Implicit or explicit self-associations with life and death? Predicting short-term self-injurious thoughts and behaviors among adolescents.

Implicit self-association with death, measured by the Death/Suicide-Implicit Association Test (D/S-IAT), predicts short-term Self-Injurious Thoughts and Behaviors (SITBs) among adolescents. However, comparing the predictive utility of the D/S-IAT with explicit (i.e. self-report) self-association with life and death was not examined previously. The current study sought to examine whether the D/S-IAT and explicit self-association with life and death predict current and prospective SITBs, and to examine the association between the two measures. One-hundred and thirty-one Jewish Israeli adolescents with SITBs, aged 10-18 years (74.8% female) were assessed at clinic intake. Participants completed D/S-IAT, depression, attitudes toward life and death and suicide risk assessment at intake and one-month follow-up. Implicit, rather than explicit, attitudes toward life and death predicted SITBs at one-month follow-up, beyond depression and past SITBs. The implicit and explicit measures were not significantly related at intake, indicating that they might capture different aspects of SITBs.

Ambivalent attitudes toward life and death and suicide ideation among adolescents-The mediating role of depression.

BACKGROUND: Ambivalence in attitudes towards life and death are associated with suicide ideation (SI) among adolescents. However, previous research was mainly cross-sectional and did not examine through which psychopathological mechanisms (such as depression) attitudes towards life and death are associated with SI. OBJECTIVE: The current longitudinal study examined the mediating role of depression at follow-up in the association between attitudes towards life and death at baseline and SI at follow-up among at-risk adolescents referred to an outpatient psychiatric clinic. METHODS: 129 adolescents aged 10-18 years (75.2% females) with a history of suicidal thoughts and behaviors were assessed at clinic intake and 1 month follow-up (80% retention rate at follow-up). All participants completed a questionnaire assessing attitudes towards life and death and SI severity at clinic intake, and depression and SI severity at 1 month follow-up. RESULTS: While controlling for SI severity at intake, attraction towards life at baseline, rather than attraction and repulsion towards death at baseline, led to higher SI severity at follow-up, while depression at follow-up fully mediated this association. CONCLUSIONS: Attitudes towards life, as well as depression play critical roles in the development of SI among adolescents. Interventions targeting reasons for living and promoting meaning of life may be beneficial in preventing depression and SI.

Implicit identification with death detects and predicts short-term suicide risk among adolescents discharged from the emergency room.

BACKGROUND: Implicit identification with death, measured by the Death-Suicide-Implicit Association Test (D/S-IAT), has been found to predict long-term suicide risk among adolescents. However, previous studies did not examine the predictive utility of D/S-IAT on short-term suicide risk trajectories among adolescents, especially during the critical period following discharge from the emergency room (ER) due to suicide behaviors. OBJECTIVE: This study examined the ability of the D/S-IAT to discriminate and predict suicide risk trajectories during the month following initial suicide risk assessment, among adolescents recently discharged from the ER. METHODS: One hundred and fifteen adolescents aged 9-18 years (77.4% female) were assessed at clinic intake. All participants completed D/S-IAT and self-report measures for suicide risk, depression, and anxiety during intake and 1-month follow-up. RESULTS: The D/S-IAT distinguished and predicted participants with continued heightened suicide risk at follow-up, above and beyond depression, anxiety, and suicide risk level at intake. CONCLUSIONS: Along with conventional measures, D/S-IAT may be utilized to predict short-term suicide risk during post-ER discharge.

The interpersonal theory of suicide and adolescent suicidal behavior.

BACKGROUND: Joiner's interpersonal theory of suicide (IPTS) proposes that suicide results from the combination of a perception of burdening others, social alienation, and the capability for self-harm. The theory gained some empirical support, however the overall model has yet to be tested. This study aimed to test the main predictions of IPTS in a large community sample of Israeli adolescents. METHOD: 1196 Israeli Jewish and Arab high-school pupils participating in the SEYLE project completed a self-report questionnaire measuring perceived burdensomeness, thwarted belongingness, health risk behaviors, and non-suicidal self-injury (risk variables), and suicidal ideation and suicide attempts (outcome measures). The data were tested in cross-sectional regression models. RESULTS: Consistent with IPTS, perceived burdensomeness was found to interact with thwarted belongingness, predicting suicidal ideation. Depression mediated most of the effect of thwarted belongingness and perceived burdensomeness on suicidal ideation. Acquired capability for self-harm, as measured by health risk behaviors and direct non-suicidal self-injurious behaviors, predicted suicide attempt. However, this mechanism operated independently from ideation rather than in interaction with it, at variance with IPTS-based predictions. LIMITATIONS: The cross-sectional design precludes conclusions about causality and directionality. Proxy measures were used to test the interpersonal theory constructs. CONCLUSION: The findings support some of the IPTS predictions but not all, and imply two separate pathways for suicidal behavior in adolescents: one related to internalizing psychopathology and the other to self-harm behaviors. This conceptualization has clinical implications for the differential identification of adolescents at risk for suicidal behavior and for the development of prevention strategies.