(PS2-A16) The Relationship Fearlessness About Suicide Verses Fearlessness About Death Has with NSSI and Suicidality

Background: The Interpersonal Theory of Suicide (IPTS) posits that acquired capability, specifically fearlessness about death (FAD), which is accumulated via exposure to painful and provocative events (e.g., non-suicidal self-injury; NSSI), is needed for suicidal ideation (SI) to transition into suicidal behaviors. Despite the theory’s logical appeal, empirical findings regarding FAD are largely mixed, likely due to the Acquired Capability for Suicide-Fearlessness about Death Scale (ACSS-FAD) lacking specificity of suicide death. To address this limitation, the Fearlessness About Suicide Scale (FSS) was developed, which captures current and future FAD specific to suicide. Initial psychometric examination of FSS supported its construct validity, good test-retest reliability, and moderate predictive validity. However, more work assessing FSS is required to see if it outperforms FAD as a facet of the IPTS. Thus, we compared the FSS to the ACSS-FAD to determine the better conceptualization of the FAD facet of acquired capability. To do this, we conducted multiple regression analysis to test whether FSS moderated the relationship between NSSI and suicidality better than FAD. 

Methods: Participants (n = 141) were recruited at a southeastern university and completed a series of self-report measures in exchange for course credit. Participants were 18 to 32 years old, mostly female (82%), white (86.8%), non-Hispanic (75.7%), and heterosexual (77.9%). The Depressive Symptom Inventory-Suicidality Subscale (DSI-SS) was used to assess current SI. FSS assessed current (FSS1) and future (FSS2) fearlessness about suicide. ACSS-FAD assessed FAD. NSSI was assessed with one item from the Self-Injurious Thoughts and Behaviors Interview. All measures had good internal consistency. Multiple linear regression analyses were conducted using the R package stats.

Results: Regression models that tested only the direct effects of FSS and NSSI history on DSI-SS scores showed both FSS1 (b=.05, p< .001) and FSS2 (b=.07, p < .001) had significant main effects on DSI-SS scores. When the interaction term was introduced, NSSI was no longer significant while the main effect of FSS1 (b=0.138, p< .01) and FSS2 (b=.22, p< 0.001) remained intact. Interaction effects in both the FSS1 model (b=-.06, p< .01) and FSS2 model (b=-.099, p< .001) were also significant. FAD was also tested as a moderator. While FAD had a significant main effect (b=.03, p< .01), it lacked moderation effects (b=.05, p >.05). When FSS1 and FSS2 were simultaneously tested for main effects and moderation effects, only FSS2 (b=.18, p< .01) and its interaction term (FSS2 x NSSI) emerged as significant. The final model that only retained FSS2 and its interaction term (FSS2 x NSSI) accounted for 32.9% of DSI-SS variance. 

Discussion: Results indicate that the FSS scale may better capture FAD specific to suicide compared to the general FAD scale. Using FSS may help advance suicide research theoretically and empirically as a novel, informative correlate of suicide. Future studies could incorporate the FSS in modeling suicide predictions, particularly across high-risk populations, to better our understanding of suicidal thoughts and behaviors.