Cross-sectional study shows patients with suicidal ideation have distinct implicit emotional associations with death, suggesting enhanced risk assessment methods.
Introduction 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. Methods 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 me/not me ) and two novel attitude D‐IAT versions (D‐IAT I like/I don’t like , D‐IAT pleasant/unpleasant ). Furthermore, we compared all versions regarding their predictive and discriminative validity and analyzed correlations between implicit associations and self‐reported suicidal ideation. Results In the D‐IAT me/not me and D‐IAT I like/I don’t like version, patients with current suicidal ideation exhibited weaker negative associations with death compared to clinical controls. The D‐IAT pleasant/unpleasant did not yield a group difference. The D‐IAT me/not me showed superior performance in predictive validity and a similar performance in discriminative validity as the D‐IAT I like/I don’t like . These two versions correlated positively with self‐reported current suicidal ideation. In the D‐IAT pleasant/unpleasant , no such correlation was found. Discussion Our findings substantiate the validity and reliability of the identity D‐IAT and suggest the D‐IAT I like/I don’t like 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.
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Aschenbrenner et al. (2025) studied this question.
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