Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T23:37:56.190Z Has data issue: false hasContentIssue false
  • English
  • Français

The death-implicit association test and suicide attempts: a systematic review and meta-analysis of discriminative and prospective utility

Published online by Cambridge University Press:  25 May 2021

Maya N. Sohn ,
Carly A. McMorris ,
Signe Bray  and
Alexander McGirr Open the ORCID record for Alexander McGirr [Opens in a new window]
Maya N. Sohn
Affiliation:
Department of Psychiatry, University of Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
Carly A. McMorris
Affiliation:
Werklund School of Education, University of Calgary, Calgary, Alberta, Canada The Owerko Centre, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
Signe Bray
Affiliation:
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Child and Adolescent Imaging Research (CAIR) Program, University of Calgary, Calgary, Alberta, Canada
Alexander McGirr*
Affiliation:
Department of Psychiatry, University of Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
*
Author for correspondence: Alexander McGirr, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Suicide risk assessment involves integrating patient disclosure of suicidal ideation and non-specific risk factors such as family history, past suicidal behaviour, and psychiatric symptoms. A death version of the implicit association test (D-IAT) has been developed to provide an objective measure of the degree to which the self is affiliated with life or death. However, this has inconsistently been associated with past and future suicidal behaviour. Here, we systematically review and quantitatively synthesize the literature examining the D-IAT and suicide attempts. We searched psychINFO, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until 9 February 2021 to identify publications reporting D-IAT scores and suicide attempts (PROSPERO; CRD42020194394). Using random-effects models, we calculated standardized mean differences (SMD) and odds ratios (ORs) for retrospective suicide attempts. We then calculated ORs for future suicide attempts. ORs were dichotomized using a cutoff of zero representing equipoise between self-association with life and death. Eighteen studies met our inclusion criteria (n = 9551). The pooled SMD revealed higher D-IAT scores in individuals with a history of suicide attempt (SMD = 0.25, 95% CI 0.15 to 0.35); however, subgroup analyses demonstrated heterogeneity with acute care settings having lower effect sizes than community settings. Dichotomized D-IAT scores discriminated those with a history of suicide attempt from those without (OR 1.38 95% CI 1.01 to 1.89) and predicted suicide attempt over a six-month follow-up period (OR 2.99 95% CI 1.45 to 6.18; six studies, n = 781). The D-IAT may have a supplementary role in suicide risk assessment; however, determination of acute suicide risk and related clinical decisions should not be based solely on D-IAT performance.

