title: Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury.
abstract: BACKGROUND
  Suicide is among the most important mental health issues affecting adolescents today despite much research on its detection and prevention. Beyond suicide attempts (SAs), clinicians are increasingly confronted with another, potentially related problem: non-suicidal self-injury (NSSI)-defined as the deliberate destruction of body tissue without intent to die. NSSI may increase risk for making an SA by sevenfold, but many studies examining this link have involved youths engaging in both NSSI and SAs. Thus, there is a need to compare homogeneous groups of adolescents engaged in NSSI-only or SA-only, but not both, to advance what is known about each form of self-harm. The self-injurious implicit association task (SI-IAT) is a particularly important computerized behavioral task to study such adolescents because the SI-IAT provides objective behavioral data about problems for which people may lack insight or be motivated to conceal, such as SAs and NSSI.
  
  
  METHODS
  We evaluated implicit associations with cutting and death/suicide using the computerized SI-IAT in three mutually exclusive groups: (1) adolescents who made an SA but had never engaged in NSSI (n = 47); (2) adolescents who engaged in NSSI but had never made an SA (n = 46); and (3) typically developing control (TDC) adolescents without history of psychiatric problems (n = 43).
  
  
  RESULTS
  Nonsuicidal self-injury participants had stronger identification with cutting versus no cutting than either SA or TDC participants. Contrary to our hypothesis, NSSI participants had stronger identification with suicide/death versus life than either SA or TDC participants.
  
  
  CONCLUSIONS
  Strong implicit attitudes towards suicide/death among adolescents with NSSI without a prior SA suggest that clinicians should not dismiss NSSI as not serious. Further work is required to elucidate the mechanism by which youths engaged in NSSI acquire these stronger identifications and make a first-time SA to develop novel treatment and prevention strategies blocking this transformation, ultimately reducing youth suicide.
authors: PediMIND Program, Bradley Hospital, East Providence, RI, USA.|Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
authors: Daniel P
authors: DP
authors: Dickstein
authors: PediMIND Program, Bradley Hospital, East Providence, RI, USA.|Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
authors: Megan E
authors: ME
authors: Puzia
authors: PediMIND Program, Bradley Hospital, East Providence, RI, USA.|Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
authors: Grace K
authors: GK
authors: Cushman
authors: PediMIND Program, Bradley Hospital, East Providence, RI, USA.|Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
authors: Alexandra B
authors: AB
authors: Weissman
authors: PediMIND Program, Bradley Hospital, East Providence, RI, USA.|Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
authors: Ezra
authors: E
authors: Wegbreit
authors: PediMIND Program, Bradley Hospital, East Providence, RI, USA.|Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
authors: Kerri L
authors: KL
authors: Kim
authors: Department of Psychology, Harvard University, Cambridge, MA, USA.
authors: Matthew K
authors: MK
authors: Nock
authors: Division of Child and Adolescent Psychiatry, Alpert Medical School, Brown University, East Providence, RI, USA.
authors: Anthony
authors: A
authors: Spirito
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001293:Attitude to Death; D005260:Female; D006801:Humans; D008297:Male; D016728:Self-Injurious Behavior / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology*
keywords: Suicide; adolescent; cognition; nonsuicidal self-injury