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Brüdern J, Spangenberg L, Stein M, Forkmann T, Schreiber D, Stengler K, Gold H, Glaesmer H. Implicit measures of suicide vulnerability: Investigating suicide-related information-processing biases and a deficit in behavioral impulse control in a high-risk sample and healthy controls. Behav Res Ther 2024; 180:104601. [PMID: 38943987 DOI: 10.1016/j.brat.2024.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE Relevant implicit markers of suicidal thoughts and behaviors (STBs) have only been studied in isolation with mixed evidence. This is the first study that investigated a suicide attentional bias, a death-identity bias and a deficit in behavioral impulsivity in a high-risk sample and healthy controls. METHOD We administered the Death Implicit Association Test, the Modified Suicide Stroop Task, and a Go/No-Go Task to inpatient suicide ideators (n = 42), suicide attempters (n = 40), and community controls (n = 61). RESULTS Suicide ideators and attempters showed a suicide attentional bias and a death-identity bias compared to healthy controls. Ideators and attempters did not differ in these implicit information-processing biases. Notably, only attempters were more behaviorally impulsive compared to controls; however, ideators and attempters did not significantly differ in behavioral impulsivity. Moreover, implicit scores were positively intercorrelated in the total sample. CONCLUSION In line with the Cognitive Model of Suicide, ideators and attempters display suicide-related information processing biases, which can be considered as implicit cognitive markers of suicide vulnerability. Furthermore, attempters have elevated levels of behavioral impulsiveness. These results are highly relevant in the context of crisis intervention strategies and warrant further research.
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Affiliation(s)
- Juliane Brüdern
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany.
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Maria Stein
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Dajana Schreiber
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Katarina Stengler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital Leipzig, Germany
| | - Helena Gold
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
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Lamontagne SJ, Gilbert JR, Zabala PK, Waldman LR, Zarate CA, Ballard ED. Clinical, behavioral, and electrophysiological profiles along a continuum of suicide risk: evidence from an implicit association task. Psychol Med 2024; 54:1431-1440. [PMID: 37997749 DOI: 10.1017/s0033291723003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND An urgent need exists to identify neural correlates associated with differing levels of suicide risk and develop novel, rapid-acting therapeutics to modulate activity within these neural networks. METHODS Electrophysiological correlates of suicide were evaluated using magnetoencephalography (MEG) in 75 adults with differing levels of suicide risk. During MEG scanning, participants completed a modified Life-Death Implicit Association Task. MEG data were source-localized in the gamma (30-58 Hz) frequency, a proxy measure of excitation-inhibition balance. Dynamic causal modeling was used to evaluate differences in connectivity estimates between risk groups. A proof-of-concept, open-label, pilot study of five high risk participants examined changes in gamma power after administration of ketamine (0.5 mg/kg), an NMDAR antagonist with rapid anti-suicide ideation effects. RESULTS Implicit self-associations with death were stronger in the highest suicide risk group relative to all other groups, which did not differ from each other. Higher gamma power for self-death compared to self-life associations was found in the orbitofrontal cortex for the highest risk group and the insula and posterior cingulate cortex for the lowest risk group. Connectivity estimates between these regions differentiated the highest risk group from the full sample. Implicit associations with death were not affected by ketamine, but enhanced gamma power was found for self-death associations in the left insula post-ketamine compared to baseline. CONCLUSIONS Differential implicit cognitive processing of life and death appears to be linked to suicide risk, highlighting the need for objective measures of suicidal states. Pharmacotherapies that modulate gamma activity, particularly in the insula, may help mitigate risk.Clinicaltrials.gov identifier: NCT02543983, NCT00397111.
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Affiliation(s)
- Steven J Lamontagne
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Paloma K Zabala
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Laura R Waldman
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Ruch DA, Bridge JA, Tissue J, Madden SP, Galfavy H, Gorlyn M, Sheftall AH, Szanto K, Keilp JG. Alterations in performance and discriminating power of the death/suicide implicit association test across the lifespan. Psychiatry Res 2024; 335:115840. [PMID: 38492262 DOI: 10.1016/j.psychres.2024.115840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/02/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
The Death/Suicide Implicit Association Test (d/s-IAT) has differentiated individuals with prior and prospective suicide attempts in previous studies, however, age effects on test results remains to be explored. A three-site study compared performance on the d/s-IAT among participants aged 16-80 years with depression and prior suicide attempt (n = 82), with depression and no attempts (n = 80), and healthy controls (n = 86). Outcome measures included the standard difference (D) score, median reaction times, and error rates. Higher D scores represent a stronger association between death/suicide and self, while lower scores represent a stronger association between life and self. The D scores differed significantly among groups overall. Participants with depression exhibited higher scores compared to healthy controls, but there was no difference between participants with and without prior suicide attempts(F[2,242]=8.76, p<.001). Response times for participants with prior attempts differed significantly from other groups, with no significant differences in error rates. The D score was significantly affected by age (β =-0.007, t = 3.65, p<.001), with slowing of response times in older ages. Results suggest reaction time d/s-IAT D scores may not distinguish implicit thinking about suicide as response times slow with age, but slowed response times may be sensitive to suicide risk potentially indicating basic information processing deficits.