Keywords

Death-implicit association testD-IATsuicidal behavioursuicide attemptssuicide
Type
Review Article
Information
Psychological Medicine , Volume 51 , Issue 11 , August 2021 , pp. 1789 - 1798
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ballard, E. D., Gilbert, J. R., Fields, J. S., Nugent, A. C., & Zarate, C. A. (2020). Network changes in insula and amygdala connectivity accompany implicit suicidal associations. Frontiers in Psychiatry, 11, 577628. https://doi.org/10.3389/fpsyt.2020.577628.CrossRefGoogle ScholarPubMed
Ballard, E. D., Reed, J. L., Szczepanik, J., Evans, J. W., Yarrington, J. S., Dickstein, D. P., … Zarate, C. A. (2019). Functional imaging of the implicit association of the self with life and death. Suicide and Life-Threatening Behavior, 49(6), 1600–1608. https://doi.org/10.1111/sltb.12543.CrossRefGoogle ScholarPubMed
Barnes, S. M., Bahraini, N. H., Forster, J. E., Stearns-Yoder, K. A., Hostetter, T. A., Smith, G., … Nock, M. K. (2017). Moving beyond self-report: Implicit associations about death/life prospectively predict suicidal behavior among veterans. Suicide and Life-Threatening Behavior, 47(1), 67–77. https://doi.org/10.1111/sltb.12265.CrossRefGoogle ScholarPubMed
Beck, A. T., Brown, G. K., & Steer, R. A. (1997). Psychometric characteristics of the scale for suicide ideation with psychiatric outpatients. Behaviour Research and Therapy, 35(11), 1039–1046. https://doi.org/10.1016/S0005-7967(97)00073-9.CrossRefGoogle ScholarPubMed
Bender, T. W., Fitzpatrick, S., Hartmann, M.-A., Hames, J., Bodell, L., Selby, E. A., & Joiner, T. E. (2019). Does it hurt to ask? An analysis of iatrogenic risk during suicide risk assessment. Neurology, Psychiatry and Brain Research, 33, 73–81. https://doi.org/10.1016/j.npbr.2019.07.005.CrossRefGoogle Scholar
Busch, K. A., Fawcett, J., & Jacobs, D. G. (2003). Clinical correlates of inpatient suicide. The Journal of Clinical Psychiatry, 64(1), 14–19. https://doi.org/10.4088/JCP.v64n0105.CrossRefGoogle ScholarPubMed
Buyukdura, J. S., McClintock, S. M., & Croarkin, P. E. (2011). Psychomotor retardation in depression: Biological underpinnings, measurement, and treatment. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(2), 395–409. https://doi.org/10.1016/j.pnpbp.2010.10.019.CrossRefGoogle ScholarPubMed
Cha, C. B., O'Connor, R. C., Kirtley, O., Cleare, S., Wetherall, K., Eschle, S., … Nock, M. K. (2018). Testing mood-activated psychological markers for suicidal ideation. Journal of Abnormal Psychology, 127(5), 448–457. https://doi.org/10.1037/abn0000358.CrossRefGoogle ScholarPubMed
Conrey, F. R., Sherman, J. W., Gawronski, B., Hugenberg, K., & Groom, C. J. (2005). Separating multiple processes in implicit social cognition: The quad model of implicit task performance. Journal of Personality and Social Psychology, 89(4), 469–487. https://doi-org.ezproxy.lib.ucalgary.ca/10.1037/0022-3514.89.4.469.CrossRefGoogle ScholarPubMed
Deeks, J.J., Higgins, J.P.T., & Altman, D.G. (Eds.). (2020). Chapter 10: Analysing data and undertaking meta-analyses. In J. P. T. Higgins, J. Thomas, J. Chandler, M. Cumpston, T. Li, M. J. Page, & V. A. Welch (Eds.), Cochrane handbook for systematic reviews of interventions (6.1) (Updated September 2020). Cochrane, 2020. Available from www.training.cochrane.org/handbook.Google Scholar
Dickstein, D. P., Puzia, M. E., Cushman, G. K., Weissman, A. B., Wegbreit, E., Kim, K. L., … Spirito, A. (2015). Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury. Journal of Child Psychology and Psychiatry, 56(10), 1127–1136. https://doi.org/10.1111/jcpp.12385.CrossRefGoogle ScholarPubMed
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629.CrossRefGoogle ScholarPubMed
Ellis, T. E., Rufino, K. A., & Green, K. L. (2016). Implicit measure of life/death orientation predicts response of suicidal ideation to treatment in psychiatric inpatients. Archives of Suicide Research, 20(1), 59–68. Academic Search Complete.CrossRefGoogle ScholarPubMed
Erickson, K., Drevets, W. C., Clark, L., Cannon, D. M., Bain, E. E., Zarate, C. A., … Sahakian, B. J. (2005). Mood-congruent bias in affective Go/No-Go performance of unmedicated patients with major depressive disorder. American Journal of Psychiatry, 162(11), 2171–2173. https://doi.org/10.1176/appi.ajp.162.11.2171.CrossRefGoogle ScholarPubMed
Faraone, S. V. (2008). Interpreting estimates of treatment effects. Pharmacy and Therapeutics, 33(12), 700–711.Google ScholarPubMed
Fischer, G., Ameis, N., Parzer, P., Plener, P. L., Groschwitz, R., Vonderlin, E., … Kaess, M. (2014). The German version of the self-injurious thoughts and behaviors interview (SITBI-G): A tool to assess non-suicidal self-injury and suicidal behavior disorder. BMC Psychiatry, 14, 265. https://doi-org.ezproxy.lib.ucalgary.ca/10.1186/s12888-014-0265-0.CrossRefGoogle ScholarPubMed
