Utility of the Death-Implicit Association Test in a Sample of Suicidal Inpatients

Research suggests that performance on the Death-Implicit Association Test (D-IAT) converges with explicit indicators of suicide risk (e.g., suicidal ideation, suicidal behaviors). However, the utility of the D-IAT in acute care settings has been questioned given limited studies and inconsistent findings. Additionally, it remains unclear whether the D-IAT incrementally improves the assessment of suicide risk beyond explicit measures.

The present study evaluated the validity of the D-IAT in a large sample of psychiatric inpatients who attempted suicide within the past two years (N = 203; M age = 32.93 [SD = 12.61]; 50.7% female; 63.5% White; 22.7% Hispanic/Latino). The D-IAT was scored three ways: (1) conventional D scoring where positive scores indicate stronger implicit associations with death, (2) dichotomized D scores where participants were categorized based on positive or negative D score, and (3) DD scoring, which is a novel procedure that differentiates self-identification with death (Me-DD) from a lack of identification with life (Not Me-DD).

D and Not Me-DD were weakly associated with suicide cognitions, hopelessness, suicidal ideation, and wishes to live/die and there were corresponding mean differences based on dichotomized D scores. D and Not Me-DD were also weakly correlated with number of lifetime suicide attempts. Me-DD evidenced fewer significant associations than Not Me-DD suggesting that a lack of association with life may be the central component of D scores.

Findings suggest that the D-IAT may not be a useful standalone measure of suicide risk in high-risk populations.