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Affiliation(s)
- Donna A Ruch
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center College of Medicine, 370W. 9th Avenue, Columbus, OH 43210, United States.
| | - Jeffrey A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center College of Medicine, 370W. 9th Avenue, Columbus, OH 43210, United States; Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370W. 9th Avenue, Columbus, OH 43210, United States
| | - Jaclyn Tissue
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States
| | - Sean P Madden
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
| | - Hanga Galfavy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States; Department of Biostatistics, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, United States
| | - Marianne Gorlyn
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, United States
| | - John G Keilp
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
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Hogenboom SAM, Schulz K, van Maanen L. Implicit association tests: Stimuli validation from participant responses. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2024; 63:975-1002. [PMID: 37916680 DOI: 10.1111/bjso.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/11/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
The Implicit Association Test (IAT, Greenwald et al., J. Pers. Soc. Psychol., 74, 1998, 1464) is a popular instrument for measuring attitudes and (stereotypical) biases. Greenwald et al. (Behav. Res. Methods, 54, 2021, 1161) proposed a concrete method for validating IAT stimuli: appropriate stimuli should be familiar and easy to classify - translating to rapid (response times <800 ms) and accurate (error < 10%) participant responses. We conducted three analyses to explore the theoretical and practical utility of these proposed validation criteria. We first applied the proposed validation criteria to the data of 15 IATs that were available via Project Implicit. A bootstrap approach with 10,000 'experiments' of 100 participants showed that 5.85% of stimuli were reliably valid (i.e., we are more than 95% confident that a stimulus will also be valid in a new sample of 18- to 25-year-old US participants). Most stimuli (78.44%) could not be reliably validated, indicating a less than 5% certainty in the outcome of stimulus (in)validity for a new sample of participants. We then explored how stimulus validity differs across IATs. Results show that only some stimuli are consistently (in)valid. Most stimuli show between-IAT variances, which indicate that stimulus validity differs across IAT contexts. In the final analysis, we explored the effect of stimulus type (images, nouns, names, adjectives) on stimulus validity. Stimulus type was a significant predictor of stimulus validity. Although images attain the highest stimulus validity, raw data show large differences within stimulus types. Together, the results indicate a need for revised validation criteria. We finish with practical recommendations for stimulus selection and (post-hoc) stimulus validation.
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Affiliation(s)
- Sally A M Hogenboom
- Faculty of Humanities, Institute for Logic, Language and Computation, University of Amsterdam, Amsterdam, The Netherlands
- Department of Theory, Methods, and Statistics, Faculty of Psychology, Open Universiteit, Heerlen, The Netherlands
| | - Katrin Schulz
- Faculty of Humanities, Institute for Logic, Language and Computation, University of Amsterdam, Amsterdam, The Netherlands
| | - Leendert van Maanen
- Department of Experimental Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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Flores-Kanter PE, Alvarado JM. The State of Open Science Practices in Psychometric Studies of Suicide: A Systematic Review. Assessment 2024:10731911241236315. [PMID: 38468149 DOI: 10.1177/10731911241236315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The adoption of open science practices (OSPs) is crucial for promoting transparency and robustness in research. We conducted a systematic review to assess the frequency and trends of OSPs in psychometric studies focusing on measures of suicidal thoughts and behavior. We analyzed publications from two international databases, examining the use of OSPs such as open access publication, preregistration, provision of open materials, and data sharing. Our findings indicate a lack of adherence to OSPs in psychometric studies of suicide. The majority of manuscripts were published under restricted access, and preregistrations were not utilized. The provision of open materials and data was rare, with limited access to instruments and analysis scripts. Open access versions (preprints/postprints) were scarce. The low adoption of OSPs in psychometric studies of suicide calls for urgent action. Embracing a culture of open science will enhance transparency, reproducibility, and the impact of research in suicide prevention efforts.
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Affiliation(s)
| | - Jesús M Alvarado
- Department of Psychobiology & Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Spain
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Falkenstein MJ, Kelley KN, Martin HS, Kuckertz JM, Coppersmith D, Bezahler A, Narine K, Beard C, Webb CA. Multi-method assessment of suicidal thoughts and behaviors among patients in treatment for OCD and related disorders. Psychiatry Res 2024; 333:115740. [PMID: 38237537 PMCID: PMC10922745 DOI: 10.1016/j.psychres.2024.115740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Obsessive-compulsive and related disorders (OCRDs) are associated with increased risk of suicidal thoughts and behaviors (STBs), yet research characterizing suicidality in OCRDs remains limited. A major challenge in assessing STBs is the reliance on explicit self-report. This study utilized multi-method assessment to examine changes in both implicit and explicit STBs in 31 adults receiving partial/residential treatment for OCRDs. Assessments were administered at admission and weekly during treatment. Approximately three-quarters of participants reported lifetime suicidal thoughts, with 16 % reporting a prior suicide attempt. OCD severity was significantly correlated with lifetime suicidal thoughts, and was significantly higher for those with lifetime suicidal thoughts and prior attempts compared to those without. Implicit biases towards death were not associated with OCD severity, and did not predict explicitly endorsed STBs. This is the first study to measure both explicit and implicit STBs in adults with OCRDs. Limitations included small sample size and lack of racial/ethnic diversity. Given the majority had recent suicidal thoughts and one in six had a prior attempt, we emphasize the importance of STB assessment in OCD treatment settings.
