Effects of Cyberball on cognitive vulnerability for suicide in youth with a history of multiple suicide attempts

Introduction While the precipitants for suicide are varied, interpersonal stressors are commonly identified. We hypothesized that interpersonal stressors increase suicide risk by exacerbating cognitive vulnerabilities in decision-making, cognitive control, and implicit associations between the self and death/suicide. Methods Interpersonal stress was modeled using the Cyberball paradigm in forty youth (16-24y) with a history of multiple (≥2) suicide attempts. Participants were randomized to either a social exclusion or overinclusion condition. Changes in mood and cognition were assessed before and after Cyberball using visual analog scales, the Game of Dice Task, the Iowa Gambling Task, the Balloon Analog Risk Test, the Word Color Stroop Test, and the Death/Suicide Implicit Association Test. Results Social exclusion and overinclusion did not significantly impact decision-making, cognitive control or implicit association of the self with death/suicide, though high inter-individual variability was observed. Group differences were observed in the change in anger ( t (34) = 2.47, p = 0.02), loneliness ( t (34) = 2.56, p = 0.015), sadness ( t (34) = 2.56, p = 0.02), and depression ( t (34) = 2.25, p = 0.03). Conclusions As compared to social overinclusion, Cyberball-induced social exclusion did not significantly influence performance on cognitive tasks associated with suicide risk. Future research may consider within-subject designs comparing exclusion and inclusion paradigms, using alternative acute stress manipulations or powering studies to detect smaller effect sizes when studying interpersonal stress in youth at high-risk for suicide.