Mapping the Psychosocial Schema of Suicide Attempts
Subject Areas : Research on Iranian social issues
mehri sadat mousavi
1
,
salman ghaderi
2
,
Maryam Beyk Mohammadi
3
,
Elham Sani
4
,
Faezeh Raeisi
5
1 - Assistant Professor, Department of Youth and Generational Studies, Institute of Humanities and Social Studies, Academic Center for Education, Culture and Research (ACECR).
2 - Ph.D. in Sociology, Social Worker and Social Emergency Expert, Tehran Social Welfare Organization, Tehran, Iran,
3 - M.A. Social Worker and Specialist, Social Emergency Department, State Welfare Organization of Iran.
4 - Ph.D. in Anthropology, Islamic Azad University, Central Tehran Branch.
5 - M.A. in Psychology and Psychologist, Social Emergency Department, State Welfare Organization of Iran.
Keywords: Suicide, Psychosocial Factors of Suicide, Social Emergency, Factor Analysis, Suicide Attempt.,
Abstract :
Mapping the Psychosocial Schema of Suicide Attempts
Mehri Sadat Mousavi*
Salman Ghaderi**
Maryam Beyk Mohammadi***
Elham Sani****
Faezeh Raeisi*****
Suicide, as one of the leading causes of death, particularly among young people, is a multidimensional phenomenon rooted in the complex interaction of psychological, social, and economic factors. This study aimed to delineate the psychosocial schema of suicide attempts through an exploratory factor analysis of the perspectives of 76 individuals who had attempted suicide and were under the intervention of Tehran Social Emergency Services. Data were collected using a researcher-made questionnaire and analyzed using descriptive statistics and factor analysis. The most frequent age group among participants was 20–30 years (36.8%), with a mean age of 33 years. The most important reasons for the attempt, from their perspective, were reported as loneliness (23.7%), financial problems (22.4%), and family conflicts (7.9%), respectively. Exploratory factor analysis extracted nine effective factors, which together explained 77.16% of the total variance. Ranking these factors revealed that helplessness and deadlock, existential emptiness and meaninglessness, and socioeconomic conditions were, respectively, the most important factors from the attempters' viewpoint. The findings depict the pattern of suicide attempts as a predominantly youth-oriented phenomenon with a multilayered psychosocial structure, indicating that although objective factors act as immediate triggers, deeper cognitive-emotional factors carry greater determining weight in the formation of the subjective schema leading to suicide. These results suggest the necessity of designing two-level interventions, including immediate interventions to address objective triggers and deep psychological interventions to combat helplessness and reconstruct meaning in life.
Keywords: Suicide, Psychosocial Factors of Suicide, Social Emergency, Factor Analysis, Suicide Attempt.
Introduction
Suicide is a complex public health crisis, reflecting deep psychological, social, and economic dysfunctions beyond individual tragedy. Globally, nearly 700,000 people die by suicide annually. In Iran, suicide rates have risen to 7.7 per 100,000, rooted in economic inequality, breakdown of traditional support networks, stigma, and limited mental health access. While previous studies have examined isolated risk factors, our understanding of how these elements interact to form a critical psychosocial schema remains incomplete. This study, focusing on the perspectives of attempters in Tehran, asks: What is the hierarchy and contribution of psychological, social, and economic factors in shaping the mental schema leading to suicide?
Theoretical Framework
Domestic studies indicate that multiple factors contribute to suicide in Iran. Feizollahi's meta-synthesis (2022) identified family dysfunction, social pressure, social rejection, and access to suicide methods as key factors. Zarani and Ahmadi's systematic review (2021) found that, contrary to global statistics, the rate of suicide attempts is higher among Iranian men than women, and that the causes and methods of suicide vary significantly across Iranian subcultures. Nasirzadeh et al. (2025) found a direct relationship between life skills and perceived social support with suicidal ideation among university students. Karim's meta-analysis (2022) showed that early marriage (Effect Size = 0.3721) and self-esteem (Effect Size = 0.6921) had the strongest relationships with suicide among social and psychological variables, respectively.
At the international level, McClelland et al. (2023) identified three categories of suicide-related factors: relational factors (belongingness, burdensomeness), mental health (depression, substance use), and internal factors (hopelessness, defeat, impulsivity). Forkmann et al. (2025) demonstrated that rumination and positive/negative metacognitions distinguish suicide attempters from non-attempters. Bahamon (2025) found significant relationships between suicide attempts and exposure to domestic violence, school violence, and sexual abuse, emphasizing that family support serves as an important protective factor.
Regarding theoretical foundations, suicide is a multidimensional phenomenon that no single theory can fully explain. Durkheim's sociological approach emphasizes macro-social factors. Agnew's general strain theory addresses strain resulting from the removal of positive stimuli and the presence of negative stimuli. In the psychological approach, Klonsky and May's (2016) three-step theory explains the transition from psychological pain and hopelessness to desire for death, then to suicidal ideation, and finally to action. Joiner's (2005) interpersonal theory posits that the simultaneous presence of thwarted belongingness, perceived burdensomeness, and acquired capability is necessary for serious suicidal behavior.
