Brüdern Juliane, Spangenberg Lena, Stein Maria, Gold Helena, Forkmann Thomas, Stengler Katarina, Glaesmer Heide
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
Front Psychiatry. 2024 Aug 7;15:1406675. doi: 10.3389/fpsyt.2024.1406675. eCollection 2024.
Suicide risk assessment based on self-report questionnaires is considered as problematic because risk states are dynamic and at-risk individuals may conceal suicidal intentions for several reasons. Therefore, recent research efforts increasingly focus on implicit risk markers such as the suicide attentional bias (SAB) measured with the Suicide Stroop Task (SST). However, most SST studies failed to demonstrate a SAB in individuals with suicide risk and repeatedly demonstrated insufficient psychometrics of the SST. This study aimed to investigate a SAB using a modified SST (M-SST) and to test its psychometric properties.
We compared n = 61 healthy controls and a high-risk inpatient sample of n = 40 suicide ideators and n = 40 suicide attempters regarding interference scores of positive, negative and suicide-related words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related words (mean RT Suicide -mean RT Neutral), resulting in a suicide-specific interference score. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words.
A Group × Interference ANOVA showed a significant interaction effect (p <.001, ηp2 = .09), indicating that group effects significantly vary across interference type. comparisons revealed that both ideators and attempters demonstrated greater interferences only for suicide-related words compared to healthy controls, indicating a SAB in patients, while a difference between ideators and attempters was lacking. The suicide interference score classified with an AUC = 0.73, 95% CI [0.65 - 0.82], p <.001, between controls and patients with STBs. The M-SST demonstrated good internal consistency and convergent validity.
The study adds evidence to the assumptions of the Cognitive Model of Suicide, viewing a SAB as a cognitive marker of suicide vulnerability independently of the engagement in suicidal behavior. The results' clinical implications are discussed in the context of recommended intervention strategies during an acute suicidal state. Future studies with the M-SST should include non-suicidal patient controls to investigate whether a SAB is uniquely related to suicidality.
基于自我报告问卷的自杀风险评估被认为存在问题，因为风险状态是动态的，且有风险的个体可能由于多种原因隐瞒自杀意图。因此，最近的研究工作越来越关注隐性风险指标，如通过自杀斯特鲁普任务（SST）测量的自杀注意偏向（SAB）。然而，大多数SST研究未能在有自杀风险的个体中证明存在SAB，并且反复证明SST的心理测量学不足。本研究旨在使用改良的SST（M-SST）调查SAB并测试其心理测量特性。
我们比较了61名健康对照者以及一个高危住院样本，该样本包括40名有自杀意念者和40名自杀未遂者，比较他们对积极、消极和与自杀相关词汇的干扰分数。干扰分数通过用与自杀相关词汇的平均反应时间（平均RT）减去中性词汇的平均反应时间来计算（平均RT自杀 - 平均RT中性），从而得出一个特定于自杀的干扰分数。同样，通过用积极和消极词汇的平均RT减去中性词汇的平均RT来计算积极和消极词汇的干扰分数。
一项组间×干扰方差分析显示出显著的交互作用（p <.001，ηp2 =.09），表明组效应在不同干扰类型间有显著差异。比较结果显示，与健康对照者相比，有自杀意念者和自杀未遂者仅在与自杀相关的词汇上表现出更大的干扰，这表明患者存在SAB，而有自杀意念者和自杀未遂者之间没有差异。自杀干扰分数的曲线下面积（AUC）为0.73，95%置信区间[0.65 - 0.82]，p <.001，可区分对照者和有自杀行为风险的患者。M-SST显示出良好的内部一致性和收敛效度。
该研究为自杀认知模型的假设增添了证据，将SAB视为自杀易感性的认知指标，而与是否参与自杀行为无关。在急性自杀状态下推荐的干预策略背景下讨论了研究结果的临床意义。未来使用M-SST的研究应纳入非自杀患者对照，以调查SAB是否与自杀倾向有独特关联。
