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Attentional Risk Factors for Suicidal Thoughts and Behaviors: A Synthesis of the Literature and Meta-Analysis

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Abstract

Although suicide is a pervasive public health issue, strong predictors of suicidal thoughts and behaviors (STBs, e.g., passive or active suicidal ideation, suicide plans, suicide attempts, etc.) are lacking. Theory suggests that attentional processes, such as attentional bias and attentional control, may contribute to STBs. Specifically, among individuals with suicidal ideation, attentional biases towards suicide-related information may increase distress. This combined with the inability to disengage and shift attention away from suicidal thoughts (i.e., deficits in attentional control) might contribute to increased risk for negative outcomes (i.e., non-suicidal self-injury, suicidal behavior). Despite this notion, there has been limited research examining associations between attentional risk factors and STBs. Therefore, the purpose of this study was to conduct a meta-analysis to examine possible associations between attentional biases and STBs and attentional control and STBs. A comprehensive literature search was conducted and a total of 20 articles were retained for this meta-analysis. A small, but significant relationship was observed between attentional bias and STBs (r = .09, 95% CI: .06, .13), but not attentional control and STBs (r = -.04, 95% CI: -.21, .12). The limited number of studies identified, and therefore low power, precluded moderator analyses from being conducted. Moreover, additional experimental and longitudinal research with diverse assessments of attentional risk factors is needed. Despite these limitations, the present study provides preliminary evidence for the association between attentional bias and STBs.

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Data Availability

The data used to produce these results is available upon request from the corresponding author.

Notes

  1. Two studies that measured the association between attentional control and STBs were comprised of samples that had psychotic or schizophrenia diagnoses. To ensure that these studies did not unduly influence the current findings, we removed them, and reexamined the association between attentional control and STBs. The pattern of results remained the same. A nonsignificant effect was observed for the association between attentional control and STBs (r = -.08, 95% CI: -.29, .14) and there was high heterogeneity in the effect (Q = 62.11, p < .001, I2 = 87.12%).

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. However, Kate Clauss is supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Medical Research Service of the Veterans Affairs Portland Health Care System, and the Department of Veterans Affairs VISN 20 Northwest Mental Illness Research, Education, and Clinical Center (MIRECC). Maya O'Neil is supported in part by a Career Development Award from the VHA RR&D (1 IK2 RX002762-01A1) as well as the VA Health Services Research and Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC). Amanda M. Raines is supported by the United States Department of Veterans Affairs (Clinical Science Research and Development Service) under Career Development Award-2 IK2cX001978-02. The contents of this article do not represent the views of the Department of Veterans Affairs of the United States Government.

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Kate Clauss conceptualized this paper, conducted the literature review, coded studies, conducted the analyses, and was involved in drafting the manuscript. Katherine Schafer coded studies, consulted on the analyses, and was involved in drafting the manuscript. Vanessa C. Somohano contributed to the updated literature search and coded studies. Maya O’Neil, as an expert in meta-analysis, consulted on the analyses and provided critical revisions. Joseph Constans, as a content expert in suicide and cognitive biases, provided critical revisions. Amanda M. Raines helped conceptualize the paper, develop the search terms, and provided critical revisions. Finally, Joseph R. Bardeen consulted on study coding and provided critical revisions.

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Correspondence to Kate Clauss.

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Kate Clauss, Katherine Schafer, Vanessa C. Somohano, Maya E. O’Neil, Joseph Constans, Amanda M. Raines, and Joseph R. Bardeen declare that they have no conflict of interest.

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Clauss, K., Schafer, K., Somohano, V.C. et al. Attentional Risk Factors for Suicidal Thoughts and Behaviors: A Synthesis of the Literature and Meta-Analysis. J Psychopathol Behav Assess 45, 1141–1153 (2023). https://doi.org/10.1007/s10862-023-10077-1

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