Suicidal behavior and social cognition: the role of hypomentalizing and fearlessness about death

Abstract

Background: Suicide attempt (SA) lethality is associated with heightened suicidal desires and social cognition deficits. Fearlessness about death (FAD) and hypomentalizing may play a role in SA and self-harm. Although studies have identified relationships between these constructs, this line of research is still limited. We aimed to explore the mediating role of FAD and mentalizing between suicidal ideation and both SA lethality and self-harm. Method: 1,371 suicide attempters (70.1% women; M = 40 years) from seven Spanish hospitals participated. We used the Fearlessness About Death (ACSS-FAD) subscale, the Reflective Functioning Questionnaire-8 (RFQ-8), and the Columbia Suicide Severity Rating Scale (CSSRS). We conducted serial multiple mediation analyses with suicidal ideation as exposure; FAD and mentalizing as mediators; SA lethality and self-harm as outcomes. Results: Indirect effects were found of suicidal ideation on self-harm (B = 0.08, CI = 0.03-0.15) and SA lethality mediated by FAD (B = 0.02, CI = 0.001-0.04); indirect effects of suicidal ideation on self-harm through mentalizing (B = 0.10, CI = 0.04-0.167), and total indirect effects between suicidal ideation and self-harm through FAD and mentalizing (B = 0.18, CI = 0.11-0.27). Conclusions: Interventions addressing mentalizing and FAD may help reduce SA lethality and self-harm risk.

This work was supported by the Instituto de Salud Carlos III (ISCIII) grant number: PI19/00941 and PI19/01027 (SURVIVE), S2022/BMD-7216 AGES 3-CM, S2017/BMD-3740 AGES-CM2-CM, PI23/01469 (SURVIVE II); and co-funded by the European Union grant numbers: COV20/00988, PI17/00768, PI20/01113, Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), the Fundación Española de Psiquiatría y Salud Mental, the Government of the Principality of Asturias PCTI-2021-2023 IDI/2021/111, the Fundación para la Investigación e Innovación Biosanitaria del Principado de Asturias (FINBA), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM).