Examining the three-step theory: Insights from the subgroups of the suicide attempts in Chinese young adults

The three-step theory (3ST) has attracted the interest of researchers owing to its brevity and clinical applicability. However, previous empirical studies examining the 3ST have depended primarily on variable-centered approaches, which conclusions are mainly based on the average level of the sample, neglecting that there are different suicide attempt groups. Therefore, the current study employed the person-centered approach to examine the rationality of the 3ST and identify distinct suicide attempt subgroups. The participants were 1,933 Chinese young adults. We used hopelessness, pain, connectedness, suicide ideation, and suicide capacity as indicators. The results showed four different suicide attempts profiles: (a) participants in no suicide ideation subgroup felt the lowest levels of pain and hopelessness (72.8%), (b) low suicide ideation subgroup felt moderate levels of pain and hopelessness (16.4%), (c) high suicide ideation subgroup has high levels of suicide ideation and the pain they felt exceeded the connectedness, but suicide capacity was relatively low (7.2%), (d) suicide attempts risk subgroup has the highest levels of suicide ideation and suicide capacity (3.6%). Furthermore, the heterogeneity between subgroups was mainly reflected in the levels of suicide attempts. The results supported the rationality of the 3ST and suggested that it is critical to construct multiple prevention mechanisms and targeted intervention programs for different suicide attempt groups.