Testing the Three-Step Theory of Suicide

Background: Suicide risk is elevated among first responders. The three-step theory of suicide (3ST), not yet tested in first responders, proposes that the combination of pain and hopelessness leads to suicidal desire, but most relevant studies examine psychological pain and a few studies exist regarding the impact of physical pain. Aims: This study aimed to replicate and expand the understanding of the 3ST by examining physical and psychological pain in Step 1 within first responders. Method: First responders (n = 204) completed an anonymous online survey assessing physical pain, psychological pain, hopelessness, and suicidal desire. Moderation analyses were used to test whether psychological pain and physical pain, respectively, potentiate the relationship between hopelessness and suicidal desire. Results: Physical pain moderated the relationship between hopelessness and suicidal desire, such that high levels of physical pain potentiated the relationship and low levels diminished the relationship, while psychological pain did not. Findings support the 3ST and provide evidence for the important role of physical pain in examining suicidal desire among first responders. Limitations and Conclusion: Although data were cross-sectional, results may inform development of measures tailored to first responders, which could ultimately lead to improved methods for assessing critical components of first responder and suicide risk.