Glaesmer, H., Kapusta, N. D., Teismann, T., Wagner, B., Hallensleben, N., Spangenberg, L., & Forkmann, T. (2018). Psychometrische eigenschaften der deutschen version des suicide behaviors questionnaire revised (SBQ-R) [psychometric properties of the German version of the suicide behaviors questionnaire revised (SBQ-R)]. Psychotherapie, Psychosomatik, medizinische Psychologie, 68(8), 346–352. https://doi-org.ezproxy.lib.ucalgary.ca/10.1055/s-0043-118335.Google Scholar
Glenn, C. R., Kleiman, E. M., Coppersmith, D. D. L., Santee, A. C., Esposito, E. C., Cha, C. B., … Auerbach, R. P. (2017a). Implicit identification with death predicts change in suicide ideation during psychiatric treatment in adolescents. Journal of Child Psychology and Psychiatry, 58(12), 1319–1329. https://doi.org/10.1111/jcpp.12769.CrossRefGoogle Scholar
Glenn, C. R., Millner, A. J., Esposito, E. C., Porter, A. C., & Nock, M. K. (2019). Implicit identification with death predicts suicidal thoughts and behaviors in adolescents. Journal of Clinical Child & Adolescent Psychology, 48(2), 263–272. https://doi.org/10.1080/15374416.2018.1528548.CrossRefGoogle ScholarPubMed
Glenn, J. J., Werntz, A. J., Slama, S. J. K., Steinman, S. A., Teachman, B. A., & Nock, M. K. (2017b). Suicide and self-injury-related implicit cognition: A large-scale examination and replication. Journal of Abnormal Psychology, 126(2), 199–211. https://doi.org/10.1037/abn0000230.CrossRefGoogle Scholar
Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74(6), 1464–1480. https://doi.org/10.1037/0022-3514.74.6.1464.CrossRefGoogle ScholarPubMed
Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85(2), 197–216. https://doi.org/10.1037/0022-3514.85.2.197.CrossRefGoogle ScholarPubMed
Harrison, D. P., Stritzke, W. G. K., Fay, N., Ellison, T. M., & Hudaib, A.-R. (2014). Probing the implicit suicidal mind: Does the death/suicide implicit association test reveal a desire to die, or a diminished desire to live? Psychological Assessment, 26(3), 831–840. https://doi.org/10.1037/pas0000001.CrossRefGoogle ScholarPubMed
Harrison, D. P., Stritzke, W. G. K., Fay, N., & Hudaib, A.-R. (2018). Suicide risk assessment: Trust an implicit probe or listen to the patient? Psychological Assessment, 30(10), 1317–1329. https://doi.org/10.1037/pas0000577.CrossRefGoogle ScholarPubMed
Harrison, D. P., Stritzke, W. G. K., Leong, J. Y. S., Ellison, T.M., Fay, N., & Hudaib, A.-R. (2020). Chapter 2—The implicit suicidal mind clings to life. In A. C. Page & W. G. K. Stritzke (Eds.), Alternatives to suicide (pp. 17–44). Academic Press. https://doi.org/10.1016/B978-0-12-814297-4.00002-9.CrossRefGoogle Scholar
Higgins, J. P. T., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21(11), 1539–1558. https://doi.org/10.1002/sim.1186.CrossRefGoogle ScholarPubMed
Ho, T. C., Cichocki, A. C., Gifuni, A. J., Catalina Camacho, M., Ordaz, S. J., Singh, M. K., & Gotlib, I. H. (2018). Reduced dorsal striatal gray matter volume predicts implicit suicidal ideation in adolescents. Social Cognitive and Affective Neuroscience, 13(11), 1215–1224. https://doi.org/10.1093/scan/nsy089.CrossRefGoogle ScholarPubMed
Ho, T. C., Teresi, G. I., Ojha, A., Walker, J. C., Kirshenbaum, J. S., Singh, M. K., & Gotlib, I. H. (2021). Smaller caudate gray matter volume is associated with greater implicit suicidal ideation in depressed adolescents. Journal of Affective Disorders, 278, 650–657. doi: 10.1016/j.jad.2020.09.046.CrossRefGoogle ScholarPubMed
Jost, J. T. (2019). The IAT Is dead, long live the IAT: Context-sensitive measures of implicit attitudes Are indispensable to social and political psychology. Current Directions in Psychological Science, 28(1), 10–19. https://doi.org/10.1177/0963721418797309.CrossRefGoogle Scholar
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., … Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988. https://doi-org.ezproxy.lib.ucalgary.ca/10.1097/00004583-199707000-00021.CrossRefGoogle ScholarPubMed
Keller, A. S., Leikauf, J. E., Holt-Gosselin, B., Staveland, B. R., & Williams, L. M. (2019). Paying attention to attention in depression. Translational Psychiatry, 9(1), 279. https://doi.org/10.1038/s41398-019-0616-1.CrossRefGoogle ScholarPubMed
Millner, A. J., Augenstein, T. M., Visser, K. H., Gallagher, K., Vergara, G. A., D'Angelo, E. J., & Nock, M. K. (2019). Implicit cognitions as a behavioral marker of suicide attempts in adolescents. Archives of Suicide Research, 23(1), 47–63. https://doi.org/10.1080/13811118.2017.1421488.CrossRefGoogle ScholarPubMed
