Critique of Cha et al.: Attentional Bias Toward Suicide-Related Content

The following was written for the class Self-Destructive Behaviors and is a critique of a 2010 article entitled “Attentional bias toward suicide-related stimuli predicts suicide behavior,” linked below.


Cha et al. addressed attention bias toward suicide-related content as a predictor of suicide behavior with a population of adults presenting to a psychiatric emergency department. Demographic and psychiatric factors were obtained, and a history of suicidal behavior was assessed; attentional bias toward suicide-related content was measured via the Stroop task. Both the clinician and the patient made predictions as to whether or not the patient would make a suicide attempt in the next 6 months. It was found that suicide attempters, especially those who had made a recent attempt, showed specific attentional bias to suicide-related content, and this surpassed other clinical procedures for predicting future attempts. The strength of the association was highly linked with how recently attempts had been made; the more recent the attempt the stronger the attentional bias.

This study addresses the need for an important assessment tool missing in the field: an object measurement of risk for suicidal behavior. Self-report is notoriously unreliable, and risk assessments often end with uncomfortable uncertainty because the clinician has to rely on something unverifiable. This measurement appears able to make not only predictions about who is at the greatest risk to exhibit suicidal behavior, but also about the time at which the behavior is most likely to occur.  Thus there’s a possibility of using it with actively suicidal patients in deciding if greater psychiatric intervention should be taken. If so, resources may be more effectively allocated, and people who may have otherwise attempted suicide could potentially be prevented from doing so.

Prevention of suicide based on attention bias means breaking a patient’s fixation on suicide in treatment. This could be accomplished through authoring scripts that focus on topics of hope and future goals, as well as practicing techniques such as thought diffusion and expansion. The goal being separating one’s identity from suicidality, thus being able to get through the current high-risk period, as well as learning skills to protect against future episodes.

The study doesn’t really address how protective factors affect attentional bias; are there certain traits that allow a person to exhibit this tendency without engaging in suicidal behavior? There could be plenty of people focused on suicide or death-related content that don’t engage in suicide behaviors; what prevents them from doing so? Would cognitive flexibility allow a person to more easily refocus on adaptive coping mechanisms? Also, the more creatively inclined may be able to channel their fixation on suicide content into something more productive. Because this study drew from a population of patients in a psychiatric emergency department there may be a certain selection bias. It may be interesting to assess suicidal thoughts and behaviors in a population that reports a baseline interest in suicide or death-related content, but who may or may not have had previous suicide attempts. If it can be found that this measurement can reliably and accurately predict suicidal behavior, populations that are least likely to seek help for thoughts of suicide may be able to be identified.

 Cha et al_2010

Cha, C. B., Najmi, S., Park, J. M., Finn, C., & Nock, M. K. (2010). Attentional bias toward suicide-related stimuli predicts suicidal behavior. Journal of Abnormal Psychology, 119, 616-622.


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