Dyadic Profiles of Romantic Partners' Suicidal Risk and Relationship Distress Presenting for Couples Therapy

Despite the prominence of individuals presenting for therapy with suicidal thoughts and behaviors (STBs), there is little research available that examines how one or both members of a couple experience STBs when presenting for couple therapy. Thus, there is a prominent gap in the literature in understanding the types of STBs for both adult partners in a committed romantic relationship presenting for couple therapy, reducing clinicians' preparedness to address suicidality in this unique therapy modality. We applied the Three-Step Theory as a guiding framework to investigate the types of couples with suicidal risk that present to couple therapy. We used clinical data from the Marriage and Family Therapy Practice Research Network (n = 337 couples) to identify Dyadic Latent Profiles. We determined a three-profile model: Profile 1: Minimal Risk; Profile 2: Active and Passive Risk; and Profile 3: Both Passive Risk. However, nearly all predictors and covariates (e.g., biological sex, race, relationship duration, mental health treatment, pressure to attend therapy, and intimate partner violence) were not associated with profile membership. These results indicate that while most couples who attend couple therapy are unlikely to display elevated suicide risk, 7% of the sample (Profile 2) displayed active risk based on the Three-Step Theory of suicide. These findings aid clinicians in understanding that a small number of couples present an active risk. Results further encourage clinicians to assess STBs with continuous and not binary assessment questions.