Forecasting a Fatal Decision: Direct Replication of the Predictive Validity of the Suicide–Implicit Association Test

Abstract

A previous study by Nock et al. (2010) suggested that people’s implicit identification with “death” or “suicide” can accurately predict whether they will attempt suicide several months in advance. We report the first direct and independent replication of this promising finding. Participants were 165 patients seeking treatment at a psychiatric unit in France. At baseline, patients completed the Suicide–Implicit Association Test (S–IAT), a semistructured interview, and a self-report measure of suicide ideation. Six months later, we contacted participants by phone and examined their hospital medical records to determine whether they had made a new suicide attempt. Results showed that the S–IAT did not distinguish between patients who were admitted to the hospital following suicide attempts and those who were admitted for other reasons. As in the original study, however, the S–IAT predicted suicide attempts within the 6-month follow-up period beyond well-known predictors. The test correctly classified 85% of patients (95% confidence interval = [76.91, 91.53]), supporting its diagnostic value for identifying who will make a suicide attempt.

Do implicit measures improve suicide risk prediction? An 18‐month prospective study using different tasks

“…To summarize, contrary to previous studies (Barnes et al, 2017;Nock et al, 2010;Tello et al, 2020), our results do not suggest that implicit measures predict suicide behavior, whether planning or an actual attempt. Yet, important differences between previous studies and the current study need to be pointed out.…”

“…Previous studies showed that the Death IAT can be used to predict suicide attempts in the long term (Barnes et al, 2017;Nock et al, 2010;Tello et al, 2020). In this study, we set out to investigate a longer follow-up period (18 months), test a wider range of implicit methods (three IATs and a subliminal priming task), and report multiple outcomes in regard to suicidality.…”

“…Third, the time point of assessment after admission was different than in Nock et al (2010) and Tello et al (2020). Nock and Tello investigated all psychiatric patients in an emergency department, not all of whom ended up hospitalized.…”

“…The question is then whether participants with a stronger association between "death" and "me" have an increased risk for suicide. Three studies (Barnes et al, 2017;Nock et al, 2010;Tello et al, 2020) found that results on the Death IAT improved the prediction of suicide attempt over a 6-month follow-up period above other risk factors (e.g., patient's prediction). The first study (Nock et al, 2010) investigated patients with a lifetime history of suicide attempt from a psychiatric emergency department; an effect recently replicated directly and independently by Tello et al (2020).…”

“…Three studies (Barnes et al, 2017;Nock et al, 2010;Tello et al, 2020) found that results on the Death IAT improved the prediction of suicide attempt over a 6-month follow-up period above other risk factors (e.g., patient's prediction). The first study (Nock et al, 2010) investigated patients with a lifetime history of suicide attempt from a psychiatric emergency department; an effect recently replicated directly and independently by Tello et al (2020). The third study (Barnes et al, 2017) investigated veterans hospitalized due to suicide risk.…”