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 current suicidal ideation have stronger implicit associations between themselves and death. We also showed in one version, that these patients emotionally evaluate death in a more positive manner than patients without suicidal behaviour or suicidal ideation. Furthermore, we were able to show that the more positive the implicit attitudes toward death were in these patients, the stronger was their explicit suicidal ideation