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

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.

Implicit and Explicit Attitudes Toward Service Robots in the Hospitality Industry: Gender Differences

“…As the modified IAT, this study develops the RIAT to measure implicit attitudes toward service robots and explore its consistency with explicit measures of robot attitudes. The results that show the inconsistent patterns between implicit robot attitudes (RIAT D-scores) and explicit robot attitudes could produce valid implicitexplicit attitude comparisons, which are similar to the modified IAT of previous studies on the Death-Implicit Association Test (D-IAT; M. N. Sohn et al, 2021), the Facebook Implicit Association Test (FIAT; , and the Preschool Implicit Association Test (PIAT; Cvencek et al, 2011) in social psychology, marketing, and education. Given the popularity of robotic platforms for service interactions in hotels (e.g., Fuentes-Moraleda et al, 2020;Lukanova & Ilieva, 2019), restaurants (e.g., Cha, 2020), and airports (e.g., Triebel et al, 2016), it is vital to use this knowledge to plan appropriate actions in real time for robotic platforms.…”

How do Explicit, Implicit, and Sociodemographic Measures relate to Concurrent Suicidal Ideation? A Comparative Machine Learning Approach.

“…In contrast, a correct indication of suicidality by the IAT would be registered as a prediction error, because the participant indicates no desire to die on the self-reported outcome variable. Hence, it remains possible that implicit measures of self-harm and suicide associations offer incremental utility in the prospective prediction of actual self-harm and suicidal behavior, as reported by Sohn et al (2021). Thus, future research in clinical samples is needed to obtain a thorough judgment of the IAT's contribution to the prediction of selfharm and suicide.…”

“…Scores on the self-harm/suicide IAT were also able to discriminate between individuals with a history of suicide attempts and those without (Sohn et al, 2021), and they correlated with specific types of self-harm behavior (Glenn et al, 2017). A recent systematic review highlighted the reasonable retrospective and prospective criterion validity of the suicide/death IAT, considering significant associations with past and future suicidal thoughts and behaviors (Moreno et al, 2022).…”

Announcement of the Registered Report “Can a variant of the Implicit Association Test detect nonsuicidal self-injury in a clinical population? A Registered Report”

“…To overcome this problem, an implicit measure has been developed that assesses automatic responding to statements about prior NSSI behaviour (i.e., the past nonsuicidal self-injury Implicit Association Test: P-NSSI-IAT; Cathelyn et al, 2021). Previous studies tested the predictive utility of this measure in online studies with samples of at risk participants and produced promising results (Franklin et al, 2017;Sohn et al, 2021).…”