Proximal correlates of suicidal ideation among transgender and gender diverse people: A preliminary test of the three-step theory

Introduction
Transgender and gender diverse (TGD) people experience higher rates of suicidal ideation than their cisgender peers; however, very little is known about factors that proximally relate to suicidal ideation in this population. This limited understanding may be due to the lack of theory-guided studies that are capable of testing proximal correlates of suicidal ideation among TGD people.
Methods
We tested the first two steps of the three-step theory (3ST) of suicide using daily survey data from a sample of 38 TGD people over 30 days.
Results
A total of 836 daily surveys were collected (73.3% compliance). Multilevel modeling supported the first and second step of the 3ST. Psychological pain and hopelessness interacted to predict same-day suicidal ideation, with psychological pain positively associating with ideation only at average and high levels of hopelessness. Furthermore, psychological pain that outweighed connectedness was moderately associated with suicidal ideation among those with high levels of hopelessness and psychological pain.
Conclusion
The 3ST of suicide shows promise for explaining and guiding interventions to reduce suicidal ideation in this vulnerable population.