Testing within-person correlates of daily fearlessness about death in young adults

Fearlessness about death (FAD) reflects a reduced fear of dying that enables individuals to act on suicidal thoughts. Understanding how FAD changes in real time is critical because suicide risk can escalate within hours. However, little is known about processes that influence FAD within brief time periods. Painful and provocative events (PPEs), affective lability and impulsivity have each been linked to suicidal behavior and may shape momentary increases in FAD, but prior studies have been largely cross-sectional. To address this gap, we enrolled 148 young adults with past year suicidal thoughts and/or behaviors to complete ecological momentary assessments five times per day for 21 days. Using multi-level modeling, we tested the impact of daily fluctuations in affective states (happy, sad, anxious, angry, ashamed, and hopeless) and impulsivity on same-day FAD, with daily engagement in PPEs as a mediator. Results indicated that greater daily lability in impulsivity, anger, sadness and shame was associated with increased same-day FAD. Contrary to hypotheses, these effects were not mediated by PPE engagement. Short-term increases in FAD may arise from rapid shifts in emotions and impulsivity, rather than experiences such as PPEs. Capturing these dynamic, within-person changes can refine suicide theory and improve real-time suicide risk assessment.