Introduction
Suicide is a major cause of morbidity and mortality worldwide. Approximately 1 million people worldwide die by suicide each year. Suicide is the second leading cause of death among young people aged 10-24 years [1]. Suicidal behaviors include a three-stage process that goes from suicidal ideation to moderate and strong ideation, and finally to suicidal attempts [4]. Currently, one of the most important challenges of the health system in Iran is suicide attempts among adolescents. Therefore, a deep understanding of this phenomenon is necessary to provide preventive and control solutions. So far, several theories have been proposed to understand the phenomenon of suicide. Zhang [7] proposed the strain theory of suicide, which assumes that suicide is usually caused by psychological strains [8]. A psychological strain consists of at least two forces that push a person in different directions and cause a person to feel pain and suffering, which can lead to suicide [9]. On the other hand, hopelessness is one of the most common risk factors for suicidal thoughts and behaviors [19]. Hopelessness is defined as negative expectations for the self and the future [20], and it seems to be the main cognitive mechanism for the vulnerability of suicidal thoughts and behavior [21]. Durkheim’s theory of social integration suggests social integration as a cause of suicide [34]. In the interpersonal-psychological theory of suicide behavior, Joiner proposed the perceived burdensomeness and thwarted belongingness as the causes of suicide [28]. The three-step theory of suicide (3ST) was proposed by Klonsky and May [35] by adding psychological pain and hopelessness to the interpersonal-psychological theory, and reported these factors as the cause of suicide. The development of structural models of suicide in school or college students according to static factors such as age and gender can correctly show a psychological picture of the predicting and mediating factors of suicidal ideation and behaviors. Therefore, this study aims to assess the moderating role of depression and hopelessness in the relationship of psychological strain, rejection sensitivity, and defeat with suicide ideation in adolescents in Iran.

Methods
This is a descriptive-correlational study, using the path analysis method. The study population consists of all high school students aged 14-19 in Lorestan Province in 2022 (n=643). Of these, 623 first- and second-grade high school students were selected using multi-stage cluster sampling method. To collect data, Cull, & Gill’s suicide probability scale (SPS), Zigmond, & Snaith’ hospital anxiety and depression scale (HADS), Zhang’s psychological strain scales (PSS), Beck, & Steer’s Beck hopelessness scale (BPS), Gilbert, & Allan’s defeat scale (DS) and Downey & Feldman’s rejection sensitivity questionnaire were used. To report the descriptive findings, Mean±SD were used. To test the research hypotheses, Pearson correlation test and path analysis were used in SPSS software, version 26 and AMOS software, version 24.

Results 
The mean age of the students was 16.86±1.61 years; 169(27.1%) aged 14 years, 117(18.8%) aged 15 years, 93(14.9%) aged 16 years, 71(11.4%) aged 17 years, 38 (6.09%) aged 18 years, and 125(20.06%) aged 19 years old. As can be seen in Figure 1 and Table 1, psychological strain, defeat, and rejection sensitivity had a significant indirect relationship with suicidal ideation through depression and hopelessness variables.


Discussion
This study, by using several theories of suicide, provide a novel insights into suicidal ideation among adolescents in Iran. The perception of psychological strain and defeat in adolescents should be considered by families, educational centers, and experts, and should provide intervention, if necessary, so that the psychological strain, defeat, and thwarted belongingness does not become a motive for their suicide. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Kermanshah University of Medical Sciences (Code: IR.KUMS.REC.1396.399).

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization, investigation, writing initial draft, validation, and review: Mohammad Javad Bagian Koulemarzi and Zohre Etemadi; Supervision, writing, review & editing: Abdolhakim Tirgari and Saba Abbaspour; Methodology: Mohammad Javad Bagian Koulemarzi and Saba Abbaspour; Validation: All authors.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the students participated in this study for their cooperation.



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