Fibromyalgia: Neuropsychological and Clinical Correlates in Suicidal Behavior Based on<em> Ideation-to-Action</em> Models – A Critical Review

Fibromyalgia (FM) is associated with increased suicidal behavior (SB). This critical review integrates the ideation-to-action models— Interpersonal Theory of Suicide (IPTS), Three-Step Theory (3ST), and Integrated Motivational-Volitional Model (IMV)—with clinical and neuropsychological correlates to discriminate between suicidal ideation (the motivational component) and suicidal action (the volitional component) in FM. Ideation is related to hopelessness, perceived burden, thwarted belongingness, and entrapment, as well as to pain/interference, sleep disturbances, fatigue, mood, pain catastrophizing, and attentional pain vigilance. The transition to action is associated with impulsivity, executive dysfunction (including inhibitory control, flexibility, and decision-making under ambiguity/risk), acquired capability due to repeated exposure to pain and medical procedures, and access to lethal means. Suicidal planning is conceptualized as high-severity ideation, while action includes preparatory behaviors and suicide attempts. Evidence from Spanish instruments is synthesized— Columbia–Suicide Severity Rating Scale (C-SSRS), Plutchik Suicide Risk Scale (PSRS), Beck Depression Inventory-II (item 9 of the BDI-II), and Suicide Behaviors Questionnaire-Revised (SBQ-R)—pointing out overlaps with pain/depression and the lack of specific validation in FM. Prospective cohorts, standardization of definitions/windows, comparable neuropsychological batteries, and mechanistic trials on motivational and volitional targets and interventions focused on pain reduction are proposed.