Preliminary Validation of a Korean Version of the Acquired Capability for Suicide Scale‐Fearlessness About Death

The interpersonal‐psychological theory of suicide proposes that the desire for suicide must be accompanied by the capability to do so in order for an individual to engage in suicidal behavior. The Acquired Capability for Suicide Scale‐Fearlessness about Death (ACSS ‐FAD ) measures fearlessness about death, a core component of the capability for suicide. This study aimed to validate a Korean version of the ACSS ‐FAD in a college student sample. We administered the ACSS ‐FAD and measures of suicide ideation, fear of suicide, death anxiety, pain anxiety, and depression in a sample of Korean college students (N  = 301) and analyzed its reliability, factor structure, invariance across genders, convergent validity, and discriminant validity. The one‐factor model achieved satisfactory model fit. Across genders, partial metric invariance and partial scalar invariance were established. The results also revealed that the ACSS ‐FAD has good internal consistency, convergent validity (positive correlations with fear of suicide, death anxiety, and pain anxiety), and discriminant validity (no relation with depression). The Korean version of the ACSS ‐FAD presents adequate psychometric properties and may be considered to be a promising instrument for measuring fearlessness about death in college students.     

Construct Validity of the Acquired Capability for Suicide Scale: Factor Structure,Convergent and Discriminant Validity

The Acquired Capability for Suicide Scale (ACSS) assesses one of three main constructs in the Interpersonal Theory of Suicide but evidence of its validity is limited. In two studies (Ns = 287 and 738) validity of the full 20-item ACSS and its shorter versions (ACSS-5, ACSS-8, ACSS-FAD) were examined in terms of factor structure and relation to indices of self-reported suicidal behaviour and self-harm. Confirmatory factor analysis (CFA) failed to show good fit for one-, two-, or three-factor models of the ACSS in its various versions. Exploratory factor analysis of the 20-item scale in the first study pointed instead to a five-factor structure and this was supported using CFA in the second study. In both studies all scale versions showed moderate negative correlations to fear of death and dying, indicating scale validity for the purpose of assessing fearlessness about death. In the second study, a model in which the five factors were indicators of a latent variable of Capability was found to predict a latent variable of Suicidality as indicated by suicidal behaviours, but the prediction was substantially enhanced by the addition of Item 20 to the model. This single item was also found in the first study to better predict suicidal and self-harming behaviour than the full ACSS or any of its short versions.     

Stoicism and Sensation Seeking: Male Vulnerabilities for the Acquired Capability for Suicide

Our aim was to investigate two personality traits (i.e., stoicism and sensation seeking) that may account for well-established gender differences in suicide, within the framework of the interpersonal theory of suicide. This theory proposes that acquired capability for suicide, a construct comprised of pain insensitivity and fearlessness about death, explains gender differences in suicide. Across two samples of undergraduates (N = 185 and N = 363), men demonstrated significantly greater levels of both facets of acquired capability than women. Further, we found that stoicism accounted for the relationship between gender and pain insensitivity, and sensation seeking accounted for the relationship between gender and fearlessness about death. Thus, personality may be one psychological mechanism accounting for gender differences in suicidal behavior.     

The Influence of Acetaminophen and Observational Conditioning on the Acquired Capability for Suicide

The effects of acetaminophen and a reading task on physical pain tolerance and fearlessness about death were tested in 106 undergraduate students. Participants were randomized into four groups, each receiving either acetaminophen or no medication, along with either a control or experimental reading task. It was predicted that acetaminophen would increase pain tolerance and fearlessness about death, that the experimental reading task would decrease both outcomes, and that the interventions would interact (i.e., acetaminophen would dampen the effects of the reading task). Multivariate analysis of variance was used to test hypotheses. No significant interaction was found (p = .17) and there was no effect for acetaminophen (p = .56), but individuals administered the experimental reading task demonstrated significantly higher physical pain tolerance (p < .05).     

Reliability and Validation of the Hebrew Version of the Reasons for Attempting Suicide Questionnaire (RASQ‐H) and its Importance for Mental Pain

This study evaluated the Hebrew Reasons for Attempting Suicide Questionnaire (RASQ‐H) and its application for suicidality, and mental pain and its tolerance. The sample comprised 97 participants who were inpatient suicide attempters, inpatient nonattempters, or nonpatient controls. Differentiation of the RASQ into internal perturbation‐based reasons and extrapunitive/manipulative motivations factors was confirmed, with each scale demonstrating strong internal reliability. While the internal perturbation‐based reasons factor related positively to some suicidal manifestations, to mental pain, and to lower mental pain tolerance, the extrapunitive/manipulative motivations factor mostly associated with lower suicidality and had fewer and smaller associations with mental pain and its tolerance.     

