The DOI matches its Crossref record.
Examining suicidal desire through the lens of the three-step theory: a cross-sectional and longitudinal investigation in a community sample
Abstract
OBJECTIVE: Advancing evidence-based theories of suicide is critical to improving suicide prevention. The aim of the current study was to investigate suicidal desire through an emerging theory of suicide, the Three-Step Theory (3ST). Specifically, this study investigated the validity and predictive utility of Steps 1 and 2 of the 3ST in a Canadian community sample. METHOD: Participants were 487 adults between the ages of 35 to 90 (M = 59; 64% female, 87% White) who completed self-report measures assessing suicidal ideation and attempt history, hopelessness, psychological pain, and 5 forms of social connectedness at baseline and 6 months later. RESULTS: In support of 3ST predictions, cross-sectional analyses showed (a) the combination of pain and hopelessness strongly correlated with suicidal desire, and (b) connectedness was protective of suicidal desire among those high in pain and hopelessness. Regarding predictive utility, longitudinal analyses showed that pain and hopelessness were strong predictors of future suicidal desire and that connectedness was protective against future suicidal desire. These relationships of pain, hopelessness, and connectedness remained when controlling for baseline suicidal desire. CONCLUSIONS: Results support the validity and predictive utility of 3ST hypotheses related to suicidal desire. Taken together with previous studies, findings suggest that Steps 1 and 2 are useful for conceptualizing suicide risk and prevention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The BSS-5 has demonstrated strong psychometric properties.
“The BSS-5 has demonstrated strong psychometric properties [39,40].”
From Mindful attention training workshop for firefighters: Design and methodology of a pilot randomized clinical trial (2022) · cites this paper as [39]
Citations
Cited by
Sorted by citations
The three-step theory of suicide: Description, evidence, and some useful points of clarification
Klonsky, E. D., Pachkowski, M. C., Shahnaz, A., & May, A. M. (2021) · Preventive Medicine · doi:10.1016/j.ypmed.2021.106549 · Cited by 256
“62 at two time-points in a Canadian adult community sample (Pachkowski et al., 2021).”
BackgroundInfluentialSelf-citationIntegrating a functional view on suicide risk into idiographic statistical models
Kaurin, A., Dombrovski, A. Y., Hallquist, M. N., & Wright, A. G. C. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.104012 · Cited by 55
The significance of cognitive-behavioral therapy on suicide: An umbrella review
Wu, H., Liu, L., Qian, Y., Jin, X., Yu, H., Du, L., Fu, X., Zhu, B., & Chen, H. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.067 · Cited by 57
Shepherd, B. F., Kelly, L. M., Brochu, P. M., Wolff, J. C., & Swenson, L. P. (2023) · American Journal of Orthopsychiatry · doi:10.1037/ort0000666 · Cited by 33
Hu, C., Huang, W., & Zhang, W. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1660164 · Cited by 27
Meerwijk, E. L., Tamang, S. R., Finlay, A. K., Ilgen, M. A., Reeves, R., & Harris, A. H. S. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-065088 · Cited by 10
Vujanovic, A. A., Lebeaut, A., Zegel, M., & Buser, S. (2022) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2022.100905 · Cited by 10
“The BSS-5 has demonstrated strong psychometric properties [39,40].”
BackgroundTorino, G., Calati, R., Brambilla, P., & Delvecchio, G. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.121138 · Cited by 10
Meerwijk, E. L., Jones, G. A., Shotqara, A. S., Reyes, S., Tamang, S. R., Eddington, H., Reeves, R., Finlay, A. K., & Harris, A. H. S. (2023) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2023.104582 · Cited by 9
Psychache, Hopelessness, and Suicidal Ideation and Behaviors: A Cross-Sectional Study from China
Siau, C. S., Klonsky, E. D., Kõlves, K., Huen, J. M. Y., Chan, C. M. H., Fariduddin, M. N., Ibrahim, N., Tan, Y. K., Jia, C.-X., Zhang, J., et al. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21070885 · Cited by 9
“Indeed, previous research has found a relationship of pain and hopelessness to future suicidal ideation or attempts [31].”
BackgroundSelf-citationIntegrating a Functional View on Suicide Risk into Idiographic Statistical ModelsPreprint
Kaurin, A., Dombrovski, A. Y., Hallquist, M. N., et al. (2021) · doi:10.31234/osf.io/xj5c6 · Cited by 7
Vehicle Firearm Storage: Prevalence and Correlates in a Sample of Male Firearm Owners
Tucker, R. P., Powers, J., Pardue-Bourgeois, S., Oakey‐Frost, N., Moscardini, E. H., Gilroy, S. P., Capron, D. W., Bryan, C. J., & Anestis, M. D. (2021) · Archives of Suicide Research · doi:10.1080/13811118.2021.2020698 · Cited by 6
Schimanski, I., Scarf, D., Rapsey, C. M., Treharne, G. J., & Mason, A. (2024) · Journal of College Student Mental Health · doi:10.1080/28367138.2024.2407428 · Cited by 5
“…three core steps of the Three Step Theory of Suicide (3ST) across both community and psychiatric samples (e.g., Klonsky & May, 2015; May et al., 2020; Pachkowski et al., 2021; Tsai et al., 2021) and across different countries (e.g., Dhingra et al., 2019; Pachkowski et al., 2021; Yang et al., 2019).”
