Probing the implicit suicidal mind: does the Death/Suicide Implicit Association Test reveal a desire to die, or a diminished desire to live?

Assessment of implicit self-associations with death relative to life, measured by a death/suicide implicit association test (d/s-IAT), has shown promise in the prediction of suicide risk. The current study examined whether the d/s-IAT reflects an individual's desire to die or a diminished desire to live and whether the predictive utility of implicit cognition is mediated by life-oriented beliefs. Four hundred eight undergraduate students (285 female; Mage = 20.36 years, SD = 4.72) participated. Participants completed the d/s-IAT and self-report measures assessing 6 indicators of suicide risk (suicide ideation frequency and intensity, depression, nonsuicidal self-harm thoughts frequency and intensity, and nonsuicidal self-harm attempts), as well as survival and coping beliefs and history of prior suicide attempts. The d/s-IAT significantly predicted 5 out of the 6 indicators of suicide risk above and beyond the strongest traditional indicator of risk, history of prior suicide attempts. However, the effect of the d/s-IAT on each of the risk indicators was mediated by individuals' survival and coping beliefs. Moreover, the distribution of d/s-IAT scores primarily reflected variability in self-associations with life. Implicit suicide-related cognition appears to reflect a gradual diminishing of the desire to live, rather than a desire to die. Contemporary theories of suicide and risk assessment protocols need to account for the dynamic relationship between both risk and life-oriented resilience factors, and intervention strategies aimed at enhancing engagement with life should be a routine part of suicide risk management.