Implicit Identification with Death Predicts Suicidal Thoughts and Behaviors in Adolescents

Abstract

Prior research indicates that adults' implicit identification with death can be used to predict suicidal thoughts and behaviors (STBs) in the community. However, no studies have examined whether this effect is found among adolescents-a group for whom suicide is the 2nd leading cause of death. The current study tested the utility of implicit identification with death, using a Death Implicit Association Test (IAT), for detecting and predicting STBs in adolescents. Participants were 141 adolescents 12-19 years of age (81.6% female, 74.5% White) with a current psychiatric disorder and/or currently receiving outpatient psychiatric treatment. All participants completed the Death IAT and self-report measures of STBs at baseline, as well as self-report measures of STBs at 6-month and 1-year follow-ups. At baseline, stronger implicit identification with death (higher Death IAT score) was related to greater suicide ideation (SI) frequency, severity, and duration, but did not differ based on suicide attempt history. Prospectively, higher Death IAT scores predicted any occurrence (but not frequency) of SI over the subsequent year, but not when controlling for prior SI. Death IAT scores were higher among adolescents with prior attempts who reattempted suicide over the follow-up. Examination of stimuli-level results suggested that Death IAT differences may be driven by responses on trials with specific words, including suicide and die. Implicit identification with death may be a useful behavioral indicator of suicide risk in adolescents. Preliminary findings suggest that the Death IAT may aid in predicting STBs among youth receiving outpatient treatment.

Figure 1.

Performance on the Death IAT at the baseline assessment among adolescents based on history of suicidal thoughts and behaviors, F(4, 136)=2.64, p=.037, η²=0.07. Post-hoc comparisons (Tukey’s HSD) indicated that no groups were statistically significantly different from each other. However, lifetime suicide ideators had more negative D scores than past-year suicide attempters at a trend level (p=.053). Error bars indicate standard error of the mean.

Figure 2.

Performance on “Suicide” word trials of the Death IAT at the baseline assessment among adolescents based on history of suicidal thoughts and behaviors, Welch’s F(4, 54.98)=5.84, p=.001, ω²=.12. Post-hoc comparisons (Games-Howell) indicated significant differences between: lifetime suicide ideators < past-year suicide attempters (p=.003), lifetime suicide ideators < lifetime suicide attempters (p=.009), and nonsuicidal psychiatric controls < past-year suicide attempters (p=.023). Error bars indicate standard error of the mean.