Millner, A. J., Coppersmith, D. D. L., Teachman, B. A., & Nock, M. K. (2018). The brief death implicit association test: Scoring recommendations, reliability, validity, and comparisons with the death implicit association test. Psychological Assessment, 30(10), 1356–1366. https://doi.org/10.1037/pas0000580.CrossRefGoogle ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G., & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefGoogle ScholarPubMed
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. https://doi.org/10.1037/1040-3590.19.3.309.CrossRefGoogle Scholar
Nock, M. K., Park, J. M., Finn, C. T., Deliberto, T. L., Dour, H. J., & Banaji, M. R. (2010). Measuring the suicidal mind: Implicit cognition predicts suicidal behavior. Psychological Science, 21(4), 511–517. https://doi.org/10.1177/0956797610364762.CrossRefGoogle ScholarPubMed
O'Shea, B. A., Glenn, J. J., Millner, A. J., Teachman, B. A., & Nock, M. K. (2020). Decomposing implicit associations about life and death improves our understanding of suicidal behavior. Suicide and Life-Threatening Behavior, 50(5), 1065–1074. https://doi.org/10.1111/sltb.12652.CrossRefGoogle ScholarPubMed
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The suicidal behaviors questionnaire-revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–454. https://doi.org/10.1177/107319110100800409.CrossRefGoogle ScholarPubMed
Oswald, F.L., Mitchell, G., Blanton, H., Jaccard, J., & Tetlock, P. E. (2013). Predicting ethnic and racial discrimination: A meta-analysis of IAT criterion studies. Journal of Personality and Social Psychology, 105(2), 171–192. https://doi.org/10.1037/a0032734.CrossRefGoogle ScholarPubMed
Podlogar, M. C., Gutierrez, P. M., & Joiner, T. E. (2020). Improving our understanding of the death/life implicit association test. Journal of Personality Assessment, 102(6), 845–857. https://doi.org/10.1080/00223891.2019.1663357.CrossRefGoogle ScholarPubMed
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The Columbia–suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704.CrossRefGoogle ScholarPubMed
Price, R. B., Iosifescu, D. V., Murrough, J. W., Chang, L. C., Al Jurdi, R. K., Iqbal, S. Z., … Mathew, S. J. (2014). Effects of ketamine on explicit and implicit suicidal cognition: A randomized controlled trail in treatment-resistant depression: Effects of ketamine on suicidality. Depression and Anxiety, 31(4), 335–343. https://doi.org/10.1002/da.22253.CrossRefGoogle Scholar
Price, R. B., Nock, M. K., Charney, D. S., & Mathew, S. J. (2009). Effects of intravenous ketamine on explicit and implicit measures of suicidality in treatment-resistant depression. Biological Psychiatry, 66(5), 522–526. https://doi.org/10.1016/j.biopsych.2009.04.029.CrossRefGoogle ScholarPubMed
Rath, D., Teismann, T., Schmitz, F., Glaesmer, H., Hallensleben, N., Paashaus, L., … Forkmann, T. (2021). Predicting suicidal behavior by implicit associations with death? Examination of the death IAT in two inpatient samples of differing suicide risk. Psychological Assessment, 33(4), 287–299. https://doi.org/10.1037/pas0000980.CrossRefGoogle ScholarPubMed
Roos, L., Sareen, J., & Bolton, J. M. (2013). Suicide risk assessment tools, predictive validity findings and utility today: Time for a revamp? Neuropsychiatry, 3(5), 483–495. https://doi.org/10.2217/npy.13.60.CrossRefGoogle Scholar
Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., … Higgins, J. P. (2016). ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clinical research ed.), 355, i4919. https://doi.org/10.1136/bmj.i4919.CrossRefGoogle ScholarPubMed
Tello, N., Harika-Germaneau, G., Serra, W., Jaafari, N., & Chatard, A. (2020). Forecasting a fatal decision: Direct replication of the predictive validity of the suicide–implicit association test. Psychological Science, 31(1), 65–74. https://doi.org/10.1177/0956797619893062.CrossRefGoogle ScholarPubMed
Wang, X., Lei, W., Kezhi, L., Liang, X., Wang, Y., Huang, C., … Chen, J. (2020). Implicit measure of suicidal ideation in patients with depression. Death Studies, 1–7. Advance online publication. https://doi.org/10.1080/07481187.2020.1850549.Google ScholarPubMed
WHO. (2020). WHO | Suicide data. WHO; World Health Organization. http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/.Google Scholar
Wilson, T. D. (2009). Know thyself. Perspectives on Psychological Science, 4(4), 384–389. https://doi.org/10.1111/j.1745-6924.2009.01143.x.CrossRefGoogle ScholarPubMed
Zhu, Y., Womer, F. Y., Leng, H., Chang, M., Yin, Z., Wei, Y., … Wang, F. (2019). The relationship between cognitive dysfunction and symptom dimensions across schizophrenia, bipolar disorder, and major depressive disorder. Frontiers in Psychiatry, 10, 253. https://doi.org/10.3389/fpsyt.2019.00253.CrossRefGoogle ScholarPubMed
Supplementary material: File

Sohn et al. supplementary material

Sohn et al. supplementary material

Download Sohn et al. supplementary material(File)
File 924.5 KB