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Affiliation(s)
- Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States.
| | - Kara N Kelley
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Heather S Martin
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | | | - Andreas Bezahler
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Kevin Narine
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Courtney Beard
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Christian A Webb
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
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Freichel R, Kahveci S, O'Shea B. How do explicit, implicit, and sociodemographic measures relate to concurrent suicidal ideation? A comparative machine learning approach. Suicide Life Threat Behav 2024; 54:49-60. [PMID: 37960948 DOI: 10.1111/sltb.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Suicide is a leading cause of death, and decades of research have identified a range of risk factors, including demographics, past self-injury and suicide attempts, and explicit suicide cognitions. More recently, implicit self-harm and suicide cognitions have been proposed as risk factors for the prospective prediction of suicidal behavior. However, most studies have examined these implicit and explicit risk factors in isolation, and little is known about their combined effects and interactions in the prediction of concurrent suicidal ideation. METHODS In an online community sample of 6855 participants, we used different machine learning techniques to evaluate the utility of measuring implicit self-harm and suicide cognitions to predict concurrent desire to self-harm or die. RESULTS Desire to self-harm was best predicted using gradient boosting, achieving 83% accuracy. However, the most important predictors were mood, explicit associations, and past suicidal thoughts and behaviors; implicit measures provided little to no gain in predictive accuracy. CONCLUSION Considering our focus on the concurrent prediction of explicit suicidal ideation, we discuss the need for future studies to assess the utility of implicit suicide cognitions in the prospective prediction of suicidal behavior using machine learning approaches.
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Affiliation(s)
- René Freichel
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Sercan Kahveci
- Department of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Brian O'Shea
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- School of Psychology, University of Nottingham, Nottingham, England
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Busch H. Evidence of an Indirect Effect of Generativity on Fear of Death Through Ego-Integrity Considering Social Desirability. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:998-1015. [PMID: 34874193 DOI: 10.1177/00302228211053159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent research has shown an indirect effect of generativity on fear of death through ego-integrity in older adults. The present paper aims at demonstrating that the indirect effect is valid even when controlling for social desirability. For that purpose, participants (N = 260 German adults) in study 1 provided self-reports on generativity, ego-integrity, fear of death, and social desirability. Analyses confirmed the indirect effect when the tendency for socially desirable responding was statistically controlled. In study 2, participants (N = 133 German adults) also reported on their generativity and ego-integrity. Fear of death, however, was assessed with a reaction time-based measure (i.e., the Implicit Associations Test). Again, the indirect effect could be confirmed. Taken together, the studies lend further credibility to the extant findings on the indirect effect of generativity on fear of death through ego-integrity.
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Katz D, Petersen T, Rabideau DJ, Stark A, Pintro K, Alvarez-Hernandez A, Stancroff N, Deng Y, Albury E, Kuperberg M, George N, Amado S, Temes C, Nierenberg AA, Sylvia L. A trial of prolonged exposure therapy for outpatients with comorbid bipolar disorder and posttraumatic stress disorder (PTSD). J Affect Disord 2024; 344:432-439. [PMID: 37802328 DOI: 10.1016/j.jad.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Bipolar disorder and posttraumatic stress disorder (PTSD) commonly co-occur, but no treatment guidelines exist for this population. Prolonged exposure (PE) is a well-established and efficacious treatment for PTSD, untested in patients with comorbid bipolar disorder. The current study evaluates the feasibility and preliminary efficacy of PE for patients with bipolar disorder and PTSD. METHODS Participants were enrolled in PE and completed assessments of PTSD symptoms, suicidality, state and trait anxiety, depression, and mania at baseline, Sessions 5 and 10, and at 6-months post-treatment. RESULTS 32 patients enrolled in this study, with 75 % (24/32) completing all ten PE sessions and 50 % completing 6-month follow-up assessments. PTSD symptoms decreased from baseline to Session 10 and continued to decrease throughout the follow-up period. Suicidality, measured by implicit associations between self and death, showed a similar pattern of decrease over treatment and follow-up periods. Suicidal thinking and depressive symptoms decreased from baseline through Session 10 and rebounded slightly, remaining below baseline at 6-months follow-up. State and trait anxiety increased initially through Session 5 but then decreased and remained stable. Mania scores remained stable at all assessment periods. LIMITATIONS The study is limited by a small sample size and absence of a control condition. Criterion A trauma was not required, limiting generalizability, and there was significant attrition at follow-up. CONCLUSIONS These findings suggest that PE is a feasible and preliminarily efficacious treatment for patients with bipolar disorder and comorbid PTSD, and support the conduct of a fully powered efficacy of PE for this comorbidity.
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Affiliation(s)
- Douglas Katz
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States.
