Richard-Devantoy Stéphane, Inja Ayla, Dicker Marina, Bertrand Josie-Anne, Turecki Gustavo, Orri M, Keilp John G
McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada.
McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada.
J Affect Disord. 2025 Mar 1;372:358-369. doi: 10.1016/j.jad.2024.12.009. Epub 2024 Dec 5.
Suicidal behavior results from a complex interplay between stressful events and vulnerability factors, including cognitive deficits. Poorer performance on the Stroop task, a measure of cognitive control, has been associated with suicidal behavior in numerous studies. The objective was to conduct an updated systematic review of the literature on the Stroop task as a neuropsychological test of vulnerability to suicidal acts in patients with mood and other psychiatric disorders, while also looking at how the type (classic versus emotional) or the version (paper or computerized) of the Stroop task, as well as the characteristics of the patient (clinical population, age, sex) moderated the Stroop effect.
A search on Medline, Embase, PsycInfo databases, and article references was performed. 53 studies (6781 participants) met the selection criteria. Interference time and errors of the Stroop Test were assessed in at least 3 studies to be analyzed. Moderators, such as the type (classic versus emotional) of the Stroop task and the characteristics of the patient (clinical population, age, sex) were also assessed.
Interference time on Stroop performance was lower in suicide attempters than in patient controls (g = 0.20; 95%CI [0.10-0.30]) and healthy controls (g = 0.79; 95 % CI [0.29-1.29]), with patient controls scoring lower than healthy controls (g = -0.63; 95%CI [-1.01-0.25]). This was moderated by age and having a mood disorder. In terms of interference errors, suicide attempters performed worse than healthy controls (g = 0.57; 95%CI [0.01-1.15]) but did not perform differently from patient controls (g = 0.20; 95 % CI [-0.06-0.45]). Patient controls also did not score differently than healthy controls (g = -0.18; 95 % CI [-0.54-0.18]). There was a significant moderation effect for the type (i.e., original Stroop task) and version (i.e., paper format) of the Stroop task, and for some characteristics of the patient (i.e., older patients and having a mood disorder).
Cognitive control impairment was associated with a history of suicidal behavior in patients, especially in older populations and those with mood disorders, however this result was moderated by outcome measure (interference time vs. errors), the type (i.e., original Stroop task) and the version (i.e., paper format) of the Stroop task. Cognitive control processes may be an important factor of suicidal vulnerability. Choosing the right neurocognitive test in the right population to detect suicide vulnerability is important direction for future research.
自杀行为是应激事件与脆弱性因素（包括认知缺陷）之间复杂相互作用的结果。在众多研究中，作为认知控制指标的斯特鲁普任务表现较差与自杀行为有关。目的是对有关斯特鲁普任务作为情绪及其他精神障碍患者自杀行为易感性神经心理学测试的文献进行更新的系统评价，同时探讨斯特鲁普任务的类型（经典型与情绪型）或版本（纸质版或计算机化版）以及患者特征（临床人群、年龄、性别）如何调节斯特鲁普效应。
在医学文献数据库、荷兰医学文摘数据库、心理学文摘数据库及文章参考文献中进行检索。53项研究（6781名参与者）符合纳入标准。至少3项待分析研究评估了斯特鲁普测试的干扰时间和错误情况。还评估了调节因素，如斯特鲁普任务的类型（经典型与情绪型）和患者特征（临床人群、年龄、性别）。
自杀未遂者在斯特鲁普任务表现上的干扰时间低于患者对照组（g = 0.20；95%置信区间[0.10 - 0.30]）和健康对照组（g = 0.79；95%置信区间[0.29 - 1.29]），患者对照组得分低于健康对照组（g = -0.63；95%置信区间[-1.01 - 0.25]）。年龄和患有情绪障碍对此有调节作用。在干扰错误方面，自杀未遂者表现比健康对照组差（g = 0.57；95%置信区间[0.01 - 1.15]），但与患者对照组无差异（g = 0.20；95%置信区间[-0.06 - 0.45]）。患者对照组得分与健康对照组也无差异（g = -0.18；95%置信区间[-0.54 - 0.18]）。斯特鲁普任务的类型（即原始斯特鲁普任务）和版本（即纸质版）以及患者的某些特征（即老年患者和患有情绪障碍）存在显著调节效应。
认知控制损害与患者的自杀行为史有关，尤其是在老年人群和患有情绪障碍的人群中，然而这一结果受结果测量指标（干扰时间与错误）、斯特鲁普任务的类型（即原始斯特鲁普任务）和版本（即纸质版）调节。认知控制过程可能是自杀易感性的一个重要因素。在合适的人群中选择合适的神经认知测试来检测自杀易感性是未来研究的重要方向。
