Suicidal Behavior and Social Cognition: The Role of Hypomentalizing and Fearlessness About Death.

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.