Klonsky and May’s three-step theory of suicide.

A theory that proposes which factors facilitate the occurrence of suicide attempts.

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

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

Suicide

Suicide is the act by which a person deliberately causes death it is provoked the death in a deliberate way. 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 deaths in traffic accidents, which was for decades the first cause of deaths from external causes (those not derived from diseases). Moreover, the suicide rate increased by 3.1% in Spain from 2017 to 2018.

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

On the other hand, 90% of people who commit suicide suffer from some type of mental disorder, the most frequent being bipolar disorder, depression and a substance abuse disorder, followed by personality disorders. Most patients present with depressive symptoms, which do not always coincide with the presence of a stressful event, but there are usually always 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 the combination of "grief and hopelessness," "lack of connection or attachment to other people," "absence of meaningful work or life project," along with one's own "capacity for suicide."

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

From intention to action

In the three-step theory of suicide, Klonsky and May establish a concrete scheme: "From Ideation to Action", and believe that it should guide suicide theory, research and prevention. According to this scheme, suicidal ideation develops first, and then moves from ideation to action (attempts and suicide). These two processes (idea and action) require different explanations.

In addition, it should be noted that in Spain it has been estimated that suicide attempts are between 10 and 20 times more frequent than suicide itself. suicide attempts are between 10 and 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 a combination of grief and hopelessness.
• If the connection to others and life is less than that pain, the ideation becomes stronger.
• To get to action (to attempt suicide) one must acquire the capacity to attempt suicide.

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

• Dispositionalmainly genetic in nature (e.g., sensitivity to pain)
• AcquiredHabituation to experiences associated with pain, self-injury, fear and death.
• PracticesFactors that make it easier to attempt suicide, such as easy access to information and methods to carry it out.

The three questions

The three steps already explained translate into three fundamental questions in theory (for practical purposes, the statement of one question leads to the next):

1. Are you in Pain and without hope?

If the subject's answer is no, then there is no suicidal ideation.. On the other hand, if the answer is YES, then there is suicidal ideation. 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 negative, the suicidal ideation is moderate; if it is affirmative, then the suicidal ideation is strong, important. Again, the affirmation to this question leads to the last question, question 3.

3. Are you capable of attempting suicide?

If the person is not capable of trying (negative response), then we are dealing with a person who only has suicidal ideas. On the other hand, if the answer is affirmative, and the person is capable of trying, then has a real intention to commit suicide..

How to reduce the risk of suicide?

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

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

• Increasing the hope of the person Increase the hope of the person who is thinking about or wants to commit suicide.
• Reduce their pain.
• Increase their connection with life, with others, with their interests.Increase his/her connection with life, with others, with his/her interests, with him/herself, etc.
• Decrease his/her capacity for suicide (by reducing his/her access to means and information to carry it out) to prevent him/her from acting.

Bibliographical 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 adolescents with suicidal behavior. Actas Esp Psiquiatr 46(3), 104-111.