Abstract: One of the reasons underlying the acute nature of suicide crisis is the limited understanding of the internal processes and the progression of suicidal ideation. Correspondingly, suicide interventions have limited efficacy. Most individuals with suicidal ideation do not attempt suicide, but the reasons are unknown. The present study adopted qualitative research methods to explore protective factors that prevent the progression of suicidal ideation to suicide attempt. This study aimed to elucidate the internal processes of suicide and to identify potential focuses of intervention efforts to prevent the progression of suicidal ideation.
In the current study, an intensive sampling method was adopted to recruit participants. The Suicidal Behavior Questionnaire-Revised (SBQ-R) and the 9-item Patient Health Questionnaire (PHQ-9) were distributed at a university to identify people without a history of suicide attempts but with suicidal ideation within the past year. The final sample was composed of 19 subjects, including 6 males and 13 females. In-depth structured interviews were conducted. All interviews were transcribed verbatim and then coded and analyzed in NVivo 11.0 based on the grounded theory. This format included data reduction and theme generation using open coding, axial coding and core coding. In addition, participant inspection and expert evaluation were adopted to improve the validity of the research results. In this study, a total of 199,918 words of interview transcripts were obtained, and 285 reference points were generated. The encoding result included 4 core categories, 11 axial categories, and 40 open categories.
The protective factors against the progression of suicidal ideation to suicide attempt were divided into the following three aspects. (1) Connection: Connection mainly refers to relationships between people and the world, including the horizontal connections between an individual and their family and society as well as the vertical connections between the individual and the present and future. Connection, especially family connection, is highly effective. (2) Sanity: Sanity refers to a rational approach to coping with suicide and has four aspects: cognition, emotion, behavior, and personality. Sanity helps individuals cope with suicidal ideation. (3) Refusal of suicide: This refers to a negative attitude toward suicide. By refusing the consequences, behaviors and objective conditions of suicide, the possibility of a suicide attempt is prevented.
Furthermore, connection, sanity and refusal of suicide seem to have protective effects against suicidal ideation, suicidal impulses, and suicide attempts, respectively, forming three “lines of defense" that prevent the progression of suicidal ideation to suicide attempt. Connection is the first and most important line of defense in the entire prevention process. Its function is to reduce the intensity of suicidal ideation. If the first line of defense fails, suicidal ideation escalates, and sanity acts as the second line of defense. Its function is mainly to reduce suicidal impulses in the presence of strong suicidal ideation. If the second line of defense fails and the individual is susceptible to suicidal impulses, refusal of suicide acts as the third line of defense. Its function is to prevent the individual from attempting suicide even with a strong suicidal impulse.
The findings of this study could help to better understand the internal processes of suicide, especially the key factors that prevent the progression of suicide, and to provide theoretical support for the prevention of suicide attempts. The focus of suicide intervention should shift to blocking suicidal ideation in the early stage.

Key words: suicidal ideation, suicide attempt, progression, protective factors

摘要： 多数自杀意念者从未尝试自杀,原因不得而知。为探索阻断自杀意念向自杀尝试演变的保护因子,采用扎根理论,访谈19名无自杀尝试史的自杀意念者。结果表明,保护因子有3个：（1）联结,其作用是减弱自杀意念。其中家庭联结最有用。（2）理智,其作用是降低自杀冲动。（3）自杀否定,其作用是预防自杀尝试。这3个因子形成阻断自杀意念向自杀尝试演变的“3道防线”。未来可充分利用3道防线,更好地阻断自杀演变。

关键词: 自杀意念, 自杀尝试, 演变, 保护因子