Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA.
Psychol Med. 2023 Jan;53(1):123-131. doi: 10.1017/S0033291721001215. Epub 2021 May 5.
Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings.
A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics.
A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84-0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85-0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52-0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55-0.79).
In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.
人们对自我报告评估在预测未来自杀企图中的效用提出了担忧。儿科急诊部门的临床医生经常需要评估自杀风险。死亡内隐联想测验（IAT）是一种替代自我报告评估自杀风险的方法，它可能在急诊环境中具有实用性。
总共 1679 名青少年从儿科急诊护理应用研究网络的 13 个儿科急诊室招募，他们使用自我报告调查评估自杀企图的风险和保护因素，以及 IAT，然后在 3 个月后进行随访，以确定是否发生了企图。使用接收者操作特征的曲线下面积（AUC）比较自我报告和 IAT 的预测准确性。
一些自我报告变量，即当前和过去的自杀意念、过去的自杀行为、总消极生活事件以及学校或社会联系，在整个样本中预测 3 个月内的自杀企图的 AUC 为 0.87 [95%置信区间（CI），0.84-0.90]，而在没有报告自杀意念的患者中 AUC 为 0.91 [95%CI 0.85-0.95]。IAT 并没有显著增加所选自我报告变量的预测能力。IAT 单独对整个样本中 3 个月内的自杀企图具有适度的预测能力（AUC = 0.59 [95%CI 0.52-0.65]），并且在基线时非自杀患者的预测能力更好（AUC = 0.67 [95%CI 0.55-0.79]）。
在儿科急诊室中，一小部分自我报告项目比 IAT 更准确地预测 3 个月内的自杀企图。
