A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients

D. A. Brent, J. Grupp-Phelan, B. A. O'Shea, S. J. Patel, E. M. Mahabee-Gittens, A. Rogers, S. J. Duffy, R. P. Shenoi, L. S. Chernick, T. C. Casper, M. W. Webb, M. K. Nock, C. A. King, Joel Fein, Marlene Melzer-Lange, Daniel Cohen, Robert Hickey, Margaret Rea, Allison Keller, Rakesh MistryDale Woolridge, Lisa Colpe, Galia Siegel, Joel Sherrill, Marie Kay, Michelle Robinson, Casey Evans, Esther Ullman, Lisa Carn, Maureen O'Brien, Rebecca Lindsay, Taylor McGuire, Afton Kirk-Johnson

Research output: Contribution to journalArticlepeer-review

Abstract

Background Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings. Methods A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics. Results A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84-0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85-0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52-0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55-0.79). Conclusions In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.

Original languageEnglish (US)
Article number001215
JournalPsychological Medicine
DOIs
StateAccepted/In press - 2021

Keywords

  • Adolescents
  • emergency department
  • implicit association test
  • prediction
  • self-report
  • suicide attempts

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

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