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

2021 ◽  
pp. 1-10
Author(s):  
Maya N. Sohn ◽  
Carly A. McMorris ◽  
Signe Bray ◽  
Alexander McGirr
Keyword(s):  
Risk Assessment ◽  
Suicide Attempt ◽  
Suicidal Behaviour ◽  
Implicit Association Test ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Association Test ◽  
Implicit Association ◽  
Suicide Risk Assessment ◽  
History Of

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.

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

2019 ◽  
Vol 31 (1) ◽  
pp. 65-74 ◽  
Author(s):  
Nina Tello ◽  
Ghina Harika-Germaneau ◽  
Wilfried Serra ◽  
Nematollah Jaafari ◽  
Armand Chatard
Keyword(s):  
Suicide Attempt ◽  
Implicit Association Test ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Diagnostic Value ◽  
Association Test ◽  
Self Report ◽  
Semistructured Interview ◽  
Implicit Association ◽  
Independent Replication

A previous study by Nock et al. (2010) suggested that people’s implicit identification with “death” or “suicide” can accurately predict whether they will attempt suicide several months in advance. We report the first direct and independent replication of this promising finding. Participants were 165 patients seeking treatment at a psychiatric unit in France. At baseline, patients completed the Suicide–Implicit Association Test (S–IAT), a semistructured interview, and a self-report measure of suicide ideation. Six months later, we contacted participants by phone and examined their hospital medical records to determine whether they had made a new suicide attempt. Results showed that the S–IAT did not distinguish between patients who were admitted to the hospital following suicide attempts and those who were admitted for other reasons. As in the original study, however, the S–IAT predicted suicide attempts within the 6-month follow-up period beyond well-known predictors. The test correctly classified 85% of patients (95% confidence interval = [76.91, 91.53]), supporting its diagnostic value for identifying who will make a suicide attempt.

scholarly journals Forecasting a Fatal Decision: Direct Replication of the Predictive Validity of the Suicide-Implicit Association Test

2018 ◽  
Author(s):  
Nina Tello ◽  
Ghina Harika-Germaneau ◽  
Wilfried Serra ◽  
Nemat Jaafari ◽  
Armand Chatard
Keyword(s):  
Suicide Attempt ◽  
Implicit Association Test ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Diagnostic Value ◽  
Association Test ◽  
Self Report ◽  
Semistructured Interview ◽  
Implicit Association ◽  
Independent Replication

Research has suggested that implicit identification with death/suicide can accuratelypredict a suicide attempt several months in advance (Nock et al., 2010). We report thefirst direct and independent replication of this promising finding. Participants included165 patients seeking treatment at a psychiatric unit in France. At baseline, patientscompleted the Suicide-Implicit Association Test (S-IAT), a semistructured interview,and a self-report measure of suicide ideation. Six months later, we contacted the patientsby phone and examined their hospital medical records, to determine whether they hadmade a new suicide attempt. Results showed that the S-IAT did not discriminatepatients who presented for suicide attempts (vs. other reasons). As in the original study,however, the S-IAT predicted suicide attempts within the 6-month follow-up periodbeyond well-known predictors. The test correctly classified 85% of patients, 95% CI[76.91, 91.53], supporting its diagnostic value for identifying who will make a futuresuicide attempt.

Psychological, Structural, Social and Economic Determinants of Suicide Attempt: Risk Assessment and Decision Making Strategies

2021 ◽  
pp. 003022282110034
Author(s):  
Azam Farmani ◽  
Mojtaba Rahimianbougar ◽  
Yousef Mohammadi ◽  
Hossein Faramarzi ◽  
Siamak Khodarahimi ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Suicide Attempt ◽  
Suicide Attempts ◽  
Psychological Services ◽  
Cross Sectional ◽  
Economic Determinants ◽  
History Of ◽  
Cross Sectional Design ◽  
High Level ◽  
Risk Assessment And Management

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.

Suicide attempts preceding completed suicide

1998 ◽  
Vol 173 (6) ◽  
pp. 531-535 ◽  
Author(s):  
Erkki T. Isometsä ◽  
Jouko K. Lönnqvist
Keyword(s):  
Suicide Attempt ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Early Recognition ◽  
Preventive Measure ◽  
Time Interval ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
History Of

BackgroundThis study investigated three questions with major implications for suicide prevention: the sensitivity of the history of previous suicide attempt(s) as an indicator of suicide risk, the time interval from a preceding suicide attempt to the fatal one, and switching of suicide methods by those eventually completing suicide.MethodThe lifetime history of suicide attempts and the methods the victims (n=1397) used were examined in a nationwide psychological autopsy study comprising all suicides in Finland within a 12-month research period in 1987–1988.ResultsOverall, 56% of suicide victims were found to have died at their first suicide attempt, more males (62%) than females (38%). In 19% of males and 39% of females the victim had made a non-fatal attempt during the final year. Of the victims with previous attempts, 82% had used at least two different methods in their suicide attempts (the fatal included).ConclusionsMost male and a substantial proportion of female suicides die in their first suicide attempt, a fact that necessitates early recognition of suicide risk, particularly among males. Recognition of periods of high suicide risk on the grounds of recent non-fatal suicide attempts is likely to be important for suicide prevention among females. Subjects completing suicide commonly switch from one suicide method to another, a finding that weakens but does not negate the credibility of restrictions on the availability of lethal methods as a preventive measure.

Who gains from suicide risk assessment: Health inspectorate and health insurances, or also psychiatrist and patient?

