Die, Dead, Deceased, Lifeless, and Suicide

Last week, I wrote about the Implicit-Association Test (IAT), and whether it has use as a real-world predictor of behavior.  I have been skeptical of the IAT, because I do not believe that a longer latency on a language-pairing task necessarily reveals a real-world social bias.  How, as I mentioned last week, the IAT has predicted differences in treatment between black and white cardiac patients by physicians who did not declare any explicit racial bias.

And while I was researching the IAT, I found another paper (on which Dr. Mahzarin Banaji was also senior author), by Nock et al., from 2010, ‘Measuring the Suicidal Mind: Implicit Cognition Predicts Suicidal Behavior’, in which the IAT was used to positively predict suicidality in an at-risk patient population.

The IAT, as I have explained, is a measure of the speed at which a patient can assign a word to one of four categories, arranged into two pairs.

IAT - Task 3

The assumption which underlies the IAT is that, when the paired categories are cognitively linked in the mind of the subject, he or she will perform the task more quickly than when the paired categories are cognitively dissonant.

The authors of this paper administered a version of the IAT to 157 patients in a psychiatric emergency room, none of whom showed cognitive impairment.  Some had a history of suicidal behavior; some did not.  Some had co-morbid psychiatric disorders; some did not.

The particular IAT administered to these patients measured the latencies between matching words which signified ‘life’ versus ‘death’ (i.e. ‘alive’, ‘live’, ‘thrive’, and ‘die’, ‘dead’, ‘deceased’, ‘lifeless’, ‘suicide’), and words which signified ‘me’ versus ‘not me’ (i.e. ‘I’, ‘myself’, ‘mine’ and ‘they’, ‘them’, ‘other’)

Nock et al. found that a strong association on the IAT between ‘death’ and ‘self’ significantly predicted a suicide attempt: “Specifically, the presence of an implicit association with death/suicide was associated with an approximately 6-fold increase in the odds of making a suicide attempt in the next 6 months.”  This means that the IAT was a better predictor of future suicidality than either the prediction of the hospital clinicians or of the patients themselves.

Importantly, the Nock study didn’t establish a causal relationship between cognitive affect bias and suicidality.  There is no way to tell, from their data, whether negative cognitive bias actually makes you more likely to to attempt suicide, or whether it is an effect of the same emotional, chemical, or cognitive disruption that will lead one psychiatric patient to suicide and not another.  Either way, the paper suggests another way in which we are governed by, or reveal ourselves through, cognitive processes of which we are not consciously aware.

Image taken from Wikipedia.

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