Fearlessness about death is not associated with particular methods of suicide attempts, according to study results published in the Journal of Psychiatric Research. The study indicates that physicians may need to focus on other facets of suicide capability in their patients, such as access to means.

Previous studies have shown characteristic and practical differences between people who attempt suicide and people with suicidal ideation. However, it remains unclear whether fearlessness of death is needed to perform suicide or to choose particular methods.

Researchers used data from the Military Suicide Research Consortium database to evaluate 848 patients (mean age, 29.3±10.9 years; 58% women; 73.8% white), including active military personnel, veterans, and civilians who survived suicide attempts. Patients were asked to provide their suicide attempt history and a description of the details behind their plan to attempt suicide and the method used. Independent raters coded whether a self-reported suicide attempt met the definition criteria for a valid attempt, and if so, the method used. The Acquired Capability for Suicide Scale — Fearlessness About Death (ACSS-FAD) was used to assess a patient’s fearlessness about death, and researchers performed exploratory analyses to determine whether individual ACSS-FAD items varied by suicide attempt method.

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Researchers revealed that there were no significant differences in ACSS-FAD scores by suicide attempt method (F[6, 841], 0.60; P =.729). Additionally, various attempt methods were all statistically equivalent to one another, suggesting that there were no meaningful differences between ACSS-FAD scores and suicide attempt method. There were no statistically significant differences between ACSS-FAD and race, attempt status, and relationship status. However, when assessing ACSS-FAD scores and gender, men had significantly higher ACSS-FAD scores than women (M=17.92; SD=6.71 vs M=16.33; SD=7.02, respectively; t[846], 71.37; P <.001).

Limitations to this study included the inability to assess lethality from attempts, reliance on self-reporting of the most lethal attempt, possible inaccuracy of descriptions of past attempts, and potential flawed scoring of fearlessness about death.

The researchers concluded that fearlessness about death does not differ by suicide attempt method and that other aspects of capability, such as familiarity with and access to means, may be more relevant in distinguishing the method used in a suicide attempt in patients at high risk for suicide.


Bauer BW, Gai AR, Duffy ME, et al. Fearlessness about death does not differ by suicide attempt method [published online February 22, 2020]. J Psychiatr Res. doi: 10.1016/j.jpsychires.2020.02.014