Suicide and self-injury-related implicit cognition: A large-scale examination and replication.

Abstract

Suicide and self-injury are difficult to predict because at-risk individuals are often unable or unwilling to report their intentions. Therefore, tools to reliably assess risk without reliance on self-report are critically needed. Prior research suggests that people who engage in suicidal and nonsuicidal self-injury often implicitly (i.e., outside conscious control) associate themselves with self-harm and death, indicating that self-harm-related implicit cognition may serve as a useful behavioral marker for suicide risk. However, earlier studies left several critical questions about the robustness, sensitivity, and specificity of self-harm-related implicit associations unaddressed. We recruited a large sample of participants (N=7,015) via a public web-based platform called Project Implicit Mental Health to test several hypotheses about self-harm-related implicit associations using the Implicit Association Test (IAT). Participants were randomly assigned to complete one of three self-harm IATs (Self + Cutting using picture stimuli, Self + Suicide using word stimuli, Self + Death using word stimuli). Results replicated prior studies demonstrating that self-harm-related implicit associations were stronger among individuals with (vs. without) a history of suicide attempt and nonsuicidal self-injury. Results also suggested that self-harm-related implicit associations are robust (based on internal replication), are sensitive to recency and severity of self-harm history (e.g., stronger associations for more recent and more lethal prior suicide attempts), and correlate with specific types of self-harm behaviors. These findings clarify the nature of self-harm-related implicit cognition and highlight the IAT's potential to track current risk for specific types of self-harm in ways that more fixed risk factors cannot.

Characterizing implicit mental health associations across clinical domains

“…Visitors could select which studies they wished to complete at the site; thus, disorder topics were not assigned randomly. In addition to the four disorder domains examined presently, individuals could choose to complete studies on mental health treatment, self-esteem, stigma toward persons with mental illness, and suicide and self-harm (latter described in Glenn et al, 2015). Research on this site was approved by affiliated Institutional Review Boards.…”

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

“…In the largest study to date, 2,042 adults completed the Death IAT online. Implicit deathrelated cognition was strongest among adults with more frequent, recent, and medically severe suicide attempts (Glenn et al, 2017). Finally, in college students, stronger implicit identification with death significantly related to greater self-reported suicide ideation (Harrison, Stritzke, Fay, Ellison, & Hudaib, 2014;Vannoy et al, 2016), suggesting that implicit death-related cognition tracks severity of suicidal thinking in addition to behavior.…”

“…(), a suicide‐specific version of the IAT has been created (the ‘Suicide IAT’), which includes words related to specific suicide methods (e.g., hanging). For clarity, and consistency with other recent publications (e.g., Glenn et al., ), we refer to the version of the IAT that displays words related to death including the word ‘suicide’ as the Death IAT.…”

Functional Imaging of the Implicit Association of the Self With Life and Death

“…The S-IAT has been associated with past suicide attempts as well as risk of suicide re-attempt above and beyond other suicide risk factors, including suicidal thoughts and clinician assessment . Since the initial publication of the S-IAT in 2010, these results have been replicated in large-scale studies (Glenn et al, 2017), and the task has been used to predict later suicide attempts and self-harm in emergency department (Randall, Rowe, Dong, Nock, & Colman, 2013) and veteran samples (Barnes et al, 2017). The S-IAT has also been shown to predict suicide ideation over the course of psychiatric hospitalization (Ellis, Rufino, & Green, 2016).…”

“…Please note that the term "Suicide IAT" is being used to describe a version of the task that uses words associated with death, such as "funeral" or "lifeless." However, other versions of this task focus on suicide method, such as "gunshot" or "overdose," and these are also sometimes titled "Suicide IAT"(Glenn et al, 2017).…”