Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Ticketed Session

Recorded Session

Back

81 Views

Suicide and Self-Injury

Testing the First Two Steps of the Three-Step Theory of Suicide Using Ecological Momentary Assessment

(PS9-D94) Testing the First Two Steps of the Three-step Theory of Suicide Using Ecological Momentary Assessment

Saturday, November 18, 2023

11:30 AM – 12:30 PM PST

Location: Regency Ballroom, Level 7

Author(s)

Olga Revzina, M.A.

Clinical Psychology PhD Candidate
The Catholic University of America
Bethesda, Maryland

Co-Author(s)

PN

Philip Ninan, M.D.

Affiliate Professor of Psychiatry
East Carolina University
Greenville, North Carolina
David A. Jobes, ABPP, Ph.D. (he/him/his)

Professor of Psychology
The Catholic University of America
Washington, District of Columbia
IZ

Irene Zhang, M.A.

Doctoral Candidate in Clinical Psychology
The Catholic University of America
Washington, District of Columbia
Abby A. Adler Mandel, Ph.D.

Assistant Professor of Psychology
The Catholic University of America
Washington, District of Columbia

Introduction. Suicide accounts for more than 800,000 deaths worldwide per year and remains a leading cause of death among adults (WHO, 2021), despite more than fifty years of research on suicide risk factors. A promising framework, The Three-Step Theory (3ST) of suicide (Klonsky & May, 2015), posits that the development of suicidal ideation (SI) and suicidal behavior should be viewed as two distinct processes. 3ST offers a parsimonious “ideation-to-action” model consisting of three steps that explain the emergence and maintenance of SI, and suicidal behavior. Previous research has demonstrated the validity and prospective utility of the first two steps of the 3ST using both concurrent and longitudinal designs. The 1st step of the 3ST posits that the interaction of psychological pain and hopelessness results in SI, and the 2nd step proposes that the intensity of SI increases when psychological pain exceeds connectedness. The 2nd step has been consistently tested by separating participants into groups characterized by high and low levels of pain and hopelessness using a median split, an imprecise statistical method that does not account for individual differences and sample variability. Moreover, 3ST has never been tested using intensive longitudinal methods. The aims of the present study were to 1) test the validity of the 1st step of the 3ST using ecological momentary assessment (EMA) and 2) identify high-risk groups with elevated levels of hopelessness and pain using latent class growth analysis (LCGA). Method. A community-based global sample of 110 participants (Mage= 38.25; SDage = 14.18; 65% female) completed a daily mobile survey assessing SI and associated symptoms for up to 143 days. Out of 110 participants, 75 endorsed SI at least once over the corresponding time period (range = 1-121 days) with intensity ranging from 0 to 10 (M = 1.15, SD = 2.23). Results. Multiple distinct trajectories of SI emerged based on LCGA analysis conducted using the lcmm package in R. In partial support of the 3ST, the high-stable (n = 9) and the high-decreasing (n = 14) SI trajectories were both associated with high hopelessness (p < .001) and the interaction of hopelessness and pain (p < .001). The moderate-decreasing (n = 15) trajectory was associated with high hopelessness (p < .037), and the low-stable (n = 72) trajectory was inversely associated with both hopelessness (p < .001) and pain (p < .001), but not their interaction. Conclusion. In accordance with the 3ST, we demonstrated that individuals characterized by high levels of SI, both stable and decreasing, are more likely to feel hopeless and endorse elevated pain. Future analyses will examine whether the degree to which pain exceeds connectedness in the high-risk group is related to higher SI.