Validation of Fearlessness About Death Scale in Adolescents

Recent theories of suicide behavior have proposed a risk factor that differentiates suicide ideators from suicide attempters: Suicide capability. Fearlessness about death, one component of capability, has predicted the likelihood of a future attempt in adult samples. Although there is preliminary evidence about its value in youth, the fearlessness about death scale (FAD) has not yet been validated in clinical adolescents. We sought to examine the psychometric properties of this scale in adolescents at high risk for making a future suicide attempt. Youth who were evaluated for an intensive outpatient program (IOP) for suicidal adolescents (N = 496; M, SD for age = 14.78, 1.59) reported lifetime history of suicide attempts and NSSI, suicide ideation, depressive symptoms, and completed the FAD at entry and at discharge (n = 329). Confirmatory factor analysis showed structural validity of the FAD scale and its invariance across age, sex, and time. Independent t-tests indicated that FAD scores distinguished between those with and without NSSI, as well as those with single versus multiple attempts. When depression was covaried in logistic regression analyses, FAD's relationship with suicide attempt history persisted, showing the construct's divergence from depression. Our findings present psychometric validity in adolescents for a widely used scale developed for adults. This validation offers confidence that this promising risk factor can be adequately investigated in adolescents. If future studies can confirm its predictive validity, the brevity of this scale would make it a practical addition to a clinical assessment. Public Significance Statement This study presents psychometric validation of the Fearlessness About Death scale (FAD) in a clinical sample of suicidal adolescents. The FAD is a promising measure that may be used by practitioners to assess suicide attempt risk and inform targeted treatment in order to combat prevalent and increasing adolescent suicide rates.