From ideation to action: recent advances in understanding suicide capability

Abstract

Suicide capability is one of few risk factors associated with suicide attempts among ideators. In the decade since the Interpersonal Psychological Theory of Suicide introduced the concept of acquired capability (i.e. the ability to face the fear and pain associated with death), understanding of the capability to attempt suicide has grown. Acquired (e.g. NSSI), dispositional (e.g. genetic), and practical contributors (e.g. access to firearms) appear to influence suicide capability via mechanisms such as the fear of death, persistence through pain, and familiarity with suicide methods. Self-report methods have shown mixed results, highlighting the importance of developing behavioral measures of suicide capability.

Links between self-injury and suicidality in autism

“…In other words: how participants felt about their self-injury appeared to be of little importance in decreasing the risk of suicidality posed by NSSI. This is consistent with the theoretical viewpoint that regardless of feelings about it or its functional purpose, NSSI increases pain tolerance and decreases fear of pain and death, thus creating the capability for lethal behaviors in those with pre-existent suicide ideation [16,17,[20][21][22][23]. This could explain why the duration of NSSI, in our analysis, was not significantly associated with the risk of suicidality, though there was a trend in this direction.…”

“…As stated previously, the majority of participants [2] (82) completed this measure as part of a previous study [40] and then completed the SBQ-R and the Interpersonal Social Evaluation List (ISEL-12) in the context of the new study. The small remainder (22) completed the SBQ-R and the ISEL-12 first in the context of the new study, and were then willing to complete the NSSI-AT as an optional extra. This comprehensive clinical assessment of self-injury documents the nature and bodily location of any self-injurious behaviors; their functional purpose, i.e., an individual's awareness of what NSSI does for them, the need that it fulfills; the recency and frequency of self-injury, and the likelihood that it will reoccur in future; the age of onset of self-injury; the severity of injuries (based on whether these did or should have received medical attention); the social and habitual routines or context around self-injurious behaviors (if, for example, individuals always make sure they are alone); the degree to which participants are habituated to the occurrence of self-injurious behavior; and whether individuals have sought therapy, their experiences in therapy, and their experiences of telling others about their self-injury.…”

“…Indeed, the current leading model of suicidality [20,21] suggests that acquired capability for suicide is required to transform suicidal intent into suicide readiness and attempts. Though provocative and painful incidents (such as violent incidents and abuse) are one means of acquiring capability for suicide through increasing tolerance for pain and fearlessness of death, NSSI is one of the most direct mechanisms by which people move from suicidal intent to being capable of lethal attempts [22,23].…”

(In)stability of Capability for Suicide in Psychiatric Inpatients: Longitudinal Assessment Using Ecological Momentary Assessments

“…() have evaluated the sensitivity of the CS facets to change after treatment in a prospective study in clinical inpatients demonstrating that the two facets differ in terms of stability: While fearlessness about death decreased after inpatient treatment (psychiatric acute care), pain tolerance did not change significantly. Although this provides first evidence that CS is subject to change over time (i.e., casting further doubt on the initially assumed static nature of the construct and supporting the assumption by Smith and Cukrowicz that there is a short‐term component of CS that may change in rather short periods), neither its temporal dynamics nor factors contributing to momentary shifts have been studied to date (Anestis et al., ; May & Victor, ).…”

“…While long‐term CS has been described theoretically and several cross‐sectional studies have supported its associations with suicide attempts within the framework of the ITS (Glaesmer et al., ; Ma, Batterham, Calear, & Han, ), the IMV (Dhingra, Boduszek, & O'Connor, ), and the 3‐ST (Dhingra, Klonsky, & Tapola, ), empirical evidence from prospective studies about its development and its predictive value for suicidal behavior is rare (Ma et al., ; George, Page, Hooke, & Stritzke, ; May & Victor, ).…”