This study explored the relationship between variables emphasized in the theory’s first step of the three-step theory (3ST)—psychache, hopelessness, and their interaction—to suicide-related variables (i.e., lifetime suicidal ideation and attempt, past-year suicidal ideation, communication of suicidal thoughts, and self-reported future suicide attempt likelihood). Chinese undergraduate students (N = 11,399; mean age = 20.69 ± 1.35) from seven provinces participated in this cross-sectional survey. They answered the Suicidal Behaviors Questionnaire-Revised, Psychache Scale, and Beck Hopelessness Scale. Bivariate and multivariate analyses were used to examine the association between psychache, hopelessness, and hopelessness × psychache interaction on the outcome variables. Bivariate analyses showed that psychache and hopelessness were correlated with suicidal ideation and behaviors. In multiple regression models, the interaction between psychache and hopelessness was significantly associated with past-year suicidal ideation and self-report chances of a future suicide attempt, p < 0.001, though effect sizes for the interaction term were small. The results are broadly consistent with the 3ST’s proposition of how the combination of pain and hopelessness is related to various suicide-related variables. The low prevalence of suicide-related communication should inform future suicide prevention measures by encouraging help-seeking. Psychache as a correlate of the self-reported likelihood of a future attempt could be further investigated.

The psychometric properties of the Malay Suicidal Behaviors Questionnaire-Revised (SBQ-R) need to be tested as it is increasingly utilized, and there is a lack of a brief, validated scale to examine suicidal behaviors in Malaysia. A total of 713 and 715 undergraduates answered the English and Malay SBQ-R, respectively. Exploratory factor analysis derived a one-factor solution, with a total explained variance of 58.0% accounted for by the four items. Confirmatory factor analyses supported the one-factor model for the Malay SBQ-R, with acceptable fit indices (χ²/df = 0.451, comparative and Tucker–Lewis fit indices = ≥1.000, standardized root mean square residual = 0.014, root mean square error of approximation = 0.000, and 90% CI [0.000, 0.083]). Measurement invariance was achieved when comparing the SBQ-R between the English and Malay versions, indicating that both versions are similar in Malaysian undergraduates. Convergent validity was established through a strong correlation between the Malay SBQ-R and the Malay Yatt Suicide Attitude Scale (r = 0.74; p < 0.001). Good internal consistency was achieved for both the English (α = 0.83; ω = 0.85) and Malay (α = 0.81; ω = 0.84) versions. The Malay SBQ-R has adequate validity and reliability for use in Malaysian undergraduates.