| | - Timothy Petersen
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Dustin J Rabideau
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Abigail Stark
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Kedie Pintro
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Noah Stancroff
- Massachusetts General Hospital, Boston, MA, United States
| | - Yunfeng Deng
- Massachusetts General Hospital, Boston, MA, United States
| | - Evan Albury
- Massachusetts General Hospital, Boston, MA, United States
| | - Maya Kuperberg
- Tel Aviv University, Israel; Beer Yaakov-Ness Ziona Mental Health Center, Israel
| | - Nevita George
- Massachusetts General Hospital, Boston, MA, United States
| | - Selen Amado
- Massachusetts General Hospital, Boston, MA, United States
| | - Christina Temes
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
| | - Louisa Sylvia
- Massachusetts General Hospital, Boston, MA, United States; Harvard University, Cambridge, MA, United States
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Fontesse S, Chevallereau T, Stinglhamber F, Demoulin S, Fiorito A, Chatard A, Jaafari N, Maurage P. Suicidal ideations and self-dehumanization in recently detoxified patients with severe alcohol use disorder: an experimental exploration through joint explicit-implicit measures. J Addict Dis 2023:1-8. [PMID: 38112194 DOI: 10.1080/10550887.2023.2292303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Metadehumanization (the feeling of being considered as less than human by others) is a pervasive phenomenon in psychiatric states, notably promoting self-dehumanization and suicide antecedents. However, its role in suicidal ideations among patients with addictive disorders remains unexplored. We thus investigated the involvement of metadehumanization/self-dehumanization in suicidal ideations and suicidal thoughts interference in severe alcohol use disorder. METHODS We measured metadehumanization, suicidal ideations, and desire for social contact through questionnaires among 35 recently detoxified patients with severe alcohol use disorder (26 males). We measured animalistic/mechanistic self-dehumanization using an Implicit Association Task, and suicidal thoughts interference using a Stroop Task with suicide-related words. We performed regression analyses while controlling for depression/anxiety. RESULTS Animalistic self-dehumanization was positively associated with suicidal thoughts interference and with decreased desire for social interactions, such link being absent for metadehumanization or mechanistic self-dehumanization. CONCLUSIONS This link between self-dehumanization and suicide-related factors suggests that a reduced sense of belonging to humanity is associated with self-harm antecedents. Results also emphasize the importance of using indirect measures to investigate sensitive variables, such as self-dehumanization and suicidal thoughts.
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Affiliation(s)
- Sullivan Fontesse
- Louvain Experimental Psychopathology Research Group, Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Tina Chevallereau
- Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Florence Stinglhamber
- Work and Organizational Psychology Lab, Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Stéphanie Demoulin
- Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | | | - Armand Chatard
- Université de Poitiers & CNRS, Poitiers, France
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nemat Jaafari
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group, Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
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Smith EG, Howard A, Schultz M, Li M, Salvatore P, O'Shea BA. Predicting suicidal ideation in psychiatrically hospitalized veterans using the death/suicide Implicit Association Test: A prospective cohort study. Suicide Life Threat Behav 2023; 53:994-1009. [PMID: 37752832 DOI: 10.1111/sltb.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION We investigated whether the Death/Suicide Implicit Association Test (D/S-IAT) predicted suicidal ideation (SI) in psychiatric inpatients. METHODS One hundred eighty veterans admitted for either SI or suicidal behavior (SB) (the primary sample) (N = 90) or alcohol detoxification (N = 90) completed the D/S-IAT and scales measuring SI. Correlation and regression coefficients were measured between the D/S-IAT (as a full-scale or dichotomized score [D > 0]) and self-reported current or imminent SI (over the next 1-3 days). RESULTS In the primary sample, the full-scale D/S-IAT was significantly correlated with the intensity of current SI (r = 0.22, p = 0.04) and especially with wishes to be dead (r = 0.35, p < 0.001). The intensity of imminent SI was significantly predicted by the full-scale (p = 0.02) and dichotomized D/S-IAT score (p = 0.05) in a multiple regression model. However, no significant associations were observed when both the D/S-IAT score and current (present/absent) or imminent SI (occurred/did not occur) were dichotomous measures. In participants receiving alcohol detoxification, the D/S-IAT significantly predicted only wishes to be dead (r = 0.33, p < 0.001). CONCLUSION The full-scale D/S-IAT score predicted the current intensity of wishes to be dead in both inpatient samples, and current and imminent SI in participants admitted for SI/SB. The dichotomized D/S-IAT score did not predict the simple occurrence of SI.
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Affiliation(s)
- Eric G Smith
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Departments of Psychiatry and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alexandra Howard
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Mark Schultz
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Mingfei Li
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
| | - Paola Salvatore
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- International Consortium for Bipolar and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Brian A O'Shea
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- School of Psychology, University of Nottingham, Nottingham, UK
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Lamontagne SJ, Zabala PK, Zarate CA, Ballard ED. Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks. Neurosci Biobehav Rev 2023; 153:105361. [PMID: 37595649 PMCID: PMC10592047 DOI: 10.1016/j.neubiorev.2023.105361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/22/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023]
Abstract
Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.
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Affiliation(s)
- Steven J Lamontagne
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Paloma K Zabala
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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13
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Doruk Camsari D, Lewis CP, Sonmez AI, Ozger C, Fatih P, Yuruk D, Shekunov J, Vande Voort JL, Croarkin PE. Event-Related Potential Markers of Suicidality in Adolescents. Int J Neuropsychopharmacol 2023; 26:566-575. [PMID: 37422891 PMCID: PMC10464930 DOI: 10.1093/ijnp/pyad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/07/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Implicit cognitive markers may assist with the prediction of suicidality beyond clinical risk factors. The aim of this study was to investigate neural correlates associated with the Death/Suicide Implicit Association Test (DS-IAT) via event-related potentials (ERP) in suicidal adolescents. METHODS Thirty inpatient adolescents with suicidal ideations and behaviors (SIBS) and 30 healthy controls from the community were recruited. All participants underwent 64-channel electroencephalography, DS-IAT, and clinical assessments. Hierarchical generalized linear models with spatiotemporal clustering were used to identify significant ERPs associated with the behavioral outcome of DS-IAT (D scores) and group differences. RESULTS Behavioral results (D scores) showed that the adolescents with SIBS had stronger implicit associations between "death" and "self" than the healthy group (P = .02). Within adolescents with SIBS, participants with stronger implicit associations between "death" and "self" reported more difficulty in controllability of suicidal ideation in the past 2 weeks based on the Columbia-Suicide Severity Rating Scale (P = .03). For the ERP data, the D scores and N100 component over the left parieto-occipital cortex had significant correlations. Significant group differences without behavioral correlation were observed for a second N100 cluster (P = .01), P200 (P = .02), and late positive potential (5 clusters, all P ≤ .02). Exploratory predictive models combining both neurophysiological and clinical measures distinguished adolescents with SIBS from healthy adolescents. CONCLUSIONS Our results suggest that N100 may be a marker of attentional resources involved in the distinction of stimuli that are congruent or incongruent to associations between death and self. Combined clinical and ERP measures may have utility in future refinements of assessment and treatment approaches for adolescents with suicidality.
