MSRC postdoctoral pilot grant award

When a patient may be at risk of suicide, it is important that the clinicians working with that patient have some objective, accurate way of assessing exactly how great the suicide risk might be. Unfortunately, the standard means of assessing such risk rely mainly on questioning the patient directly about his or her suicidal thoughts or intentions, and this approach has several major weaknesses. Some individuals have limited insight into their own thoughts and feelings, for example, so their answers may not accurately reflect their degree of suicidality. But the biggest weakness of such self-reporting is that suicidal individuals often try to hide the fact that they have been thinking about suicide. They might, for instance, want to avoid being put into a psychiatric hospital, or they may simply wish to avoid being seen as weak or not in control of their emotions. Such concerns are a particular problem for members of the military, who often believe that disclosing suicidal thoughts will hurt their chances for promotion and other forms of advancement. Thus it would be useful for clinicians to have some way to gauge suicide risk that does not depend on self-reports.

One approach to determining an individual’s true thoughts and feelings on a subject even if the individual is trying to hide them is to administer what is known as an implicit association test. An individual taking such a test is presented with a long series of stimuli, such as words flashed up on a screen, and asked to quickly sort each into one of two categories, such as “pleasant” or “unpleasant.” The length of time it takes the person to respond to each stimuli is recorded, and the pattern of response times offers an indication of how the person feels about the topic under investigation, since faster responses indicate stronger mental associations. Because the results of the test depend on the response times rather than subjective reports of thoughts or feelings, the test is considered to be a behavioral measure.

Recently, psychologists at Harvard University developed an implicit association test designed to measure suicidal thoughts and intentions. In tests they showed that it could identify individuals who had recently attempted suicide and also predict which individuals were most likely to attempt suicide in the coming six months. Despite the promising results, however, no other researchers have attempted to repeat the findings.

Thus Sean Barnes and colleagues at the VA’s Mental Illness Research, Education, and Clinical Center in Denver are testing the suicide version of the implicit association test on a sample of 160 Veterans admitted to an inpatient psychiatric unit. The researchers will check to see if the test can be used to identify those Veterans who have attempted suicide recently and also see if it can predict which Veterans are most likely to attempt suicide in the six months following the administration of the test. If this behavioral assessment proves to be accurate, it will give clinicians a new and more objective method of determining which Veterans are most at risk for future suicide attempts, one that does not rely on the subjective reports of the Veterans themselves.