Moving Beyond Self‐Report: Implicit Associations about Death/Life Prospectively Predict Suicidal Behavior among Veterans

Abstract

Reliance on self-report limits clinicians' ability to accurately predict suicidal behavior. In this study the predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans. Following acute stabilization, 176 participants completed the d/sIAT and traditional suicide risk assessments. Participants had similar d/sIAT scores regardless of whether they had recently attempted suicide. However, d/sIAT scores significantly predicted suicide attempts during the 6-month follow-up above and beyond other known risk factors for suicidal behavior (OR = 1.89; 95% CI: 1.15-3.12; based on 1SD increase). The d/sIAT may augment the accuracy of suicide risk assessment.

Implicit identification with death predicts change in suicide ideation during psychiatric treatment in adolescents

“…Consistent with research using the self‐injury version of the IAT among adolescents (Cha, Augenstein et al., ; Glenn, Kleiman, Cha, Nock, & Prinstein, ; Nock & Banaji, ), current findings indicate that implicit identification with death is present early on in the development of suicidal thoughts and behaviors—rather than after decades of chronic suicidal thoughts, urges, and behaviors. Moreover, like research in adults (Barnes et al., ; Ellis et al., ; Nock et al., ), implicit death‐related cognition correlates with suicidal states: among a group of suicidal adolescents, implicit identification with death significantly predicted persistent suicidal thinking at hospital discharge. Integrating this study with prior work, the Death IAT appears to assess suicidal thinking (and potentially suicide risk) that is not consciously accessible to the individual or measurable via explicit self‐report measures.…”

Developing Predictive Models to Enhance Clinician Prediction of Suicide Attempts Among Veterans With and Without PTSD

“…Study procedures are described in detail in Barnes et al. () and were reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB) and the Human Research Protections Office (HRPO). Eligible participants met with a research team member for a baseline visit on the psychiatric inpatient unit to complete the interview and self‐report measures described below.…”

“…The Death IAT, SITBI, BSS, demographics form, and medical record review are described in additional detail in Barnes et al. ().…”

“…The Death IAT evaluates implicit self‐associations with death and life (i.e., unconscious associations held by the respondent regarding self and death or life) by measuring participants’ reaction times in classifying stimuli related to death (e.g., lifeless, suicide) and life (e.g., thrive, breathing) via a computerized semantic categorization task. Stronger associations between self and death than between self and life prospectively predict suicide attempts among Veterans following inpatient hospitalization and among patients following psychiatric emergency care—above and beyond established risk factors for suicide (Barnes et al., ; Nock, Park et al., ; Randall, Rowe, Dong, Nock, & Colman, ). For example, accounting for age, clinician prediction, and patient prediction of the likelihood of attempting suicide, Death IAT performance demonstrated incremental validity in predicting suicide attempts during the next six months among Veterans hospitalized for elevated suicide risk (Barnes et al., ).…”

“…Stronger associations between self and death than between self and life prospectively predict suicide attempts among Veterans following inpatient hospitalization and among patients following psychiatric emergency care—above and beyond established risk factors for suicide (Barnes et al., ; Nock, Park et al., ; Randall, Rowe, Dong, Nock, & Colman, ). For example, accounting for age, clinician prediction, and patient prediction of the likelihood of attempting suicide, Death IAT performance demonstrated incremental validity in predicting suicide attempts during the next six months among Veterans hospitalized for elevated suicide risk (Barnes et al., ). However, the Death IAT used alone still lacks the predictive precision to meet the needs of clinicians.…”