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Affiliation(s)
- Deniz Doruk Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles P Lewis
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ayse Irem Sonmez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Can Ozger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Parmis Fatih
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Psychiatry, Rush University, Chicago, Illinois, USA
| | - Deniz Yuruk
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Freichel R, O'Shea BA. Suicidality and mood: the impact of trends, seasons, day of the week, and time of day on explicit and implicit cognitions among an online community sample. Transl Psychiatry 2023; 13:157. [PMID: 37169758 PMCID: PMC10175253 DOI: 10.1038/s41398-023-02434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 05/13/2023] Open
Abstract
Decades of research have established seasonality effects on completed and attempted suicides, with rates increasing in spring. Little advancements have been made to explain this phenomenon, with most studies focusing almost exclusively on the number of suicide attempts and deaths. Using more than six years of data collected among a US, UK, and Canadian online community sample (N > 10,000), we used newly developed Prophet forecasting and autoregressive-integrated moving average time-series models to examine the temporal dynamics of explicit and implicit self-harm cognitions. We created three groups (past suicide attempters; suicide ideation and/or non-suicidal self-injury; no previous self-harm, suicidal thoughts, or behaviors). We found a general increase of negative self-harm cognitions across the six years and seasonality effects for mood and desire to die, particularly among those who previously made a suicide attempt. Negative explicit self-harm cognitions peaked in winter (December), with implicit self-harm showing a lagged peak of two months (February). Moreover, daily negative self-harm cognitions consistently peaked around 4-5 am, with implicit cognitions again showing a lagged effect (1-hour). Limitations include the volunteer sample not being representative and the cross-sectional nature of the data being unable to separate between-subject and within-subject structural trends in the time series. Our findings show that negative explicit and implicit cognitions precede the rise in suicidal behaviors in spring. We proposed a conceptual model of seasonal suicide risk that may offer fertile ground for theoretical advancements, including implications for clinical risk assessment and public policies regarding the availability of health services.
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Affiliation(s)
- René Freichel
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Brian A O'Shea
- School of Psychology, University of Nottingham, Nottingham, UK.
- Department of Psychology, Harvard University, Cambridge, MA, USA.
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15
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Shin KE, Baroni A, Gerson RS, Bell KA, Pollak OH, Tezanos K, Spirito A, Cha CB. Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01507-y. [PMID: 36821015 DOI: 10.1007/s10578-023-01507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
Suicide screening is critical in pediatric emergency departments (EDs). Behavioral measures of suicide risk may complement self-report measures. The current study examines suicide-specific behavioral measures and tests their potential short-term within-person effects among respondents, ability to discriminate future suicide attempt from suicidal ideation, and translation into interpretable categorical composite scores. The sample included 167 youth (10-17 years), presenting for suicide-related reasons to a pediatric psychiatric ED. During their ED visit, participants completed the Death/Life Implicit Association Test (IAT) and the Suicide Stroop Task. Recurrent suicidal thoughts and attempts were assessed within 6 months of the ED visit via medical records and email surveys. Youth displayed a decrease in the levels of distress and self-injurious desires (negative mood, desire to hurt themselves, and desire to die) after completing the behavioral tasks. The Death/Life IAT prospectively differentiated with 68% accuracy between youth who attempted suicide after their ED visit and those who had suicidal ideation but no attempt, p = 0.04, OR = 5.65, although this effect became marginally significant after controlling for self-report and demographic covariates. Neither the Suicide Stroop Task, nor the categorical composite scores predicted suicide attempts, ps = 0.08-0.87, ORs = 0.96-3.95. Behavioral measures of suicide risk administered in the ED do not appear to increase distress or self-injurious desires. They may be able to distinguish those who go on to attempt suicide (vs. consider suicide) within six months after discharge.
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Affiliation(s)
- Ki Eun Shin
- Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ruth S Gerson
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Kerri-Anne Bell
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine Tezanos
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA.
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16
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Brent DA, Grupp-Phelan J, O’Shea BA, Patel SJ, Mahabee-Gittens EM, Rogers A, Duffy SJ, Shenoi RP, Chernick LS, Casper TC, Webb MW, Nock MK, King CA. A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients. Psychol Med 2023; 53:123-131. [PMID: 33947480 PMCID: PMC8568726 DOI: 10.1017/s0033291721001215] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings. METHODS A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics. RESULTS A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84-0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85-0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52-0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55-0.79). CONCLUSIONS In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.
