Suicide is a leading cause of death, and first responders are at elevated risk compared to the general population. The Three-Step Theory of Suicide (3ST), not yet tested among first responders, proposes that in Step 1 of the theory, the combination of physical or psychological pain and hopelessness is necessary for the onset of suicidal desire, but little data exists regarding the impact of physical pain, rather than psychological pain. First responders often experience cultural stigma associated with disclosure of psychological symptoms. Thus, physical pain may be more informative from an assessment perspective regarding identifying suicidal desire in first responders. The study aimed to replicate and expand the 3ST by examining both physical and psychological pain in Step 1 within first responders. First responders (n = 204) completed an anonymous online survey assessing physical pain, psychological pain, hopelessness, and suicidal desire. Moderation analyses using hierarchical multiple regression were used to test study hypotheses. Psychological pain did not moderate the relationship between hopelessness and suicidal desire in first responders. Physical pain moderated the relationship between hopelessness and suicidal desire, such that high levels of physical pain potentiated the relationship, while low levels diminished the relationship. Overall findings support the 3ST and provide evidence for the important role of physical pain in predicting suicidal desire among first responders. Findings highlight the necessity of considering cultural differences, such as stigma associated with psychological symptoms, when testing suicide theory among first responders. Results may inform development of screeners and assessments tailored to first responder populations, which could ultimately lead to improved methods of assessing critical components of first responder health and improved identification of first responders at risk for suicide.


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Graduation Date





Rozek, David


Master of Science (M.S.)


College of Sciences



Degree Program

Psychology Clinical




CFE0009476; DP0027474





Release Date

May 2026

Length of Campus-only Access

3 years

Access Status

Masters Thesis (Campus-only Access)

Restricted to the UCF community until May 2026; it will then be open access.