Predicting Suicidal Behavior by Implicit Associations with Death? Examination of the Death IAT in Two Inpatient Samples of Differing Suicide Risk

Assessment of implicit self-associations with death, measured by a death Implicit Association Test (IAT), has shown promise for the prediction of suicide risk. The present study examined whether the performance on the death IAT is associated with lifetime, recent, or future suicide attempt status as well as self-report measures of suicide risk factors (e.g., perceived burdensomeness, thwarted belongingness) in two inpatient samples with low versus high severity of suicidality. Furthermore, we investigated whether explicit suicidal ideation and implicit associations with death predict recent and future suicide attempt status. Seventy-one depressed inpatients with recent/lifetime suicidal ideation (first sample) as well as 226 inpatients with a recent suicide attempt or a severe suicidal crisis (second sample) were interviewed on lifetime suicidal ideation and behavior, completed self-report measures (i.e., suicidal ideation, thwarted belongingness, perceived burdensomeness), and conducted the death IAT. The second sample was also interviewed and completed self-report measures longitudinally, 6, 9, and 12 months later. The IAT was conducted twice in this sample, at the beginning of the assessment (T-0) as well as 12 months later (T-3). Implicit associations with death neither differ between lifetime suicide ideators, single attempters, and multiple attempters, nor between recent and future nonattempters and attempters. IAT scores were unrelated to other suicide risk factors. Neither the IAT scores nor the interaction of IAT scores and explicitly stated suicidal ideation was predictive of recent or future suicide attempts. The present study points to a limited utility of the death IAT for the prediction of suicide risk.