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Affiliation(s)
- D. A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - J. Grupp-Phelan
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - B. A. O’Shea
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychology, University of Amsterdam, Netherlands
| | - S. J. Patel
- Departments of Emergency Medicine and Trauma Services at the Children’s National Health System, USA
| | | | - A. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - S. J. Duffy
- Departments of Emergency Medicine and Pediatrics at the Alpert Medical School at Brown University, USA
| | - R. P. Shenoi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - L. S. Chernick
- Department of Emergency Medicine, Columbia University, New York, NY, USA
| | - T. C. Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - M. W. Webb
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - M. K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - C. A. King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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17
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Rogers ML, Bafna A, Galynker I. Comparative clinical utility of screening for Suicide Crisis Syndrome versus suicidal ideation in relation to suicidal ideation and attempts at one-month follow-up. Suicide Life Threat Behav 2022; 52:866-875. [PMID: 35441411 DOI: 10.1111/sltb.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Suicidal ideation (SI) has numerous limitations in predicting suicidal behavior. The Suicide Crisis Syndrome (SCS) is proposed as an alternative method of detecting risk. This study compares the relative utility of SI and SCS in statistically predicting SI and behaviors at one-month follow-up. METHODS 382 psychiatric patients (98 inpatients, 284 outpatients) completed baseline measures and provided information about suicide-related outcomes one month later. Participants were grouped based on responses to measures assessing SCS and SI. RESULTS Rates of follow-up suicidal behavior were significantly higher among those reporting both SCS and SI (22.2%) than those reporting SI alone (6.0%) or neither SCS nor SI (0.9%). SCS alone (8.3%) had descriptively, but not statistically, higher rates of suicidal behavior than those with neither SCS nor SI, and did not differ from SI alone and the combination of SCS and SI. Those reporting SI-with and without SCS-had higher levels of follow-up suicidal thoughts than those without SI. CONCLUSION The SCS was equivalent to SI, and incrementally informative alongside SI, in detecting individuals at risk of future suicidal behavior, whereas SI was more strongly related to future SI than SCS. The combination of SCS and SI may be clinically useful in detecting individuals who are at risk for suicide.
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Affiliation(s)
- Megan L Rogers
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Anokhi Bafna
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
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18
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Validation of a novel Psychosis-Implicit Association Test (P-IAT) as a diagnostic support tool. Psychiatry Res 2022; 314:114647. [PMID: 35660967 DOI: 10.1016/j.psychres.2022.114647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022]
Abstract
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.
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19
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Knipe D, Padmanathan P, Newton-Howes G, Chan LF, Kapur N. Suicide and self-harm. Lancet 2022; 399:1903-1916. [PMID: 35512727 DOI: 10.1016/s0140-6736(22)00173-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022]
Abstract
Suicide and self-harm are major health and societal issues worldwide, but the greatest burden of both behaviours occurs in low-income and middle-income countries. Although rates of suicide are higher in male than in female individuals, self-harm is more common in female individuals. Rather than having a single cause, suicide and self-harm are the result of a complex interplay of several factors that occur throughout the life course, and vary by gender, age, ethnicity, and geography. Several clinical and public health interventions show promise, although our understanding of their effectiveness has largely originated from high-income countries. Attempting to predict suicide is unlikely to be helpful. Intervention and prevention must include both a clinical and community focus, and every health professional has a crucial part to play.
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Affiliation(s)
- Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, Academic Health Science Centre, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
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20
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Hatta H, Ueda R, Ashida H, Abe N. Are implicit attitudes toward dishonesty associated with self-serving dishonesty? Implications for the reliability of the IAT. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2022. [DOI: 10.1016/j.jesp.2022.104285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Affiliation(s)
- Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | | | - Sheikh Shoib
- Dept. of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, Kashmir, India
| | - Arpit Parmar
- Dept. of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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22
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Abstract
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.
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Scheunemann J, Jelinek L, Peth J, Runde A, Arlt S, Gallinat J, Kühn S. Do implicit measures improve suicide risk prediction? An 18-month prospective study using different tasks. Suicide Life Threat Behav 2021; 51:993-1004. [PMID: 34196996 DOI: 10.1111/sltb.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/12/2020] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Runde
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Lise-Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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24
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Sohn MN, McMorris CA, Bray S, McGirr A. The death-implicit association test and suicide attempts: a systematic review and meta-analysis of discriminative and prospective utility. Psychol Med 2021; 51:1789-1798. [PMID: 34030752 DOI: 10.1017/s0033291721002117] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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.
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Affiliation(s)
- Maya N Sohn
- 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
- 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
- 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
- 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
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25
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von Hippel C, Brener L, Rose G, Kjelsaas K, von Hippel W. No evidence that implicit identification with mental illness predicts recovery. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:530-545. [PMID: 34096627 DOI: 10.1111/bjc.12312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/07/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Recovery from mental illness is multiply-determined, but one factor that has been proposed to influence recovery is the degree to which the person identifies as someone with a mental illness. This study examines the relationship between implicit identification with being mentally unwell and recovery among clients of a community mental health service. A multi-faceted view of recovery was adopted. METHODS A longitudinal design was used to assess implicit identification with mental illness and its relationship to recovery, including symptom severity, well-being, life satisfaction, and optimism, which were supplemented with ratings by both support workers and the research assistants who conducted the study. Participants were 216 community mental health care clients, with 150 retested at Time 2, and 100 retested at Time 3. RESULTS Implicit identification with mental illness was correlated with recovery at Time 1 and Time 3, though this relationship did not emerge at Time 2. Cross-lag regression analyses failed to reveal evidence that implicit identification with mental illness predicts subsequent recovery. CONCLUSIONS The current research suggests that implicit identification with mental illness can be considered a marker of ongoing recovery, but is not predictive of subsequent recovery. Hence, these data suggest that implicit identification with mental illness is unlikely to play an independent role in the recovery process. PRACTITIONER POINTS Research regarding the mental health consequences of implicit identification focuses on symptomatology. Recovery is more than a reduction in symptoms, however, and thus, a broader conceptualization of recovery was examined. Implicit identification with being mentally unwell was associated with poorer recovery broadly operationalized, but did not predict subsequent recovery.
