Canadian Psychological Association Annual Convention, June 2015, Ottawa, Ontario NON-SUICIDAL SELF-INJURY PREDICTS INCREASED SUICIDAL IDEATION, SUICIDE ATTEMPTS, AND ACQUIRED CAPABILITY FOR SUICIDE Christine E. Lambert, Queen’s University, Kingston, Ontario Abstract Hypotheses Results II Non-suicidal self-injury (NSSI) has been defined as the direct and deliberate destruction of one’s own body tissue without suicidal intent. Despite the lack of suicidal intent characteristic of NSSI, a history of NSSI is predictive of suicide attempts. However, little empirical research has assessed NSSI as a risk factor for suicide. According to the Interpersonal Theory of Suicide (ITS), a person will not die by suicide without the simultaneous presence of three characteristics: thwarted belongingness, perceived burdensomeness, and acquired capability for suicide (Van Orden et al., 2010). Acquired capability for suicide consists of fearlessness of death and increased pain tolerance, and emerges via repeated exposure to fear-inducing and physically painful stimuli. According to the ITS, NSSI could be related to increased risk of death by suicide by increasing acquired capability for suicide. The current study investigated whether NSSI was a significant predictor of suicidal ideation or suicide attempts. Results showed that NSSI was a significant predictor of both, outperforming some of the traditional measures. NSSI also significantly predicted increased acquired capability for suicide and increased pain tolerance. These findings support the value of NSSI in predicting suicide attempts, as well as the theory that NSSI increases risk of death by suicide by increasing acquired capability for suicide. Study 1: Hypothesis 1: Psychache, hopelessness, depression, and NSSI will all be significant predictors of suicide attempts. Hypothesis 2: Psychache, hopelessness, depression, and NSSI will all be significant predictors of suicide ideation. Hypothesis 3: Consistent with previous research, hopelessness and depression will predict suicide motivation (3a), and psychache and NSSI will predict suicide preparation (3b) Study 2: Hypothesis 1: Both self-harmer status and severity of self-harm will predict higher capability for suicide. Hypothesis 2: Both self-harmer status and severity of self-harm will predict higher pain tolerance. Table 2. Study 1 Regression Coefficients   Hyp. 1: Suicide Attempts Hyp. 2: Total Suicidal Ideation Hyp. 3a: Suicide Motivation Hyp. 3b: Suicide Preparation R2 .17** .72** .44** .46** Statistical Predictor β p Depression .054 .694 .136 .207 .261 .065 -.022 .825 Hopelessness -.039 .781 .107 .309 .208 .064 .114 .273 Psychache .191 .330 .263 .014 .090 .475 .314 .002 NSSI .283 .067 .395 .000 .269 .032 .436 Method Participants Study 1: 212 students, age 17-37 years (M = 19.63, SD = 1.79), 191 women Study 2: 182 women, age 17-26 years (M = 18.83, SD = 1.37) Materials Suicide history questions, Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSS), Psychache Scale, Deliberate Self-Harm Inventory (DSHI), Interpersonal Needs Questionnaire, Acquired Capability for Suicide Scale, measure of pain tolerance across 5 trials using a Model 50 FPX Algometer NSSI was measured operationally using the DSHI: participants respond yes/no to 17 forms of intentional, non-suicidal self-injury, including cutting, burning, scratching, biting, banging, etc. ** Significant at the 0.01 level (2-tailed); * Significant at the 0.05 level (2-tailed). Study 2 Individuals with a history of self-harm (M = 41.81, SD = 11.40) had significantly higher acquired capability for suicide scores than those without (M = 35.56, SD = 11.03), t(178) = 3.72, p < .001. DSHI total scores were significantly, positively correlated with acquired capability for suicide, r = .337, p < .001. Those with a history of NSSI (M = 7.04, SD = 3.26) had significantly higher pain tolerance scores than those without (M = 5.76, SD = 2.45), t(174) = 2.98, p = .003. Significant correlation between severity of self-harm and pain tolerance, r = .155, p = .039. Background Hopelessness & Depression: established statistical predictors of suicidal ideation and death by suicide Psychache: intense psychological pain/aching/anguish. Posited by Shneidman (1993) to be a necessary condition for death by suicide: the individual deems that the only solution to the pain is cessation of consciousness. All other factors (depression, etc.) are considered secondary. Interpersonal Theory of Suicide (ITS): suicide will not occur without the presence of 2 interpersonal factors and Acquired Capability for Suicide (Van Orden et al., 2010) Interpersonal Factors Perceived Burdensomeness: the belief that one is a burden to the people around him, and that others would be better off if (s)he were gone Thwarted Belongingness: feeling different or disconnected from other people; a frustrated human need to belong Acquired Capability for Suicide (ACS) Consists of Pain Tolerance and Fearlessness of Death Develops gradually through repeated exposure to painful and provocative events, such as self-injury Therefore, NSSI may increase risk of death by suicide by increasing Acquired Capability for Suicide Suicide Motivation: suicide ideation/desire to die by suicide Suicide Preparation: a more severe form of suicide ideation; consists of making plans or taking actions toward dying by suicide Conclusions Only NSSI was a marginal predictor of suicide attempts due to the low number of attempts in this sample. Suggests that with more power, NSSI would outperform traditional predictors. Only NSSI and Psychache were significant predictors of suicidal ideation - outperformed traditional predictors. Only NSSI was a significant predictor of suicide motivation; NSSI and Psychache were significant predictors of suicide preparation – NSSI predicts the more severe subtype of suicidal ideation. A history of NSSI predicted increased Acquired Capability for Suicide scores – supports hypothesis that NSSI may increase risk of death by suicide by increasing ACS. A history of NSSI predicted increase Pain Tolerance scores –further support for NSSI increasing risk of death by suicide by increasing ACS hypothesis. Results I Table 1. Prevalence of NSSI and Suicide Attempts Study 1 Study 2 Participants 212 182 Past NSSI 80 (38%) 83 (45%) 68/80 women All women Suicide Attempt 7 (3.3%) 14 (7.7%) References Holden, R. R., Mehta, K., Cunningham, E. J., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science/Revue Canadienne Des Sciences Du Comportement, 33(4), 224–232. http://doi.org/10.1037/h0087144 Shneidman, E. S. (1993). Suicide as psychache. The Journal of Nervous and Mental Disease. http://doi.org/10.1097/00005053-199303000-00001 Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. Correspondence Christine E. Lambert, Department of Psychology, Queen’s University, Kingston, ON K7L 3N6, Canada. Email: 41cel2@queensu.ca