Number and violence of suicide attempt methods: A preliminary investigation of the associations with fearlessness of suicide and fearlessness about death

The Interpersonal Psychological Theory of Suicide (IPTS) proposes that to attempt suicide one must not only desire death, but must also have acquired the capability to act on that desire. The IPTS states capability for suicide can be acquired through exposure to painful and provocative events, with events most closely related to suicide (e.g., non-fatal attempt) having the strongest effects on capability. We tested the effects of two aspects of suicide attempt history—number and violence of methods—on acquired capability, operationalized as both fearlessness about death and fearlessness of suicide, in a sample of psychiatric inpatients with a history of multiple suicide attempts. Results from three separate models suggest that number of methods and number of violent methods, but not history of ever using a violent method, are associated with increased fearlessness of suicide, even after accounting for hopelessness, general painful and provocative events, NSSI, and number of attempts. Few variables were associated with fearlessness about death. Our results raise the possibility that fearlessness of death and suicide may not be synonymous constructs. They also indicate that number of methods, and/or number of violent methods, may be important markers of fearlessness of suicide among those at high risk.