Body Investment as a Protective Factor in the Relationship Between Acquired Capability for Suicide and Suicide Attempts

Acquired capability for suicide is associated with increased suicide risk and behaviors, but little research has examined factors that may qualify this relationship. Body investment is proposed as one such factor, as it may engage self-preservation instincts and serve as a buffer to capability for suicide. It was expected that facets of body investment (body feelings, body care, comfort with touch, and body protection) would moderate the relationship between acquired capability for suicide and suicide attempts. The current study included a sample of 1,150 undergraduate students with a mean age of 19.74 (3.44). The majority of the sample identified as female (71%) and White/Caucasian (78%). Participants completed self-report measures of body investment (Body Investment Scale [BIS]), acquired capability (Acquired Capability for Suicide Scale [ACSS]), suicide thoughts and attempt history (Self-Harm Behavior Questionnaire [SHBQ]), and demographic information. Four moderation analyses were run using the PROCESS macro; one for each body investment subscale. All facets of body investment showed significant moderation except for body care. Acquired capability was significantly associated with suicide attempts when body feelings, comfort with touch, and body protection were low, but not when they were high. Results indicate that fostering aspects of body investment may be important for suicide prevention.     

Validation of the Urdu translation of the Beck Scale for Suicide Ideation

This study aimed at developing an Urdu version of the Beck Scale for Suicide Ideation (BSI) for use with Pakistani adolescents and young adults. For this purpose, the English BSI was translated into Urdu and tested for psychometric properties. The analyses were carried out with data from a sample of 904 adolescents and young adults from eight major cities of Pakistan. The Cronbach's alpha of .75 showed that the Urdu version of the BSI has reasonable internal consistency. Principal Component Analysis gave one meaningful component that indicated Active Suicidal Desire. This preliminary validation study of the Urdu version of the BSI showed that it is an acceptable measure to be used with Pakistani adolescents and young adults. The need for further research on suicide in Pakistan is discussed.     

Capable of Suicide: A Functional Model of the Acquired Capability Component of the Interpersonal‐Psychological Theory of Suicide

A functional model of the acquired capability for suicide, a component of Joiner's (2005 ) Interpersonal‐Psychological Theory of Suicide, is presented. A component of Joiner's (2005 ) Interpersonal‐Psychological Theory of Suicide a functional model of the acquired capability for suicide is presented. The model integrates the points discussed by Joiner into a unified and specific conceptualization of acquired capability. Several points are elaborated on, such as the interaction between specific diatheses with life events, the role of short‐term bolstering of the capability for suicide, and how contextual factors moderate the experience of painful and provocative life events; thereby leading to fearlessness and pain insensitivity to the actions and ideas involved in suicide.     

PTSD Symptom Clusters Are Differentially Associated with Components of the Acquired Capability for Suicide

Previous research has established the link between posttraumatic stress disorder (PTSD) and suicidal behavior. In the current study, constructs proposed to explain this relationship were examined, applying the framework of the interpersonal‐psychological theory of suicide (IPTS). Relationships between acquired capability for suicide (ACS; i.e., fearlessness about death [FAD] and pain tolerance) and specific PTSD symptom clusters were explored. In a sample of 334 trauma‐exposed undergraduates, anxious arousal and FAD were negatively associated, and numbing and pain tolerance were positively associated. Results establish a foundation for investigating the role of ACS in understanding observed relationships between suicidal behavior and PTSD symptoms.     

Posttraumatic Stress Disorder Symptom Clusters and Acquired Capability for Suicide: A Reexamination Using DSM-5 Criteria

This study used the interpersonal–psychological theory of suicide to explore the relationships among DSM-5 posttraumatic stress disorder (PTSD) symptom clusters derived from the six-factor anhedonia model and facets of acquired capability for suicide (ACS). In a sample of 373 trauma-exposed undergraduates, most PTSD symptom clusters were negatively associated with facets of ACS in bivariate correlations, but the anhedonia cluster was positively associated with ACS in regression models. Structure coefficients and commonality analysis indicated that anhedonia served as a suppressor variable for the other symptom clusters. Our findings further elucidate the complex relationship between specific PTSD symptom clusters and ACS.     

The Comprehensive Alcohol Expectancy Questionnaire: Confirmatory Factor Analysis,Scale Refinement,and Further Validation

The Comprehensive Alcohol Expectancy Questionnaire (CAEQ; Demmel & Hagen, 2003a, 2003b) is a self-report measure designed to assess an individual’s alcohol expectancies. In this study, we examined the CAEQ in a student sample (N= 932) and in a clinical sample of alcohol-dependent inpatients (N= 744). The Five-factor structure was confirmed by means of confirmatory factor analysis. Convergent validity of the revised CAEQ was supported by showing significant relationships to quantity and frequency of drinking. The results of this study suggest that the revised CAEQ appears to be a psychometrically sound tool for the assessment of alcohol expectancies among both students and alcohol-dependent inpatients.     

Validation of the German version of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-G)

The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) is widely used in the English-speaking countries as a measure of sociocultural influences on body image. Aim of this study was to provide validation data for three subscales of a boys’ and girls’ German version of the SATAQ (SATAQ-G). A sample of 819 male and 791 female Swiss adolescents completed the SATAQ-G internalization of body ideals, perceived pressure and awareness subscales. They also completed assessments of body dissatisfaction, weight and shape concerns, drive for thinness, weight and height. Factor analyses replicated the three subscales of the SATAQ for the boys’ as well as for the girls’ version. All three subscales showed good internal consistency. The internalization and pressure subscales indicated acceptable convergent validity. Awareness did not significantly predict body dissatisfaction. The SATAQ-G, particularly the subscales internalization and perceived pressure, seems to be a satisfactory measure of sociocultural influences on body image.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.