Application of the three-step ideation-to-action theory to passive and active suicidal ideation in college students

BACKGROUND: Few studies have tested the three-step theory of suicide (3ST), particularly in college students, who have unique developmental experiences of connectedness and high rates of suicidal ideation (SI). This study tested if factors purported in the 3ST distinguish undergraduate students with no SI, passive SI, and active SI using two concep-tualizations of connectedness: social connection and meaning in life.METHODS: A sample of undergraduate students aged 18-26 from an urban university completed an online survey (N.=265).RESULTS: Results showed some support for the 3ST. Greater psychological pain increased likelihood of passive SI (OR=3.74, P<0.001); the model accurately identified 36% of students with passive SI. Greater pain (OR=2.74, P=0.01) and hopelessness (OR=17.17, P<0.05) differentiated students with active SI from those without SI in social connection models. In meaning models, greater pain relative to meaning in life differentiated students with passive SI (OR=2.29, P<0.01) and active SI (OR=1.81, P<0.05) relative to no SI. Each model accurately identified 68% of students with active SI. No 3ST factors differentiated students with passive SI from those with active SI.CONCLUSIONS: There was limited applicability for 3ST in differentiating college students with passive SI from those with no SI or active SI, with better differentiation of students with active SI relative to no SI. Interventions for college students with passive and active SI could target psychological pain, foster hope, and cultivate meaning.(Cite this article as: Kelly LM, Swenson LP, Wolff JC. Application of the three-step ideation-to-action theory to passive and active suicidal ideation in college students. Minerva Psychiatry 2023;64:1-12. DOI: 10.23736/S2724-6612.21.02263-6)