with hopelessness (Step 1) and is buffered by connectedness (Step 2). This study tested Steps 1–2 of 3ST in Iranian adolescents.
Methods and Materials: In a cross-sectional school-based survey, 456 adolescents (75.7% female; ages 12–20) from six secondary schools in Tehran completed the Beck Scale for Suicidal Ideation, Psychache Scale, Beck Hopelessness Scale, and the Interpersonal Needs Questionnaire-15 (reverse-scored thwarted belongingness as connectedness). Empathy (EQ-10) and systemizing (SQ-10) were also assessed. Hierarchical OLS regression with mean-centered predictors examined the main effects of pain and hopelessness and their interaction (pain×hopelessness) on suicidal ideation. Step 2 was explored via associations between connectedness and ideation and subgroup analyses among high-pain/high-hopelessness adolescents. Suicide-risk management procedures (clinical evaluation/referral) were implemented for elevated ideation.
Findings: Pain and hopelessness independently predicted suicidal ideation (β≈.42–.43, p<.001). Their interaction explained additional variance (ΔR² = .02, p = .001), and the full Step 1 model accounted for 59% of ideation variance (R² = .59). Connectedness was negatively associated with ideation (r =- .52, p < .01) and showed a protective pattern, particularly in the high-pain/high-hopelessness subgroup.
Conclusion: Results support 3ST Steps 1–2 in a convenience sample of adolescents in Tehran, highlighting the combined impact of pain and hopelessness and the potential protective role of connectedness. Longitudinal and continuous moderation models are recommended.
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