Empirical evaluation of three 21st century suicide theories: interpersonal theory of suicide, cultural model of suicide, and the integrated motivational-volitional model

Introduction: Suicide, suicide attempts, and suicidal ideation since the pandemic have been tied to both unemployment and being an essential worker. This study examined three suicide theories – the Interpersonal Theory, the Cultural Model of Suicide, and the Integrated Motivational-Volitional model - in this population. Methods: Participants were recruited through Prolific in late 2020 if unemployed because of COVID-19 or an essential worker. Participants completed a baseline survey including measures of suicide theories as well as suicide risk. Those experiencing distress were invited to enroll in a randomized trial of mobile apps and the suicide theories' performance in predicting suicide risk was examined in this subsample (N = 843), adjusting for COVID-19 work status and history of suicide attempt. Results: Cross-sectional analysis showed perceived burdensomeness but not thwarted belongingness predicted suicide risk. Cross-sectional analysis found idioms of distress and cultural sanctions predicting suicide risk while minority stress and social discord did not. In cross-sectional analysis, both defeat and entrapment predicted suicide risk with partial mediation of defeat through entrapment. In cross-lagged analysis, defeat predicted entrapment, but entrapment did not predict defeat. Conclusion: There was partial support for the Interpersonal and Cultural theories of suicide and full support for the Integrated Motivational-Volitional model's primary pathway.