(PS9-A24) Depression and Impairment Moderate the Relationship Between Death Orientation and Suicide Ideation in Adolescents

Among adolescents, the rates of suicide thoughts and behaviors continue to increase (CDC, 2019). Previous research has largely relied on self-report of suicide risk, but implicit association tasks (IAT) for death and suicide have been developed and used with adolescents as an alternative way to assess for suicide risk (Nock, 2007). The death/suicide IAT has been found to significantly predict future suicide thoughts and behaviors in adolescents (Glenn, 2019). However, this finding is in need of replication, and it’s possible that other factors moderate the relationship between implicit suicide risk and future suicide ideation severity. One potential moderating factor is depression, which is a common risk factor for suicide with increasing rates and severity in adolescents (Bitsko, 2018). Overall impairment in many domains, such as interpersonal relations, broad psychopathological symptoms, functioning in school, and use of leisure time, also associate with suicide risk and could be a potential moderating factor (Hatkevich, 2019). The current study aimed to replicate and extend prior research by examining whether implicit suicide risk at baseline was associated with future suicide ideation severity. It was also hypothesized that this relationship would be moderated by depressive symptoms and overall impairment.

Data were from a longitudinal study of 401 high school students in the south-central region of the United States, collected from 2018-2022. Data were collected at baseline and 6-month follow-up. Of the sample 78.7% were white, 62.7% were female and 34.1% were male, with a mean age of 16.67. Data collection took place at schools, and participants completed several self-report measures at both time points including the Suicide Ideation Questionnaire (SIQ), the Columbia Impairment Scale (CIS), and the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Participants also completed the Death/Suicide Implicit Association Task (DS-IAT) on an iPad.

The PROCESS Macro for SPSS was used to test moderation hypotheses. The first model found that impairment, but not DS/IAT scores, were significantly associated with suicide ideation. The interaction was significant, and baseline DS/IAT scores were associated with time 2 suicide ideation severity at moderate (b=1.82, p< .01) and high (b=3.92, p< .01) levels of impairment. The second model found that depressive symptoms, but not DS/IAT scores, were significantly associated with suicide ideation. The interaction was again significant, and baseline DS/IAT scores were associated with time 2 suicide ideation severity at moderate (b=1.36, p=.02) and high (b=4.38, p< .001) levels of depressive symptoms. Overall, as DS/IAT scores increase, indicating a stronger implicit association with death and suicide, future suicide ideation severity also increased.

Results showed that baseline implicit suicide risk was only associated with future suicide ideation at increased levels of impairment and depression. Overall, the results indicate that death orientation alone may not be indicative of future suicide ideation severity, and that reducing levels of impairment and depression could help mitigate suicide ideation among adolescents.