The three-step theory of suicide (3ST) proposes that suicidal ideation (SI) and behavior develops in the context of unbearable pain and hopelessness (Step 1), low social connection (Step 2) and acquired capability (Step 3 - not assessed in this study; Klonsky et al., 2016). Distress disclosure is one way a person may utilize their social network to mitigate feelings of distress and can be a critical measure of social connectedness. Building on efforts to diversify measurement of social connectedness in the 3ST, a sample of 549 college students (mean age = 19.27, SD = 1.28; 56.6% reporting history of SI) completed measures of physical and psychological pain (Patient Health Questionnaire – Revised; Unbearable Psychache Scale-3), hopelessness (State Hopelessness Scale; Beck Hopelessness Scale-4), social connectedness (Interpersonal Needs Questionnaire; Social Connectedness Scale – Revised; Distress Disclosure Index), and suicidal ideation (Depression Severity Index; Suicide Cognitions Scale – Shortened). Structural equation modeling was used to evaluate steps one and two of the 3ST and the utility of incorporating distress disclosure into this framework. In line with the 3ST, the structural model including pain, hopelessness, and social connectedness was supported and the direct effects of these variables on SI was significant (p < .05). In contrast to the 3ST, the interaction between pain and hopelessness did not predict SI (p = .385), nor was the moderating role of social connectedness supported (p = .133). Although distress disclosure was a significant indicator of social connectedness (p = .001), this variable did not contribute additional variance over other measures of connectedness. The results provide partial support for core features of the 3ST, however further research is needed to verify the theoretical assumptions of Step 2. Additionally, although disclosure is associated with SI, it may not be a critical measure of social connectedness when considered alongside traditional measures.

Unsatisfactory results for the aim of reducing suicide rates have motivated the creation of new models to predict suicide, such as the ideation-to-action framework, which focuses on differentiating those with suicidal ideation and those who attempt suicide. The most recently published theory on the ideation-to-action framework is the Three-Step Theory (3ST). Step 1 proposes that the combination of pain and hopelessness causes suicidal ideation, step 2 proposes that ideation increases when pain and hopelessness surpass connectedness, and step 3 proposes that strong suicidal ideation escalates to action when the person has the capacity to attempt suicide. The theory’s concepts are intentionally conceptualized very broadly. The current study aims to compare the traditional conceptualization measurements of the Three-Step Theory with a broader range of predictors. We aim to test the first two steps of the theory through a mediation model and examine if connectedness serves as a mediator in the relationship between psychological pain and hopelessness in predicting the severity of suicidal ideation. We hypothesized that adding a broader conceptualization of pain (i.e., physical pain) and connectedness (i.e., perceived meaning of life, social pleasure, affective empathy) will better account for the level of suicidal ideation. We also hypothesized that connectedness serves as a mediator in the relationship between psychological pain and hopelessness in predicting suicide ideation severity. Following exclusions and removing missing data, 97 participants were available for analysis. Results showed that one of our novel measurements of connectedness, perceived burdensomeness, mediated the relationship between psychological pain and suicidal ideation severity.