A Cross-Sectional and Longitudinal Study Examining the Validity and Predictive Utility of Step 1 and Step 2 of the Three-Step Theory (3ST) in Adult Psychiatric Inpatients

The primary aim of the proposed study was to examine the validity and predictive utility of the Three-Step Theory (3ST) of suicide. Specifically, this study tested step 1 and step 2 of the 3ST utilizing cross-sectional and longitudinal data from a pre-existing dataset. Participants were 101 U.S. adult psychiatric inpatients (54.5% female, 67.3% non-Hispanic, 67.3% White) assessed at baseline and post-discharge 4 (n = 69) and 8 (n = 49) weeks later. Results did not support the validity and predictive utility of the 3ST. Cross-sectional analysis showed only hopelessness as a robust predictor of suicide ideation, and, connectedness was found to be non-significant protective factor for those high in pain and hopelessness. Regarding the predictive utility, longitudinal analyses showed that only hopelessness was a robust predictor at 4 weeks follow-up but no significant findings were present at 8 weeks follow-up. Conclusions: Results did not support the validity and predictive utility of the 3ST, and thus suggest more stringent testing of the 3ST is necessary in multiple locations and populations.