# Toward Optimizing Behavioral Markers of Suicide Risk

> **NIH VA I01** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2022 · —

## Abstract

Despite ongoing efforts to enhance suicide risk assessment, current methods rely heavily on patient report of
suicidal ideation and related factors (e.g., intent, plan, access to means) to determine level of risk. Reliance on
self-report is problematic because many patients are unwilling or unable to report thoughts and intentions of
suicide.1 In addition to these limitations, the emphasis of self-report measures on conscious thoughts and
emotions has fostered little insight into the largely unconscious cognitive processes that are theorized to
underlie suicidal crises.2,3 These suicide-related cognitive processes, or habitual ways of thinking that promote
suicide, are believed to emerge when individuals become distressed, but at other times may be dormant. This
notion of “suicidal cognitive reactivity” is consistent with clinicians’ and patients’ observations that for some
individuals suicidal thoughts and intentions may be absent during a clinical interview, but then rapidly resurface
in the presence of distress. Although suicidal cognitive reactivity is purported to be a critical underlying
mechanism of suicide risk, it has received little empirical evaluation because there have not been any
established procedures to elicit and assess it. The ability to elicit and assess suicidal cognitive reactivity could
be extremely clinically useful. If clinicians could assess the likelihood of suicidal thoughts and intentions
emerging in the near future, they would be better able to accurately determine patients’ risk of suicide. We
have developed and pilot tested a procedure to evaluate suicidal cognitive reactivity using a suicide-specific
mood induction and computerized reaction-time tasks (i.e., the Death/Suicide Implicit Association Test,4 and
the Suicide Stroop5) that implicitly measure cognitive processes (i.e., association of self with death, and biased
attention toward suicide-related cues) and have predicted suicide attempts among high-risk civilians and
Veterans.4,6,7 These tasks serve as behavioral markers of suicide risk. Although promising, the tasks are still
not very accurate. This may be due to suicide-related cognitive processes not being active in some participants
at the time of assessment. In order to optimize the tasks and test the critical theoretical prediction that distress
activates suicidal thinking, the proposed research will examine scores on the Death/Suicide Implicit
Association Test and Suicide Stroop task both before and after inducing a dysphoric mood in participants by
having them watch a brief scene from a movie having to do with suicide. The study will compare two groups of
Veterans: (1) a “Suicide Group” who have or have had a mood anxiety and/or trauma related disorder and
have attempted suicide within the past year, and (2) a “No Suicide Group” who similarly have or have/had a
mood anxiety and/or trauma related disorder, but have never seriously considered attempting suicide. If the
cognitive theory of suicidal beha...

## Key facts

- **NIH application ID:** 10520005
- **Project number:** 5I01CX001303-05
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** SEAN BARNES
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-07-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10520005

## Citation

> US National Institutes of Health, RePORTER application 10520005, Toward Optimizing Behavioral Markers of Suicide Risk (5I01CX001303-05). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10520005. Licensed CC0.

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