Every year about one million people commit suicide . Suicides have been increasing progressively, and in Spain in 2017 3,679 people took their own lives. The most current theory that tries to explain this phenomenon is the three-step theory of suicide of the researchers Klonsky and May .

Through Klonsky and May’s theory we will know how one goes from thinking about suicide to attempting it or finally committing suicide.

Suicide

Suicide is the act by which a person deliberately causes his or her own death . In Spain, suicide is the first cause of unnatural death, and it has been so for the last 10 years. In 2007, suicide surpassed for the first time those who died in traffic accidents, which for decades was the leading cause of death from external causes (those not derived from illness). Furthermore, the suicide rate increased 3.1% in Spain from 2017 to 2018.

Suicide has been and is a problem that has been silenced for so many years , that currently the Health Department is developing a suicide prevention plan.

On the other hand, 90% of people who commit suicide suffer from some kind of mental disorder, the most frequent being bipolar disorder, depression and a substance abuse disorder, followed by personality disorders. Most patients present with clinical depression, which does not always coincide with the presence of a stressful event, but there are usually past suicide attempts as well as thoughts of wanting to die or more structured suicidal ideation.

The three-step theory of suicide

The most current theory that attempts to explain suicide is Klonsky and May’s three-step theory of suicide (3ST), which postulates that suicidal ideation originates from a combination of “pain and despair,” “lack of connection or attachment to other people,” “absence of a meaningful work or life project,” along with one’s “ability to commit suicide.

The theory proposes that the combination of these factors explains the passage from suicidal ideation to action (attempts and suicides).

From intention to action

In the three-step theory of suicide, Klonsky and May establish a concrete framework: “From Ideation to Action,” and they believe that this should guide suicide theory, research, and prevention. According to this scheme, first a suicidal ideation is developed, and then the ideation is moved into action (attempts and suicide). These two processes (idea and action) require different explanations.

Furthermore, it should be noted that in Spain it has been estimated that suicide attempts are 10 to 20 times more frequent than suicide itself .

The three steps

The three steps established by Klonsky and May’s three-step theory of suicide are

  • Suicidal ideation results from the combination of pain and despair .
  • If the connection with others and life is less than that pain, the ideation becomes stronger.
  • To get to the action (to attempt suicide) you have to acquire the ability to attempt suicide.

Klonsky and May propose three specific categories of variables that contribute to suicidal ability:

  • Devices : mainly genetic (e.g. sensitivity to pain)
  • Acquired : habituation to experiences associated with pain, self-harm, fear and death.
  • Practices : factors that make the suicide attempt easier, such as easy access to information and methods to carry it out.

The three questions

The three steps already explained, are translated into three fundamental questions in the theory (for practical purposes, the affirmation of a question leads to the following one):

1. Are you in pain and without hope?

If the subject’s answer is no, then there is no idea of suicide . If the answer is YES, then there is an idea of suicide. A positive answer to this question leads to question 2.

2. Is your pain greater than your connection?

If the answer to this question is no, the suicidal ideation is moderate; if it is yes, the suicidal ideation is strong, important. Once again, the affirmation of this question leads to the last question, question 3.

3. Are you capable of attempting suicide?

If the person is not able to try, (negative response), then we find a person who is only suicidal. However, if the answer is yes, and the person is capable of trying, then he has a real intention of committing suicide .

How to reduce the risk of suicide?

The most important tool will obviously be prevention. For this reason, campaigns to prevent suicide are and will be necessary, as well as specific protocols for action in the face of suicidal ideas and attempts. It will be essential that these be applied in all mental health centres (mainly primary care centres, hospitals, clinics, etc.) whether public or private.

On the other hand, and following the three-step theory of Klonsky and May’s suicide, either as friends, family, and especially health (and therefore mental health) professionals, we should focus on:

  • To increase the hope of the person who thinks or wants to commit suicide.
  • Reduce your pain.
  • Increase his/her connection to life , to others, to his/her interests, to him/herself, etc.
  • Decrease their ability to commit suicide (by reducing their access to the means and information to do so) to prevent them from acting.

Bibliographic references:

  • Klonsky, E. and May, A. (2015). The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the “Ideation-to-Action” Framework. International Journal of Cognitive Therapy, 8(2), 114-129.
  • Klonsky, E. and May, A. (2015). Impulse control disorders. Psychiatric Times, 13-21.
  • Villar-Cabeza, F., Esnaola-Letemendia, E., Blasco-Blasco, T., Prieto-Toribio, T., Vergé-Muñoz, M., Vila-Grifoll, M., Sánchez-Fernández, B. and Castellano-Tejedor, C. (2018). Dimensional analysis of the personality of the adolescent with suicidal behaviour. Actas Esp Psiquiatr 46(3), 104-111.