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Affiliation(s)
| | - Loren Brener
- University of New South Wales, Sydney, New South Wales, Australia
| | - Grenville Rose
- University of New South Wales, Sydney, New South Wales, Australia
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Use of Ecological Momentary Assessment to Study Suicidal Thoughts and Behavior: a Systematic Review. Curr Psychiatry Rep 2021; 23:41. [PMID: 34003405 DOI: 10.1007/s11920-021-01255-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Ecological momentary assessment (EMA) is a recently introduced approach to patient evaluation that consists of asking patients questions in real time and in their usual habitat. This method seeks to contribute to suicide prevention by providing psychiatrists with detailed information about suicidal thoughts and behavior, how these fluctuate over short periods of time, and the short-term risk factors presented by patients. We conducted a systematic review of published research using EMA to study suicidal thoughts and behavior. RECENT FINDINGS Several systematic reviews of EMA in mental health have been conducted to date, and the literature contains numerous theoretical papers and compilations on EMA and suicide phenomena. To date, however, no systematic reviews have explored the use of this tool to study suicidal thoughts and behavior. We performed a systematic review of five databases (i.e., PubMed, Embase, Scopus, Web of Science, and PsycINFO) to identify studies on EMA and suicidal thoughts and behavior. An initial search revealed 544 articles. Following the study selection process, 35 studies were included in the review. Almost three-quarters of the studies were published in the last 4 years. The studies reviewed concluded that EMA was generally feasible and well accepted. EMA findings correlated well with the results of a retrospective assessment, though tended to over-represent symptom severity. Our review points to important aspects of suicidal thoughts and behavior, such as its wide fluctuation over short periods of time. Negative affect and disturbed sleep, among others, emerged as short-term predictors of suicidal thoughts and behavior. Therefore, EMA is a potentially useful tool in clinical practice, although not without drawbacks, such as participant fatigue with questionnaires and ethical concerns.
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Schimmack U. Invalid Claims About the Validity of Implicit Association Tests by Prisoners of the Implicit Social-Cognition Paradigm. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 16:435-442. [PMID: 33709849 PMCID: PMC8167921 DOI: 10.1177/1745691621991860] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a prior publication, I used structural equation modeling of multimethod data to examine the construct validity of Implicit Association Tests. The results showed no evidence that IATs measure implicit constructs (e.g., implicit self-esteem, implicit racial bias). This critique of IATs elicited several responses by implicit social-cognition researchers, who tried to defend the validity and usefulness of IATs. I carefully examine these arguments and show that they lack validity. IAT proponents consistently ignore or misrepresent facts that challenge the validity of IATs as measures of individual differences in implicit cognitions. One response suggests that IATs can be useful even if they merely measure the same constructs as self-report measures, but I find no support for the claim that IATs have practically significant incremental predictive validity. In conclusions, IATs are widely used without psychometric evidence of construct or predictive validity.
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Carpenter TP, Law KC. Optimizing the scientific study of suicide with open and transparent research practices. Suicide Life Threat Behav 2021; 51:36-46. [PMID: 33624871 DOI: 10.1111/sltb.12665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Suicide research is vitally important, yet-like psychology research more broadly-faces methodological challenges. In recent years, researchers have raised concerns about standard practices in psychological research, concerns that apply to suicide research and raise questions about its robustness and validity. In the present paper, we review these concerns and the corresponding solutions put forth by the "open science" community. These include using open science platforms, pre-registering studies, ensuring reproducible analyses, using high-powered studies, ensuring open access to research materials and products, and conducting replication studies. We build upon existing guides, address specific obstacles faced by suicide researchers, and offer a clear set of recommended practices for suicide researchers. In particular, we consider challenges that suicide researchers may face in seeking to adopt "open science" practices (e.g., prioritizing large samples) and suggest possible strategies that the field may use in order to ensure robust and transparent research, despite these challenges.
