Aschenbrenner L M, Frei A, Knapp D, Forkmann T, Schreiber D, Glaesmer H, Brüdern J, Stein M, Walther S, Gysin-Maillart A
Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Graduate School for Health Sciences, Faculty of Medicine, University of Bern, Bern, Switzerland.
Suicide Life Threat Behav. 2025 Oct;55(5):e70047. doi: 10.1111/sltb.70047.
Assessing suicide risk in clinical settings is challenging, as conventional self-report scales have limited predictive validity. The Death Implicit Association Test (D-IAT) was developed to explore implicit associations related to death and the self-concept. However, it omits the emotional association with death that may be crucial in suicide risk assessment. This cross-sectional study on individuals with current suicidal ideation integrates the implicit emotional association with death into the conventional D-IAT.
We aimed to explore whether patients with current suicidal ideation exhibit more positive implicit emotional associations with death compared to a clinical control group without current suicidal ideation and lifetime suicidal behavior (total N = 182). We employed the standard identity D-IAT (D-IAT) and two novel attitude D-IAT versions (D-IAT, D-IAT). Furthermore, we compared all versions regarding their predictive and discriminative validity and analyzed correlations between implicit associations and self-reported suicidal ideation.
In the D-IAT and D-IAT version, patients with current suicidal ideation exhibited weaker negative associations with death compared to clinical controls. The D-IAT did not yield a group difference. The D-IAT showed superior performance in predictive validity and a similar performance in discriminative validity as the D-IAT. These two versions correlated positively with self-reported current suicidal ideation. In the D-IAT, no such correlation was found.
Our findings substantiate the validity and reliability of the identity D-IAT and suggest the D-IAT as a potential complementary attitude variant with personalized categories. Incorporating implicit emotional associations when working with suicidal patients could enhance the evaluation and treatment of individuals at risk of suicide. Further investigation is warranted to gain a more comprehensive understanding of these relationships.
在临床环境中评估自杀风险具有挑战性，因为传统的自我报告量表预测效度有限。死亡内隐联想测验（D-IAT）旨在探索与死亡和自我概念相关的内隐联想。然而，它忽略了与死亡的情感联想，而这种联想在自杀风险评估中可能至关重要。这项针对当前有自杀意念个体的横断面研究将与死亡的内隐情感联想纳入了传统的D-IAT中。
我们旨在探究与没有当前自杀意念和终身自杀行为的临床对照组相比，当前有自杀意念的患者是否表现出与死亡更积极的内隐情感联想（总样本量N = 182）。我们采用了标准身份D-IAT（D-IAT）和两个新颖的态度D-IAT版本（D-IAT、D-IAT）。此外，我们比较了所有版本的预测效度和区分效度，并分析了内隐联想与自我报告的自杀意念之间的相关性。
在D-IAT和D-IAT版本中，与临床对照组相比，当前有自杀意念的患者与死亡的负性联想较弱。D-IAT未产生组间差异。D-IAT在预测效度方面表现出色，在区分效度方面与D-IAT表现相似。这两个版本与自我报告的当前自杀意念呈正相关。在D-IAT中未发现此类相关性。
我们的研究结果证实了身份D-IAT的效度和可靠性，并表明D-IAT作为一种具有个性化类别的潜在补充态度变体。在处理自杀患者时纳入内隐情感联想可以加强对有自杀风险个体的评估和治疗。有必要进行进一步调查以更全面地理解这些关系。
