Self-Injury Implicit Association Test: Comparison of Suicide Attempters and Non-attempters

Childhood Maltreatment and Non-Suicidal Self-Injury in Adolescents: Testing a Moderated Mediating Model

There is a wealth of evidence to suggest that childhood maltreatment is a major risk factor contributing to non-suicidal self-injury (NSSI) among adolescents. However, how and under what conditions childhood maltreatment is related to NSSI remains largely unclear. This study examined the indirect effect of depressive symptoms in the relation between childhood maltreatment and non-suicidal self-injury, as well as the moderating role of cognitive reappraisal and emotion reactivity in those associations. A sample of 1,984 Chinese adolescents (Mage = 12.84, SD = 1.27, 47.9% girls) completed self-report questionnaires. The results of path analysis showed that childhood maltreatment was significantly related to NSSI and that depressive symptoms play an indirect effect in the relation between them. Cognitive reappraisal mitigated the effect of childhood maltreatment on depressive symptoms, and emotion reactivity strengthened the effect of depressive symptoms on non-suicidal self-injury. The results further showed that the indirect effect of depressive symptoms was more prominent for youths with lower levels of cognitive reappraisal and greater emotion reactivity. Interventions that enhance cognitive reappraisal and reduce emotion reactivity may interrupt the pathway from childhood maltreatment to NSSI via depressive symptoms.

Implicit cognitions on self-injurious and suicidal behavior in borderline personality disorder

BACKGROUND AND OBJECTIVES

Performance on implicit measures of suicidality has been associated with suicidal and nonsuicidal self-injury. Despite the high prevalence of self-harm in patients with borderline personality disorder (BPD), no previous study has assessed implicit measures in this patient group.

METHODS

Forty patients with BPD and 25 healthy controls completed three implicit association tests (IATs) (Death words - Me/Others words, Self-Harm pictures - Me/Others, and Self-Harm pictures - Good/Bad words) and a subliminal priming task (effect of the primes "dying"/"growing" on the categorization speed of positive/negative adjectives) as well as measures of psychopathology (suicidal ideation, previous nonsuicidal self-injury, borderline symptomatology, depression, and hopelessness).

RESULTS

Patients with BPD had higher scores on all three IATs than healthy controls. The subliminal priming procedure did not reveal group differences. Correlations between implicit measures and psychopathology among patients with BPD were mostly weak and nonsignificant with a few exceptions: Positive correlations were observed between IAT Self-Harm - Good/Bad and lifetime frequency of nonsuicidal self-injury, between IAT Self-Harm - Me/Others and depression, and between IAT Death - Me/Others and depression. Correlations between implicit measures were weak to moderate.

LIMITATIONS

The study was cross-sectional only, and the study had reduced power as the sample size was limited.

CONCLUSIONS

As expected, patients with BPD had higher scores than healthy controls on the IATs, which indicates higher implicit self-identification with self-harm and death as well as stronger implicit positive attitudes towards self-harm. The mostly weak correlations between implicit and explicit measures speak against the discriminative value of IATs in patients with BPD.

Validation of a novel Psychosis-Implicit Association Test (P-IAT) as a diagnostic support tool

Despite significant advances in early-intervention services for psychosis, delays in identifying patients continue to impede the delivery of prompt and effective treatments. We sought to develop and preliminarily validate a self-administered psychosis implicit association task (P-IAT) as a screening and diagnostic support tool for identifying individuals with psychotic illness in community settings. The P-IAT is a response latency task, designed to measure the extent to which individuals implicitly associate psychosis-related terms with the "self." The P-IAT was administered to 57 participants across 3 groups: healthy controls (N=19), inpatients hospitalized with active psychosis (N=19), and outpatients with psychotic disorders (N=19). Mean D-scores (the output of the task) differed significantly between the illness groups and healthy controls (Mann-Whitney U=138, p<.001). A receiver operating curve was plotted to assess the performance of D-scores in predicting a psychosis diagnosis, yielding an area under the curve of 0.81. When participant D-scores exceeded -0.24, the test achieved a specificity of 100% (sensitivity: 47%), with all 18 participants scoring above this threshold belonging to the illness groups. The discriminant performance of the P-IAT suggests its potential to augment existing screening instruments and inform referral decision making, particularly in settings with limited access to specialist providers.

Implicit Cognition Tests for the Assessment of Suicide Risk: a Systematic Review

PURPOSE OF REVIEW

Suicide risk assessment is a challenge in clinical practice. Implicit measures may present with advantages with respect to explicit methods, and therefore may be useful for the assessment of suicide risk. We conducted a systematic review of 2 databases (PubMed and EMBASE) about implicit tests that measure suicide risk to explore their validity and reliability.

RECENT FINDINGS

Initial research revealed 321 articles. After the selection process, 31 articles were included in the review. The most death-related implicit cognition test used was the Death/Suicide Implicit association test (D/S IAT), followed by the Suicide Stroop Task. The Suicide Affect Misattribution Procedure (S-AMP) and the Death version of the Implicit Relational Assessment Procedure (D-IRAP) were also used. We found that the measures reviewed were generally valid for the assessment of past and future suicidal thoughts and behaviors, with statistically significant results regarding retrospective and prospective associations.

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

BACKGROUND

There is accumulating evidence that implicit measures improve the prediction of suicidality within a 6-month follow-up period in psychiatric populations. Building upon these results, we set out to expand the follow-up period and to investigate various implicit methods.

METHODS

Seventy-nine inpatients completed the Beck Scale for Suicidal Ideation (BSS) and a range of implicit measures: three implicit association tests (IATs: Death; Self-harm-Me/Others; Self-Harm-Good/Bad) and a subliminal priming task (with separate scores for negative and positive adjectives, each indicating the association between the primes "dying" and "growing"). After 18 months, we reached n = 52 patients and reassessed suicidal ideation, plans, and attempts.

RESULTS

In a hierarchical regression, the five implicit task indices were entered after the patient's age, gender, and BSS score at baseline. The implicit scores improved prediction of BSS scores after 18 months compared to prediction based on age, gender, and BSS score at baseline alone. However, none of the implicit measures was associated with suicide plans or attempts during the follow-up period.

CONCLUSION

Results suggest that implicit measures can be a useful assessment tool for the prediction of suicidal ideation, even beyond the BSS. However, long-term prediction of suicide plans or attempts using implicit measures seems limited.