What is Capability for Suicide? A Review of the Current Evidence

Abstract

It is well known that most people who think about suicide do not attempt or die by suicide. Capability for suicide, a construct proposed by Joiner (2005) within the interpersonal theory of suicide, was relatively novel in that it explained a potential mechanism by which individuals move from thinking about suicide to engaging in suicidal behavior. In this paper, we examine Joiner’s (2005) original conceptualization of the nature of capability for suicide, and review the evidence for and against this conceptualization. We examine the evidence for specific constructs that comprise capability for suicide, how capability for suicide develops, whether it can change, and possibilities regarding the functional neural correlates of capability for suicide. We then end our review proposing future directions in the study of capability for suicide, which include research across disciplines and countries.

Exploring the indirect effects of acute dissociation on capability and suicide risk: A multi‐method investigation with augmented reality

“…Capability for suicide may develop over time after the accumulation of PPEs. However, temporary increases and reductions in capability may result, given the presence of short-term or state-based factors (Gallyer et al, 2020).…”

“…However, other experimental and longitudinal evidence suggests that PPEs, such as prior suicide attempts and deployment history, have not been shown to increase capability (Ribeiro et al, 2020). Instead of capability steadily increasing over time, it has been proposed that capability may instead be influenced and temporarily fluctuate by certain short‐term and state‐dependent factors, but this has yet to be examined (Gallyer et al, 2020). It seems possible that state‐dependent factors may temporarily influence capability for suicide; thus, examining whether state‐dependent factors impact capability is relevant to understand the suicidal process further.…”

Are all pain tolerance tasks the same? Convergent validity of four behavioral pain tolerance tasks, self‐reported capability for suicide, and lifetime self‐injurious behaviors

“…Furthermore, it is also plausible that capability for suicide may be a more stable construct than originally hypothesized. In particular, some evidence suggests that, although capability for suicide may fluctuate within brief windows of time (Rogers et al, under review; Spangenberg et al, 2019; Zuromski et al, 2018), it may remain relatively stable over longer durations (Bryan et al, 2016; Gallyer et al, 2020; Velkoff & Smith, 2019). Finally, pain tolerance and persistence may be somewhat context‐dependent, in that who inflicts self‐directed pain (e.g., the individual in a naturalistic setting vs. a researcher in a lab setting) influences the degree of pain that an individual is able and willing to withstand.…”

“…Specifically, according to several leading theories of suicide, elevated pain tolerance is a component of capability for suicide, a factor that differentiates individuals who desire suicide from those who are able to attempt suicide (Joiner, 2005; Klonsky & May, 2015; O'Connor & Kirtley, 2018; Van Orden et al, 2010). Research to date supports the role of pain tolerance in capability for suicide (Gallyer et al, 2020), as well as the role of capability for suicide—and pain tolerance, specifically—in both self‐injurious and suicidal behaviors (Chu et al, 2017; Koenig et al, 2016; Law et al, 2017).…”

“…In addition to not knowing how various measures of pain threshold, tolerance, and persistence relate to each other, little is known about these pain facets' relative associations with capability for suicide or with suicidal behaviors. This dearth of knowledge results, in part, from the fact that most studies that investigate the pain tolerance component of capability for suicide use self‐report measures (Chu et al, 2017; Gallyer et al, 2020) and that other such studies use only a single task (e.g., the cold pressor task or the pressure algometer; Franklin et al, 2011; Rogers & Joiner, 2019) to assess pain tolerance. Addressing these gaps in the literature may have implications for the study of capability for suicide and for the use of behavioral pain tolerance tasks in better detecting and understanding suicidal behaviors among those with suicidal desire.…”