Guo, Z., Han, X., Kong, T., Wu, Y., Kang, Y., Liu, Y., & Wang, F. (2025) · BMC Psychiatry · doi:10.1186/s12888-024-06415-6 · Cited by 6
Lyu, S., Guo, Z., Jiang, S. Y., & Li, Y. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241272648 · Cited by 3
“Signi fi cantly, the 3ST has been tested and validated across countries, cultures, and groups (e.g., Dhingra et al., 2019; Pachkowski et al., 2021; Tsai et al., 2021; Yang et al., 2019), demonstrating its wide applicability and feasibility.”
Mental pain and lifetime suicide attempts in early adolescence: a preliminary study
García‐Ormaza, J., Tabares, J. V., Ammendola, E., & Muela, A. (2025) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-025-00883-8 · Cited by 4
“These assumptions have garnered significant empirical support in both adult [12] and youth populations [13].”
Testing the Three-Step Theory of Suicide
Baker, S. N., Bowers, C. A., Beidel, D. C., & Rozek, D. C. (2024) · Crisis · doi:10.1027/0227-5910/a000987 · Cited by 1
Russolillo, A., Hawkins, C., & Kealy, D. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70182 · Cited by 1
“Intolerable psychological pain, conceptualized by Shneidman (1993) as unbearable psychache, refers to the severe mental anguish that follows from core psychological needs being unmet (Pachkowski et al. 2021).”
Sardarzehi, R., Mohajerin, B., Kianimoghadam, A. S., & Bakhtiari, M. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70146 · Cited by 1
Lyu, S., Jiang, S. Y., & Li, Y. (2025) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.70053 · Cited by 1
Utility of Psychological Pain Measurement as a Population Health Risk Stratification Tool
Mee, S., Cascio, M., & Reist, C. (2023) · Medical Research Archives · doi:10.18103/mra.v11i8.4281
Wang, F., Guo, Z., Han, X., Kong, T., Wu, Y., Kang, Y., & Liu, Y. (2023) · doi:10.2196/preprints.55911
Priambodo, R., Fitryasari, R., & Tristiana, R. D. (2024) · Journal of Telenursing (JOTING) · doi:10.31539/joting.v6i2.10748
“Penelitian lain terdapat 27% siswa menunjukkan adanya keinginan bunuh diri dan 10% melaporkan bahwa mereka telah melakukan upaya bunuh diri selama hidupnya (Pachkowski et al., 2021).”
BackgroundLotfizadeh, M., Sharifi, F., Kopaei, Z. S. A., Ramezannejad, P., Karimi, Z., Mansouri, M., & Ganji, F. (2024) · Taḥqīq va tusi̒ah-i salāmata · doi:10.61186/jhrd.2.3.58
Meerwijk, E. L., Shotqara, A. S., Finlay, A. K., Reeves, R. R., Tamang, S. R., Ilgen, M. A., & Harris, A. H. S. (2026) · Medical Care · doi:10.1097/mlr.0000000000002289
Harvey, T. D., Lam, B., Baskin-sommers, A. R., Thomas, K. A., Wang, E. A., Winkelman, T. N. A., & Howell, B. A. (2026) · Community Mental Health Journal · doi:10.1007/s10597-026-01632-7
Zhou, Y., Liu, J., & Fan, H. (2026) · Children and Youth Services Review · doi:10.1016/j.childyouth.2026.109034
Chernetska, V., & Millgram, Y. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122006 · Cited by 1
Theorien der Suizidalität und die Rolle psychischer Störungen
Michalak, J., & Teismann, T. (2026) · Springer eBooks · doi:10.1007/978-3-662-72796-6_2
A Large-Sample Replication and Validation of the Three-Step Theory of Suicide in Iranian Students
Mahmoudzadeh, M. P., Pirmoradi, M., Tajrishi, K. Z., Salehi, A., & Mansouri, K. (2026) · Archives of Suicide Research · doi:10.1080/13811118.2026.2698811
Modeste-James, A. (2025) · Digital Commons - DU (University of Denver) · doi:10.56902/etdcrp.2025.145
Ababneh, A., Zaben, F., Abuadas, M. H., Alrida, N. A., & Rabeh, M. I. (2026) · BMC Nursing · doi:10.1186/s12912-026-05259-7
Lin, Y., & Lee, Y.-T. (2026) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2026.08.016
Sardarzehi, R., Mohajerin, B., Fard, M. G., Kianimoghadam, A. S., Banihashem, S., & Bakhtiari, M. (2026) · British Journal of Clinical Psychology · doi:10.1111/bjc.70095
Lyu, C., Lin, J., Zhang, K., Wang, S., Hu, Y., Wei, J.-M., & Chang, B. (2026) · Behavioral Sciences · doi:10.3390/bs16101836
“…to the Three-Step Theory of suicide (Klonsky et al., 2021), although psychological pain represents a critical factor contributing to suicidal desire, it only leads to intense suicidal desire when individuals experience a severe lack of connectedness (Pachkowski et al., 2021; Yang et al., 2018).”
Metadata
- Authors
- Pachkowski, M. C., Hewitt, P. L., & Klonsky, E. D.
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2021-01
- Volume
- 89
- Issue
- 1
- Pages
- 1-10
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W3122309075
- Cited by
- 34
- References
- 0
- Citations by year
- 2026: 12 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 3
- FWCI
- 2.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Social Sciences and Humanities Research Council of Canada (435-2015-0412)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicidal desire, suicidal ideation, suicide risk, hopelessness, psychological suffering, social connectedness, suicide prevention, suicide attempt history, community-dwelling adults
- MeSH terms
- Adult, Aged, Aged, 80 and over, Canada, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Psychological Theory, Suicide, Attempted, Suicidal Ideation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