The present study employs an integrated theoretical framework comprising three levels of analysis: micro-level (Klonsky & May's theory), meso-level (Agnew's general strain theory and Cobb's social support theory), and macro-level (structural-social factors). The main objective is to discover and validate the "critical psychosocial schema" from the perspective of suicide attempters themselves using exploratory factor analysis, in order to determine which psychological and social factors carry greater weight in explaining the variance of this schema.
Methodology
This was a descriptive-analytical study employing an exploratory factor analysis approach. The statistical population consisted of all individuals who contacted Tehran's Social Emergency service (Line 123) due to a suicide crisis in 2024. Using convenience sampling, 76 of these attempters participated in the study. Data were collected using a researcher-made questionnaire comprising sections on demographic information, history of the attempt, 35 items on contributing factors (on a Likert scale), and protective factors. The instrument's reliability was confirmed with a Cronbach's alpha of 0.892. Data were analyzed using SPSS software, employing descriptive statistics, exploratory factor analysis (Principal Component Analysis with Varimax rotation), and the Friedman test for ranking the factors.
Findings
- Demographic Characteristics: Attempters were predominantly young (mean age 33, largest age group 20-30 years old), single (43.4%), residents of Tehran (89.5%), and with poor economic status (46.1%). Women (60.5%) had attempted more than men.
- Reasons and Methods of Attempt: The most important self-reported reasons were, in order: loneliness (23.7%), financial problems (22.4%), and family conflicts (7.9%). The most common methods were poisoning (39.5%) and acute physical methods (38.2%).
- Factor Structure: Exploratory factor analysis extracted 9 contributing factors, which together explained 77.167% of the total variance. These factors are: 1) Emptiness and Isolation, 2) Helplessness and Impasse, 3) Escape from Situation, 4) Inhibition and Cognitive Beliefs, 5) Stigma and Lack of Help-Seeking Knowledge, 6) Socio-economic Conditions, 7) Lack of Social Support, 8) Unbearable Emotional Pain, and 9) Cessation of Suffering and Impulsive Behavior.
- Factor Ranking: Based on the Friedman test, from the attempters' perspective, the top three factors in order of importance were: Helplessness and Impasse (mean rank: 8.38), Existential Emptiness and Meaninglessness (mean rank: 8.20), and Socio-economic Conditions (mean rank: 7.12).
Discussion and Conclusion
The findings depict the pattern of suicide attempts in the studied sample as a predominantly youth-oriented phenomenon, with primary triggers of loneliness and financial problems, and possessing a multi-layered and complex structure. A crucial point is that while objective and situational factors (such as economic and familial problems) act as immediate and apparent triggers, deeper cognitive-emotional factors such as feelings of helplessness, being trapped in an impasse, and experiences of emptiness and meaninglessness carry greater determinative weight in shaping the mental schema leading to suicide. This finding aligns with theories such as learned helplessness (Seligman), General Strain Theory (Agnew), and Frankl's logotherapy.
The results emphasize the necessity of adopting a multi-level and integrated approach in designing preventive interventions:
- In-depth Psychological Interventions: Targeting foundational cognitive-emotional factors like helplessness and emptiness through meaning-focused psychotherapies (e.g., logotherapy) and enhancing resilience.
- Immediate Socio-economic Interventions: Reducing the burden of objective triggers through targeted financial support, employment services, and family-focused interventions to reduce tension and isolation.
- Macro-policy Interventions: Designing comprehensive prevention programs focused on high-risk groups (youth, single individuals, and the deprived), increasing access to mental health services, reducing the stigma of seeking such services, and establishing sustainable social support networks at the community level.
- In summary, this research demonstrates that suicide is the end product of the dynamic interaction of individual (cognitive-emotional), interpersonal (social support), and structural (socio-economic) factors. Effective confrontation with it requires a proportionate and simultaneous response to all these levels.
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* Corresponding Author: Assistant Professor, Department of Youth and Generational Studies, Institute of Humanities and Social Studies, Academic Center for Education, Culture and Research (ACECR).
http://orcid.org/0000-0003-1069-6091
** Ph.D. in Sociology, Social Worker and Social Emergency Expert, Tehran Social Welfare Organization, Tehran, Iran,
salmang41@gmail.com
http://orcid.org/0000-0006-9167-6161
*** M.A. Social Worker and Specialist, Social Emergency Department, State Welfare Organization of Iran.
sahar.bekmohamadi6767@gmail.com
http://orcid.org/0000-0008-1874-0888
**** Ph.D. in Anthropology, Islamic Azad University, Central Tehran Branch.
http://orcid.org/0000-0003-6464-8457
***** M.A. in Psychology and Psychologist, Social Emergency Department, State Welfare Organization of Iran.
http://orcid.org/0000-0001-8396-5307
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https://doi.org/10.3390/ijerph22030411.
