Summary

Suicide remains one of the most critical global public health challenges, especially in regions such as South Asia, which accounts for approximately 40% of the world’s annual suicide deaths. Modern suicide research now distinguishes between two separate processes: the generation of suicidal thoughts (ideation) and the transition from thoughts to action (attempt). This article provides an accessible explanation of the Three-Step Theory (3ST), developed by E. David Klonsky and Alexis M. May, which has become a widely used framework for understanding how suicidal behavior emerges.

The theory proposes that suicidal ideation arises from the combination of psychological pain and hopelessness. Pain alone is not enough; only when a person believes that their suffering will not improve does suicidal ideation begin to form. However, whether this ideation becomes severe depends on “connectedness,” a broad protective factor that includes relationships, responsibilities, meaningful activities, or any element that ties a person to life. Even when both pain and hopelessness are present, strong connectedness can prevent escalation.

Transitioning from ideation to suicidal behavior requires what the theory calls “capacity”—the ability to overcome the natural human instinct for self-preservation. This capacity is influenced by dispositional factors (such as low pain sensitivity), acquired factors (like habituation to pain or fear through trauma or self-injury), and practical contributors (such as access to lethal means).

By understanding these mechanisms, teachers—especially younger educators—can better recognize warning signs and support vulnerable students. This article also presents data on suicide in India and the United States, illustrating the importance of accurate reporting and public health interventions. Knowledge is a vital first step in prevention, and being informed may one day save a life.

Full English Translation (No Omission)

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My name is TobiraAI, living in this region. Thank you as always for reading. Please make yourself comfortable.

There is no QUIZ this time. You will soon understand why.

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Table of Contents

• Current Situation (India and the United States)
  1. Suicide in India and the Need for Policy
  2. Suicide Trends in the United States
• The Process of Suicidal Ideation
• The Three-Step Theory (3ST)
  • Step 1: The Emergence of Suicidal Ideation
  • Step 2: Escalation of Ideation — The Protective Factor “Connectedness”
  • Step 3: Transition to Action (Attempts)
• Three Categories That Contribute to Suicidal Behavior

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Recently, I took a lecture at Wesleyan University in the United States, passed the exam, and received a certificate of completion. I don’t think I’ve ever felt so conflicted about receiving a certificate.

(Image: Certificate from Wesleyan University; my real name is hidden.)

The lecture was titled “Suicide Prevention.”
In my 25 years as a cram school instructor, I have fortunately never experienced a case in which one of my own students engaged in such an act. However, as a company, we have experienced cases. Some of my classmates from my own school years also lost their lives this way.

Listening to the content of the lecture was emotionally difficult.
Although this series is titled “To Young Teachers,” I believe that veteran teachers like us must also listen carefully. Preparing ourselves with knowledge to prevent the worst outcome is absolutely necessary.

In this article, I will summarize the lecture by Assistant Professor Alexis May over three installments. Please remember that this is based on her research. If reading this causes emotional distress, please call the mental health consultation hotline.

Japanese Mental Health Consultation Hotline
https://www.mhlw.go.jp

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Current Situation (Examples from India and the United States)

Suicide is a major global public health problem. Southeast Asia accounts for about 40% of the world’s estimated 800,000 annual suicide deaths.
Modern suicide research adopts the “ideation-to-action” framework.

In other words:

1. The process of generating suicidal thoughts (ideation)
2. The process of turning those thoughts into action

These are treated as separate processes with different explanations and risk factors.

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1. Suicide in India and the Need for Policy

Suicide is a serious public health crisis in India.
According to the National Crime Records Bureau (NCRB), the official suicide rate in 2015 was 10.6 per 100,000. However, an analysis using Global Burden of Disease (GBD) data by Dandona et al. estimated that India’s age-standardized suicide death rate (SDR) in 2016 was 17.9 per 100,000.

This corresponds to 230,000 suicide deaths per year, about 100,000 more than reported by NCRB.
Underreporting and misclassification are common in police-based statistics.

India’s share of global suicide deaths increased between 1990 and 2016—from 25.3% to 36.6% among women, and 18.7% to 24.3% among men.
There is large variation among states—SDR varies tenfold for women and sixfold for men. Southern states such as Tamil Nadu and Karnataka show higher rates.

I remember NHK World News covering issues surrounding the dowry system just last month. Below is a 2022 report from CNN, also about Kerala, a southern Indian state known for its natural beauty.

(CNN article introduction)

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2. Suicide Trends in the United States

In contrast, suicide is the 10th leading cause of death in the U.S., and the 2nd leading cause for ages 10–34.

After more than ten consecutive years of increase, the overall U.S. suicide rate declined by 2.1% from 2018 to 2019 (from 14.2 to 13.9 per 100,000).

Rates are lowest in large metropolitan areas (11.2) and increase progressively toward rural areas (20.1).

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The Process of Suicidal Ideation

As mentioned before, modern theories separate ideation from action.
Today we focus on the ideation part.
You understand this already, I know—but let me say clearly:
I am not writing this out of curiosity. This is for sharing essential knowledge.

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The Three-Step Theory (3ST)

This theory was first proposed in 2015 by E. David Klonsky and Alexis M. May.
It offers a concise explanation using the concepts of pain, hopelessness, connectedness, and capability.

3ST explains the pathway from ideation to behavior through 3 steps.

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Step 1: The Emergence of Suicidal Ideation

Suicidal ideation (the desire to die or persistent thoughts about suicide) arises from two interacting elements:

1. Pain

The process begins with pain—normally psychological or emotional, but physical pain may also be included.
Regardless of its source, life begins to feel like a punishment, and one’s desire to live diminishes.

2. Hopelessness

Pain alone does not produce suicidal ideation. Only when one loses hope that the pain will improve does suicidal ideation appear.

3. The Interaction of Pain & Hopelessness

According to 3ST, both must be present.
If only one is high (pain but with hope, or hopelessness without pain), ideation remains negligible.

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Step 2: Escalation of Ideation — The Protective Factor “Connectedness”

Whether ideation becomes strong (“I would kill myself if I had the chance”) depends on connectedness.

Connectedness includes:

• Human relationships
• Work, roles, or responsibilities
• Projects or hobbies
• A sense of purpose or meaning in life

Even if someone feels daily pain and hopelessness, their connection to (for example) their children may outweigh their suffering, preventing active suicidal desire.

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Step 3: Transition to Action (Attempts)

Once strong ideation emerges, whether a person attempts suicide depends on their capacity.

Humans are evolutionarily programmed to avoid pain, injury, and death.
Thus, acting on suicidal desire is extremely difficult without the ability to override this instinct.

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Three Categories Contributing to Suicide Capacity

1. Dispositional Contributors

Innate traits such as low pain sensitivity or low risk avoidance.

2. Acquired Contributors

Capabilities developed through repeated exposure to pain or fear, such as:

• Non-suicidal self-injury (NSSI)
• Physical abuse
• Combat training
• Other traumatic experiences

These may reduce fear of death or increase habituation to pain.

3. Practical Contributors

Factors that make attempts easier:

• Access to lethal means (e.g., firearms)
• Technical knowledge of methods (e.g., lethal dosage expertise)

The higher the capability, the greater the risk that strong ideation becomes action.

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Conclusion

Next time, I will discuss how to stop this progression.

Please remember:
If you are suffering, call the mental health hotline.

Japanese Mental Health Consultation Hotline
https://www.mhlw.go.jp

Thank you very much for reading.
If you enjoyed this article, I’d be grateful for a “like.”
I also look forward to exchanging ideas in the comments.
Your follow means more than words can express.

With deep gratitude,
Warm regards,
TobiraAI

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