2016 ◽  
Vol 33 (S1) ◽  
pp. S601-S601
Author(s):  
A. Gonlag ◽  
M. van Baest ◽  
C. Rijnders ◽  
R. Teijeiro
Keyword(s):  
Risk Assessment ◽  
The Netherlands ◽  
Suicidal Behaviour ◽  
Suicide Risk ◽  
Attempted Suicide ◽  
Suicide Risk Assessment ◽  
Treatment Policy ◽  
Observation Instruments ◽  
Competing Interest ◽  
Treatment Policies

IntroductionThe number of suicides rises in the Netherlands. In 2008, 1435 suicides were recorded; in 2012: 1753 (CBS). Adequate risk assessment with suicidal behaviour (SRA) is essential for prevention. The Health Inspectorate and Insurances seek to have a stronger grip on the way suicide risk is assessed and insist on using questionnaires. This runs counter to the multidisciplinary guidelines in the Netherlands for diagnosis and treatment of suicidal behaviour, which state that “questionnaires or observation instruments cannot replace clinical diagnostic examination.”ObjectiveDo questionnaires rather than ‘care as usual’ (CAU) in SRA lead to different treatment policies?AimTo determine whether the use of questionnaires rather than CAU in SRA leads to different treatment policies.MethodsPatients who were seen by staff at the department of Psychiatry at the ETS Hospital, either for in-house consultation or at the MPU, in connection with attempted suicide, auto-intoxication, or psychological distress with suicidal statements. Patients were examined by conducting a questionnaire, resulting in treatment policy (admission, discharge with an appointment with patient's own practitioner, discharge with referral to a practitioner, discharge without aftercare). Then, the same patient was again examined by another colleague in a free interview (CAU). The colleague was not informed about the outcome of the first assessment. Again, treatment policy was determined as a result. The two outcomes were then compared.ResultsData collection still continues.ConclusionsThere are signs that there are no differences in the determined treatment policies following SRA based on the use of questionnaires or CAU.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Patient is Suicidal: What Should I Do as a Clinician?

2017 ◽  
Vol 41 (S1) ◽  
pp. S41-S41
Author(s):  
V. Carli
Keyword(s):  
Risk Assessment ◽  
Social Network ◽  
Mental Health Professionals ◽  
Suicidal Behaviour ◽  
Suicide Risk ◽  
Treatment Process ◽  
Suicide Risk Assessment ◽  
The Family ◽  
The Future ◽  
Approximate Probability

Suicidal behaviour is the most common psychiatric emergency. A large proportion of suicidal behaviour can be prevented, particularly in cases associated with mental disorders. Early recognition of suicidality and reliable evaluation of suicide risk are crucial for the clinical prevention of suicide. Evaluation of suicidal risk involves assessment of suicidal intent, previous suicide attempts, underlying psychiatric disorders, the patients’ personality, the social network, and suicide in the family or among acquaintances as well as other well-known risk factors. Suicide risk assessment should take place on several levels and relate to the patient, the family and social network but also to the availability of treatment, rehabilitation and prevention resources in the community. As suicide risk fluctuates within a short period of time, it is important to repeat the suicide risk assessment over time in an emphatic and not mechanistic way. The suicidal person may mislead both family members and hospital staff, giving a false sense of independence and of being able to manage without the help of others. Although extreme ambivalence to living or dying is often strongly expressed by the suicidal individual, it is not seldom missed by others. If observed in the diagnostic and treatment process, dialogue and reflection on such ambivalence can be used to motivate the patient for treatment and to prevent suicide. If ambivalence and suicidal communications go undiscovered, the treatment process and the life of the patient can be endangered. Today, several measurement tools of suicide risk exist, including psychometric and biological measurements. Some of these tools have been extensively studied and measures of their sensitivity and specificity have been estimated. This allows for the formulation of an approximate probability that a suicidal event might happen in the future. However, the low precision of the predictions make these tools insufficient from the clinical perspective and they contribute very little information that is not already gained in a standard clinical interview. Psychiatrists and other mental health professionals have always longed for reliable and precise tools to predict suicidal behavior, which could support their clinical practice, allow them to concentrate resources on patients that really need them, and backup their clinical judgement, in case of eventual legal problems. In order to be useful, however, the approximate probability that a suicidal event might happen in the future is not sufficient to significantly change clinical routines and practices. These should rely on the available evidence base and always consider the safety of the patient as paramount.Disclosure of interestThe author declares that he has no competing interest.

The Effect of Parental Remarriage following Parental Divorce on Offspring Suicide Attempt

2010 ◽  
Vol 91 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Dana M. Lizardi ◽  
Ronald G. Thompson ◽  
Katherine M. Keyes ◽  
Deborah S. Hasin
Keyword(s):  
Suicide Attempt ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Parental Divorce ◽  
Female Offspring ◽  
Female Adult ◽  
History Of Childhood ◽  
Epidemiologic Survey ◽  
Increased Risk ◽  
History Of

Parental divorce during childhood is associated with an increased risk of suicide attempts for male but not female offspring. This study examines whether parental remarriage has a differential effect on suicide risk for male and female adult offspring. Using the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the sample consists of respondents who experienced parental divorce ( N = 6,436). Multivariable regressions were estimated. Females who lived with a stepparent were significantly more likely to report a lifetime suicide attempt compared with females who had not. Clinicians should note that female depressed patients who have a history of childhood parental divorce and remarriage may be at more risk for suicide attempt than previously recognized.

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