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J Clin Psychiatry. 2017 Jun;78(6):e614-e621. doi: 10.4088/JCP.16m10647.

Cognitive Control Deficits Differentiate Adolescent Suicide Ideators From Attempters.

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McLean Hospital, 115 Mill St, Mailstop 331, de Marneffe Building, Room 239, Belmont, MA 02478-9106.
Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA.
Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, Massachusetts, USA.
Clinical and Social Sciences in Psychology, University of Rochester, New York, USA.
Teachers College, Columbia University, New York, New York, USA.
Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.



Mental illness and suicidal ideation are among the strongest correlates of suicidal behaviors, but few adolescents with these risk factors make a suicide attempt. Therefore, it is critical to identify factors associated with the transition from suicide ideation to attempts. The present study tested whether deficits in cognitive control in the context of suicide-relevant stimuli (ie, suicide interference) reliably differentiated adolescent ideators and attempters.


Adolescents (n = 99; 71 girls) aged 13-18 years (mean = 15.53, SD = 1.34) with recent suicide ideation (n = 60) or a recent suicide attempt (n = 39) were recruited from an acute residential treatment facility between August 2012 and December 2013. We measured interference to suicide-related, negative, and positive words using the Suicide Stroop Task (SST).


When stimuli were analyzed separately, suicide attempters showed greater interference for suicide (t₉₇ = 2.04, P = .044, d = 0.41) and positive (t₉₇ = 2.63, P = .010, d = 0.53) stimuli compared to suicide ideators. An additional omnibus interference (suicide, negative, positive) x group (suicide ideator, suicide attempter) analysis of variance revealed a main effect of group (F₁,₉₇ = 4.31, P = .041, ηp² = 0.04) but no interaction (P = .166), indicating that attempters showed greater interference for emotional stimuli, regardless of valence. Multiple attempters drove this effect; single attempters and ideators did not differ in SST performance (P = .608).


General deficits in cognitive control in the context of emotional stimuli may be a marker of adolescent suicide risk.

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