Alterations in performance and discriminating power of the death/suicide implicit association test across the lifespan.

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 (ß =-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.

The impact of peer influencing on adolescent suicidal ideation and suicide attempts.

OBJECTIVE: The purpose of this study was to examine the role of peer influence on adolescent suicidal ideation and attempts within youth seeking emergency care or outpatient mental health services. We examined whether affiliation with peers reporting suicidal thoughts/behaviors was associated with an adolescent's own suicidal ideation and/or suicide attempt beyond individual risk factors. METHODS: One hundred and eighteen adolescents, ages 13-18, were recruited from the emergency department and outpatient mental health clinics at a large, metropolitan children's hospital. Adolescents with suicidal ideation in the past six months (ideators, n=19) and with a suicide attempt in the past year (attempters, n=40) were matched with controls with no history of ideation or attempt on age (±1 year), sex, and race. Adolescents and parents completed semi-structured interviews and self-report questionnaires to examine individual and peer associated risk factors. RESULTS: Both ideators and attempters were more likely to affiliate with peers with suicidal behavior compared to their matched controls. However, affiliation with suicidal peers was only associated with attempter group status after controlling for individual risk factors. CONCLUSION: Affiliation with peers reporting suicidal thoughts/behaviors was linked to an adolescent's own history of suicide attempt. Through understanding peer affiliation, peers may be an important resource for both identifying and preventing youth suicidal behavior. Evidence-based programs that focus and utilize peer influence may be invaluable for prevention efforts.

Depressed Mood Prior to Death.

Background: Suicide is a leading cause of death among youth in the United States. Multiple factors have been shown to increase risk for suicidal behavior, including depressed mood. Aims: The purpose of this study was to examine individual characteristics and precipitating circumstances of suicide in youth decedents with and without depressed mood at the time of death. Method: Data from the National Violent Death Reporting System (NVDRS) were analyzed for 17 US states from 2003 to 2012. Participants included suicide decedents aged 10-19 years (N = 4,053). Analyses compared youth suicide decedents with depressed mood at time of death with those without depressed mood using logistic regression. Sex-specific differences in youth with depressed mood were also explored. Results: Youth suicide decedents with depressed mood were more likely than those without depressed mood to exhibit clinical characteristics and precipitating circumstances associated with suicide. Comparison of males and females with depressed mood found unique sex-specific differences. Limitations: Data were limited to 17 states, analyses did not include a control group, and data were collected through postmortem reporting. Conclusion: Findings support a significant association between depressed mood and factors associated with suicidal behavior in youth and offer potential areas to focus prevention strategies.

Neurocognitive vulnerability to youth suicidal behavior.

Neurocognitive deficits have been associated with suicidal behavior in adults with major depressive disorder (MDD), but it is unclear if similar impairments are linked to youth suicidal behavior. This study compared neurocognitive functioning in suicidal and non-suicidal youth with a lifetime history of MDD and explored whether neurocognitive functioning predicted future suicide attempts. Neurocognition was examined using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and Iowa Gambling Task (IGT) in 309 youths ages 12-15 (117 suicide attempters; 132 suicidal ideators; 60 never-suicidal). Prospective analyses included 284 youths (41 youth with a future attempt; 243 without a future attempt). Multivariate analysis of variance (MANOVA) yielded a significant group-by-sex interaction effect [Wilks' Λ = 0.901, F (16, 560) = 1.87, p = .021] for the primary neurocognitive outcomes, guiding the decision to stratify the sample by sex. Female suicide attempters and ideators were slower to respond correctly to both positive and negative emotion words than never-suicidal controls on tests of affective bias. Male suicide attempters and ideators made significantly more total and between errors than never-suicidal subjects. Exploratory analyses found that total commission errors on the Affective Go/No-Go (AGN) test significantly predicted future suicide attempts in females, and that higher strategy scores on Spatial Working Memory (SWM) tests predicted future male attempts. Study findings identified sex-specific neurocognitive deficits that differentiate suicidal and non-suicidal youth with histories of MDD. Extended longitudinal studies are needed to elucidate the temporal association between neurocognitive impairments and suicidal behavior and frame targets for early preventive interventions.