Chesney, E., Goodwin, G. M., & Fazel, S. (2014) Risks of all‐cause and suicide mortality in mental disorders: a meta‐review. World psychiatry, 13(2), 153-160. DOI: 10.1002/wps.20128.
Douglas, J. D. (2015) Social meanings of suicide. Permalink: http://digital.casalini.it/9781400868117.
Erlangsen, A., Stenager, E., & Conwell, Y. (2015). Physical diseases as predictors of suicide in older adults: a nationwide, register-based cohort study. Social psychiatry and psychiatric epidemiology, 50(9), 1427-1439.
DOI: 10.1007/s00127-015-1051-0.
Fazel, S., Ramesh, T., & Hawton, K. (2017) Suicide in prisons: an international study of prevalence and contributory factors. The Lancet Psychiatry, 4(12), 946-952. doi: 10.1016/S2215-0366(17)30514.
Forkmann, T., Fiorentino, L., Müßeler, S.S. et al. (2025) Thinking About Suicidal Thinking: Suicide-Related Metacognitions’ Relation to Maladaptive Processing of Suicidal Thoughts. Int. J. Cogn. Behav. Ther. 18, 241–255 https://doi.org/10.1007/s41811-025-00239-2.
Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, Musacchio KM, Jaroszewski AC, Chang BP, Nock MK. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull. 2017 Feb;143(2):187-232.
doi: 10.1037/bul0000084. Epub 2016 Nov 14. PMID: 27841450.
Guin, A. J. (2023) Exploring Lived Experiences of Suicide Surviving Spouses: An Interpretive Phenomenological Qualitative Study.
Johnson J, Gooding P, Tarrier N. Suicide risk in schizophrenia: explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychol Psychother. 2008; 81, pp 55-77.
Joiner, T. E. (2005) Why people die by suicide. Harvard University Press. Journal DOI: https://doi.org/10.7439/ijasr.
Klonsky E, May A, Saffer B. Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol. 2016; 12:307.
Klonsky, E. D., & May, A. M. (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.
DOI: 10.1146/annurev-clinpsy-021815-093204.
Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016) Suicide, suicide attempts, and suicidal ideation. Annual review of clinical psychology, 12(1), 307-330.
DOI: 10.1146/annurev-clinpsy-021815-093204.
Lester, D. (2010). Theories of suicide. In Suicide among racial and ethnic minority groups (pp. 51-65). Routledge.
Liu, R. T., & Alloy, L. B. (2010) Stress generation in depression: A systematic review of the empirical literature and recommendations for future study. Clinical psychology review, 30(5), 582-593.
DOI: 10.1016/j.cpr.2010.04.010.
Liu, R. T., Kleiman, E. M., Nestor, B. A., & Cheek, S. M. (2015) The hopelessness theory of depression: A quarter‐century in review. Clinical Psychology: Science and Practice, 22(4), 345-365.
DOI: 10.1111/cpsp.12125.
McClelland, Heather and Loney, Krystyna and Platt, Stephen (2023) Psychological factors associated with suicide attempt and suicide death in Scotland: A systematic review, Journal of Affective Disorders Reports.
Doi: 10.1016/j.jadr.2023.100711.
Mohandie, K., Meloy, J. R., & Collins, P. I. (2009) Suicide by cop among officer‐involved shooting cases. Journal of Forensic Sciences, 54(2), 456-462. DOI: 10.1111/j.1556-4029.2008.00981.x.
O'Connor, R. C., & Kirtley, O. J. (2018) The integrated motivational–volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B: Biological Sciences, 373(1754), 20170268.
DOI: 10.1098/rstb.2017.0268.
Phillips, J. A., Robin, A. V., Nugent, C. N., & Idler, E. L. (2010) Understanding recent changes in suicide rates among the middle-aged: Period or cohort effects? Public Health Reports, 125(5), 680–688.
https://doi.org/10.1177/003335491012500510.
Shepard, D. S., Gurewich, D., Lwin, A. K., Reed, G. A., & Silverman, M. M. (2016) Suicide and suicidal attempts in the United States: Costs and policy implications. *Suicide and Life-Threatening Behavior, 46*(3), 352–362.
https://doi.org/10.1111/sltb.12225.
Shneidman ES. The suicidal mind. Oxford University Press, USA; 1998. BY-NC-SA 3.0 IGO. Wagenaar, A. C., Tobler, A. L., & Komro, K. A. (2010) Effects of alcohol tax and price policies on morbidity and mortality: A systematic review. American Journal of Public Health, 100 , 2270–2278.
DOI: 10.2105/AJPH.2009.186007.
World Health Organization, & United Nations Children’s Fund (UNICEF). (2021). Helping adolescents thrive toolkit: Strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviours . Geneva: WHO.CC.
World Health Organization. (2025) Suicide worldwide in 2021: global health estimates. World Health Organization.
