From hopeless thoughts to suicidal attempt: a topographic analysis of adolescents’ suicidal process using structural equation modeling

This study examined adolescents' suicidal process by considering suicidal-related behaviors as related but distinct elements of the suicidal process, which in turn can explain the association between psychological distress and suicidal attempts. Participants were 918 secondary education students between 14 and 21 years old. Suicidal-related behaviors were measured using Paykel's Suicide Scale, which includes hopeless thoughts about life's worth, the wish to be dead, thoughts about taking one's life, suicidal planning, and suicidal attempts. Psychological distress was measured using the depression and anxiety subscales of DASS-21. Structural equation modeling was used to test the direct and indirect effects of psychological distress on suicidal attempts. Two pathways predominantly explain the effect of psychological distress on suicidal attempts: one through the complete process and another, more direct, from the hopeless thoughts and wish to be dead to the attempt. Hopeless thoughts about life's worth and wishing to be dead have been demonstrated as crucial factors in the explanation of adolescents' suicidal attempts. Interventions to prevent adolescents' suicidal attempts should focus not only on explicit suicidal ideation but on less intense life and death-related ideas like hopeless thoughts and the wish to be dead.