Suicide risk assessment: Trust an implicit probe or listen to the patient?

Abstract

Previous research suggests implicit cognition can predict suicidal behavior. This study examined the utility of the death/suicide implicit association test (d/s-IAT) in acute and prospective assessment of suicide risk and protective factors, relative to clinician and patient estimates of future suicide risk. Patients (N = 128; 79 female; 111 Caucasian) presenting to an emergency department were recruited if they reported current suicidal ideation or had been admitted because of an acute suicide attempt. Patients completed the d/s-IAT and self-report measures assessing three death-promoting (e.g., suicide ideation) and two life-sustaining (e.g., zest for life) factors, with self-report measures completed again at 3- and 6-month follow-ups. The clinician and patient provided risk estimates of that patient making a suicide attempt within the next 6 months. Results showed that among current attempters, the d/s-IAT differentiated between first time and multiple attempters; with multiple attempters having significantly weaker self-associations with life relative to death. The d/s-IAT was associated with concurrent suicidal ideation and zest for life, but only predicted the desire to die prospectively at 3 months. By contrast, clinician and patient estimates predicted suicide risk at 3- and 6-month follow-up, with clinician estimates predicting death-promoting factors, and only patient estimates predicting life-sustaining factors. The utility of the d/s-IAT was more pronounced in the assessment of concurrent risk. Prospectively, clinician and patient predictions complemented each other in predicting suicide risk and resilience, respectively. Our findings indicate collaborative rather than implicit approaches add greater value to the management of risk and recovery in suicidal patients. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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

“…For instance, Chiurliza et al (2018) found that the S-IAT was not related to a history of suicidal ideation among 1,548 U.S. military service members. In the same way, Running head: IMPLICIT ASSOCIATION, SUICIDE, AND REPLICATION 6 Harrison, Stritzke, Fay, and Hudaib (2018) found little evidence that the S-IAT prospectively predicted suicide risks in a clinical sample, above and beyond clinician prediction.…”

Reduced dorsal striatal gray matter volume predicts implicit suicidal ideation in adolescents

“…Third, individuals—and, in particular, adolescents—may not have the self-awareness to report accurately on the cognitive processes underlying their behavior (Nock et al ., 2010 ; Weil et al ., 2013 ). To address these limitations, researchers examining risk for suicidal behaviors have begun to use cognitive tasks involving implicit measurements that do not rely on self-report (Cha et al ., 2010 ; Barnes et al ., 2016 ; Harrison et al ., 2018 ). One such task is a version of the Implicit Association Test (IAT) that measures response latencies to speeded judgments of pairs of death-related and self-related words (Nock et al ., 2010 ; Glenn et al ., 2017 ).…”

Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research

“…In contrast, Harrison, Stritzke, Fay, and Hudaib (2018) reported that clinician prediction did not significantly predict future attempts at three-and six-month follow-up (p ¼ 0.16 and p ¼ 0.30, respectively), despite significantly predicting suicidal ideations at both timepoints (p ¼ 0.049 and p ¼ 0.011, respectively). Another study found that, while clinician assessment of risk was moderately accurate at predicting future suicide attempts (AUC ¼ 0.728, 95%CI 0.66-0.79), it was not effective at predicting deaths from suicide (AUC ¼ 0.546, 95%CI 0.36-0.73) (Randall et al, 2019).…”