The Implicit Emotional Evaluation of Death versus Life in Persons with Acute Suicidal Thoughts

Background: Individuals with suicidal ideation share cognitive biases linking multiple thoughts to death. Previous studies have explored implicit associations between a person's self and death using the suicide-specific Implicit Association Test (IAT-S). While the IAT-S exhibits good predictive validity for future suicide attempts, it omits the emotional component that has been indicated in research as a factor in suicidality. In this cross-sectional study, we investigated the association between the self and death based on the classic IAT-S as well as the influence of emotional proximity to death on suicidality applying two new IAT-S versions. It was hypothesised that patients with current suicidal ideation exhibit stronger and more positive associations towards death than patients without suicidal ideation and behaviour. Methods: A total of N = 100 patients were studied and divided into two groups: Patients with suicidal ideation within the last week (n = 65) and patients without suicidal behaviour and thoughts within the last six months (n = 35). Three versions of the IAT-S were applied to record implicit associations between "death" / "life" and (01) "me" / "not me", "pleasant" / "unpleasant" and (03) "I like" / "I don’t like". The resulting d-values measured the strength of the associations. A positive d-value corresponded to stronger associations between the self and death than between the self and life and a more positive emotional evaluation of death than life. Additionally, data of explicit suicidal ideation were collected and correlated with the d-scores. Results: In all versions, mean d-scores were more positive for current suicide ideators compared to clinical controls. While we did not find an effect in version 02, in versions 01 and 03, was a significant difference in d-scores. We found a positive correlation between the d-scores of the suicide ideators in all versions and their scales for explicit suicidal ideation. Conclusion: We were able to find evidence for the hypothesis that patients with ...