Implicit Identification with Death, Clinician Evaluation and Suicide Ideation among Adolescent Psychiatric Outpatients-The Mediating Role of Depression

AbstractImplicit identification with death (i.e., subconsciously self-associating oneself with death), measured by the Death-Suicide Implicit Association Test (D/S-IAT), is associated with Suicide Ideation (SI). Our understanding of the mechanisms underlying this association is limited. The current study examined (1) the mediating role of depression between D/S-IAT and recent SI and (2) the association between SI, D/S-IAT, and clinician evaluation of SI among a clinical sample of adolescents. 148 adolescents aged 10–18 years (69.4% female) from two outpatient clinics were assessed at intake. Participants completed D/S-IAT and self-report measures for recent SI and depression during intake. Findings indicate that depression is a mediator between D/S-IAT and recent SI, controlling for gender, site differences, and past suicidal thoughts and behaviors. D/S-IAT and clinician evaluation were correlated with recent SI but not beyond depression. Our findings highlight the importance of examining the underlying psychological mechanisms regarding the association between D/S-IAT and suicide.Keywords: Adolescentsclinician evaluationdeath/suicide implicit association testdepressionsuicide ideation ETHICS APPROVALAll the study procedures were approved by the institutional review board of Geha’s and Rabin’s Medical Center.INFORMED CONSENTParticipants and their legal guardians signed an informed consent form. The informed consent forms included permission to use the questionnaire data.DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).DATA AVAILABILITY STATEMENTThe data that support the findings of this study are available from the corresponding author.Additional informationFundingDr. Shira Barzilay’s work is funded by the Israeli Ministry of Science and Technology and the American Foundation for Suicide Prevention.Notes on contributorsNermin ToukhyNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Yari GvionNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Shira BarzilayNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Alan ApterNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Liat Haruvi-CatalanNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Cendrine Bursztein-LipsicasNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Maya ShilianNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Ori MijiritskyNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Noa Benaroya-MilshteinNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Silvana FennigNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.Sami HamdanNermin Toukhy, Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Yari Gvion, Department of Psychology, Bar Ilan University, Ramat Gan, Israel. Shira Barzilay, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Department of Community Mental Health, University of Haifa, Haifa, Israel. Alan Apter, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Interdisciplinary Center Herzliya, Herzliya, Israel; Ruppin Academic Center, Emek Hefer, Israel. Liat Haruvi-Catalan, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. Cendrine Bursztein-Lipsicas, Maya Shilian, and Ori Mijiritsky, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel. Noa Benaroya-Milshtein and Silvana Fennig, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Sami Hamdan, School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv-Yaffo, Israel.