Assessment of self-harm risk using implicit thoughts

Assessing for the risk of self-harm in acute care is a difficult task, and more information on pertinent risk factors is needed to inform clinical practice. This study examined the relationship of 6 forms of implicit cognition about death, suicide, and self-harm with the occurrence of self-harm in the future. We then attempted to develop a model using these measures of implicit cognition along with other psychometric tests and clinical risk factors. We conducted a prospective cohort of 107 patients (age > 17 years) with a baseline assessment that included 6 implicit association tests that assessed thoughts of death, suicide, and self-harm. Psychometric questionnaires were also completed by the patients, and these included the Beck Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974), Barratt impulsiveness scale (Patton, Stanford, & Barratt, 1995), brief symptom inventory (Derogatis & Melisaratos, 1983), CAGE questionnaire for alcoholism (Ewing, 1984), and the drug abuse screening test 10 (Skinner, 1982). Medical and demographic information was also obtained for patients as potential confounders or useful covariables. The outcome measure was the occurrence of self-harm within 3 months. Implicit associations with death versus life as a predictor added significantly (odds ratio = 5.1, 95% confidence interval [1.3, 20.3]) to a multivariable model. The model had 96.6% sensitivity and 53.9% specificity with a high cutoff, or 58.6% sensitivity and 96.2% specificity with a low cutoff. This scale shows promise for screening emergency department patients with mental health presentations who may be at risk for future self-harm or suicide.