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Affiliation(s)
| | - Keyne C Law
- Seattle Pacific University, Seattle, Washington, USA
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Ho TC, Teresib GI, Ojhac A, Walker JC, Kirshenbaum JS, Singh MK, Gotlib IH. Smaller caudate gray matter volume is associated with greater implicit suicidal ideation in depressed adolescents. J Affect Disord 2021; 278:650-657. [PMID: 33039875 PMCID: PMC9386733 DOI: 10.1016/j.jad.2020.09.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/13/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Objective biomarkers of cognitive vulnerabilities related to suicidal ideation (SI) may assist in early prevention in adolescents. Previously, we found that smaller gray matter volumes (GMVs) of the dorsal striatum prospectively predicted implicit SI, measured using a computerized implicit association test (IAT) assessing associations between "self" and "death," in a community sample of adolescents. Here, we sought to replicate these findings in an independent sample of depressed adolescents. METHODS 53 depressed adolescents who varied in severity of suicidal thoughts and behaviors completed high-resolution structural MRI. Caudate, putamen, and nucleus accumbens GMVs were estimated using FreeSurfer 6.0. Robust linear regressions were used to examine associations between striatal GMVs and implicit and explicit SI, covarying for sex, age, total intracranial volume, medication use, and depression severity. Significance was determined using Bonferroni correction. Finally, LASSO regression was used to identify which striatal GMV contributed most to prediction of implicit SI. RESULTS Smaller bilateral caudate and right nucleus accumbens GMVs were associated with higher IAT scores (all ps<0.001). Smaller putamen and nucleus accumbens GMVs were not associated with implicit or explicit SI. Our LASSO analysis indicated that right caudate GMV contributed most to the prediction of IAT scores. CONCLUSIONS This study is the first to demonstrate that caudate GMVs are significantly associated with implicit self-associations with death in a sample of depressed adolescents. When considered with our previous work, smaller caudate GMVs may be a robust biomarker of implicit SI in adolescents, with clinical implications for early identification of youth at risk for engaging in suicidal behaviors.
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Affiliation(s)
- Tiffany C. Ho
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA,Corresponding author.
| | | | - Amar Ojhac
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Manpreet K. Singh
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA
| | - Ian H. Gotlib
- Department of Psychology, Stanford University, Stanford, CA
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Moreno M, Porras-Segovia A, Lopez-Castroman J, Peñuelas-Calvo I, Díaz-Oliván I, Barrigón ML, Baca-García E. Validation of the Spanish version of the Death/Suicide Implicit Association Test for the assessment of suicidal behavior. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Wang X, Lei W, Liu K, Liang X, Wang Y, Huang C, Zhang T, Chen J. Implicit measure of suicidal ideation in patients with depression. DEATH STUDIES 2020; 46:1807-1813. [PMID: 33246393 DOI: 10.1080/07481187.2020.1850549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The death/suicide implicit association test (IAT) may be more resilient to accurately assess suicide risk than self-reports. We examined the IAT in 130 patients with depression and 125 healthy controls, along with self-reported suicidal ideation. IAT could differentiate patients with suicide attempts from patients without suicide attempts and controls. IAT measures were significantly correlated to explicit suicidal ideation and clinical symptoms in patients. Moreover, the IAT-symptom correlations were significant in female but not male patients. The IAT showed promise as a valid tool to estimate suicide risk in patients with depression and may be particularly useful in female patients.
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Affiliation(s)
- Xu Wang
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wei Lei
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Kezhi Liu
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xuemei Liang
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Wang
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chaohua Huang
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Tao Zhang
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing Chen
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
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Van Dessel P, Cummins J, Hughes S, Kasran S, Cathelyn F, Moran T. Reflecting on 25 Years of Research Using Implicit Measures: Recommendations for Their Future Use. SOCIAL COGNITION 2020. [DOI: 10.1521/soco.2020.38.supp.s223] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For more than 25 years, implicit measures have shaped research, theorizing, and intervention in psychological science. During this period, the development and deployment of implicit measures have been predicated on a number of theoretical, methodological, and applied assumptions. Yet these assumptions are frequently violated and rarely met. As a result, the merit of research using implicit measures has increasingly been cast into doubt. In this article, we argue that future implicit measures research could benefit from adherence to four guidelines based on a functional approach wherein performance on implicit measures is described and analyzed as behavior emitted under specific conditions and captured in a specific measurement context. We unpack this approach and highlight recent work illustrating both its theoretical and practical value.
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O’Shea BA, Glenn JJ, Millner AJ, Teachman BA, Nock MK. Decomposing implicit associations about life and death improves our understanding of suicidal behavior. Suicide Life Threat Behav 2020; 50:1065-1074. [PMID: 33463733 PMCID: PMC7689854 DOI: 10.1111/sltb.12652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/27/2022]
Abstract
The Death/Suicide Implicit Association Test (IAT) is effective at detecting and prospectively predicting suicidal thoughts and behaviors. However, traditional IAT scoring procedures used in all prior studies (i.e., D-scores) provide an aggregate score that is inherently relative, obfuscating the separate associations (i.e., "Me = Death/Suicide," "Me = Life") that might be most relevant for understanding suicide-related implicit cognition. Here, we decompose the D-scores and validate a new analytic technique called the Decomposed D-scores ("DD-scores") that creates separate scores for each category ("Me," "Not Me") in the IAT. Across large online volunteer samples (N > 12,000), results consistently showed that a weakened association between "Me = Life" is more strongly predictive of having a history of suicidal attempts than is a stronger association between "Me = Death/Suicide." These findings replicated across three different versions of the IAT and were observed when calculated using both reaction times and error rates. However, among those who previously attempted suicide, a strengthened association between "Me = Death" is more strongly predictive of the recency of a suicide attempt. These results suggest that decomposing traditional IAT D-scores can offer new insights into the mental associations that may underlie clinical phenomena and may help to improve the prediction, and ultimately the prevention, of these clinical outcomes.
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Affiliation(s)
- Brian A. O’Shea
- Harvard UniversityCambridgeMAUSA,University of AmsterdamAmsterdamThe Netherlands
| | - Jeffrey J. Glenn
- Durham Veterans Affairs Health Care SystemDurhamNCUSA,VA Mid‐Atlantic Mental Illness Research, Education, and Clinical CenterDurhamNCUSA
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