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

Published online by Cambridge University Press:  25 May 2021

Maya N. Sohn ,
Carly A. McMorris ,
Signe Bray  and
Alexander McGirr Open the ORCID record for Alexander McGirr [Opens in a new window]
Maya N. Sohn
Affiliation:
Department of Psychiatry, University of Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
Carly A. McMorris
Affiliation:
Werklund School of Education, University of Calgary, Calgary, Alberta, Canada The Owerko Centre, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
Signe Bray
Affiliation:
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Child and Adolescent Imaging Research (CAIR) Program, University of Calgary, Calgary, Alberta, Canada
Alexander McGirr*
Affiliation:
Department of Psychiatry, University of Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
*
Author for correspondence: Alexander McGirr, E-mail: [email protected]
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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.

Keywords

Death-implicit association testD-IATsuicidal behavioursuicide attemptssuicide
Type
Review Article
Information
Psychological Medicine , Volume 51 , Issue 11 , August 2021 , pp. 1789 - 1798
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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