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Psychological pain, hopelessness, and social connectedness in the suicidal process among Brazilian adolescents: empirical contributions to the three-step theory

Year: 2026

Type: article

Abstract: BACKGROUND: Suicidal behavior among adolescents in low- and middle-income countries remains understudied in ideation-to-action frameworks. This study examined Step 1 of the Three-Step Theory (3ST) and extended its framework by examining social connectedness in relation to suicide planning among ideators. METHODS: Data were drawn from the Projeto Atitude 2022, a statewide survey conducted in public schools of Pernambuco, Brazil (N = 4,514; 14-19 years). A two-stage design using multilevel logistic regression was implemented. Stage A examined associations between psychological pain (composite distress index), hopelessness, and suicidal ideation (n = 3,724). Stage B examined the role of family, school, and peer connectedness in the ideation-to-plan transition among adolescents with suicidal ideation (n = 990). RESULTS: Psychological pain (OR = 8.32, 95% CI: 7.00-9.90) and hopelessness (OR = 12.69, 95% CI: 10.17-15.84) were independently associated with suicidal ideation. Their co-occurrence was associated with a predicted probability of suicidal ideation of 59.14%, compared to 4.03% among adolescents with neither factor; the interaction term was statistically significant (OR = 0.57, 95% CI: 0.36-0.92), indicating a submultiplicative combined effect. All three connectedness domains were associated with lower odds of suicide plan, with intermediate and high levels conferring comparable reductions relative to low connectedness. CONCLUSIONS: These findings contribute to the empirical advancement of the 3ST in a Brazilian adolescent population and suggest that psychological pain, hopelessness, and social connectedness across family, school, and peer domains may represent relevant targets at the earliest stages of the suicidal process, with implications for prevention research and practice.

Source: Psychiatry Research

DOI: 10.1016/j.psychres.2026.117557

Authors: Carlos Moreno Moya, Ann-Marie Küchler, Fernanda Cunha Soares, Rodrigo Antunes Lima, Andrea Miranda-Mendizabal, Mauro Virgílio Gomes de Barros