Psychological Assessment on Suicide Indicators

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Psychologists are chiefly concerned with stuying the human mind in order to get a better undrstanding of how it functions. Like any other part of the body, the mind can also suffer from illness. When this occurs, psychologists are challenged to assess the characteristics of the mental illness, define it, and devise a way of restoring the mind’s health. Some mental conditions are more challenging than others, especially those that follow no apparent pattern and are dormant until one day they just happen. In order to have a deeper understanding of the mind’s processes and its health, the field of psychology has turned to the scientific method, developing a structured process of scientific investigation that is known as psychological testing.  Some may believe that “interest among psychologists/psychoanalysts in psychological testing has waned” (Lerner, 2007, p. 210), but even if such claim was true, countless tests are currently being developed.  Assessment of mind’s healthstate is something that can only be done through psychological testing.

Through the continued use of psychological testing, psychologists have managed to uncover countless mental conditions; they have also developed effective forms of treatment for many of those conditions. However, there are still conditions that remain elusive; suicide is one of them. Despite continued efforts, the psychological community had been unable to come up with a psychological test that would have helped to identify suicidal tendencies effectively and prevent suicide. In 2010, however, Harvard Professor Matthew K. Nock seemingly revolutionized the field of psychology by proposing a test that takes a few minutes to complete (on a computer) and alledgedly predicts what subjects think about suicide as well as their propensity to commit suicide. Since the proposal of this test, questions regarding its validity, reliability, and usefulness have arised.  A thorough assessment of the test and its development indicates that despite it being a breakthrough in the study of suicide, it cannot be viewed as an effective test to detect suicide tndencies; therefore, it is unreliable in treating and preventing suicide.

It is undeniable that “recent advances in psychological science have made it possible to objectively measure psychological characteristics that may be associated with specific thoughts, feelings, and behaviors” (Cha, Najmi, Park, Finn, & Nock, 2010, p. 1). Based on this assertion it is possible to verify that Matthew K. Nock could have studied and measured specific characterstics that throughout the years have been associated with suicide.  However, psychological research can also challenge the validty and reliability of Nock’s investigation, especially if one considers that long years of research have been unable to produce any major advancements in the field: 

Effectively assessing suicide risk is dependent on the availability of sensitive and specific measures of long-term risk factors, short-term warning signs, and an appreciation for the complexity and variability of suicide risk over time. Unlike many diagnostic procedures assessing relatively stable phenomena, we do not yet possess a single test, or panel of tests that accurately identifies the emergence of a suicide crisis. Among the many reason is that suicide risk is fluid, highly state-dependent, and variable over time (Fowler, 2012, p. 82).

If suicide is variable, dependent on the subject’s state of mind at a given time, it would seem impossible that a computer-based test taken one time could reliably indicate if a subject is prone to commiting suicide.  Up until the presentation of this new psychologic test for suicide, the best method of suicide detection had been self-reports from subjects themselves.  This approach to detecting and treating suicide has been, however, equally ineffective, as “self-reported psychological states consistently yield high false-positive prediction rates, limiting their predictive value” (Fowler, 2012, p. 82).

The difficulty in finding a consistent and effective way of detecting suicide tendencies has made it impossible for psychologists to prevent and treat suicide effectively.  Despite this, Nock is confident that his research has signified an unprecedented advancement in the study of suicide. Building on the Implicit Association Test (IAT), modifications were made so that the test stimulated only mental associations with two topics: life and death.  In words of Nock et al. (2010), “the IAT is a brief computer-administered test that uses people’s reaction times when classifying semantic stimuli to measure the automatic mental associations they hold about various topics, in this case, life and death/suicide” (p. 2). After customizing the IAC to test for suicidal tendencies, Nock conducted his study on a sample group of 124 subjects, all of which were adults seeking psyquiatric care.  In other words, the study was conducted on a group of individuals who consciously sought psyquiatric help.  This raises serious questions, and not only regarding the test’s reliabilty, but also in terms of its validity. 

We tested whether individuals who have made a decision to kill themselves would reveal stronger implicit cognition associating self with death/suicide and whether the strength of such an association would predict actual suicide attempts. We developed and evaluated a version of the Implicit Association Test that measures the association of death/suicide with self (Nock, et al., 2010, pp. 1–2).

The test is conceived to find if a person associates him or herself with death.  However, the test also sought to determine if the associations that the subject made with death actually indicated suicidal tendencies.  The results proved consistent throughout the 124 subject sample. They were valid as well, given that a six-month follow up conducted on 60 subjects clearly indicated an increased attentional bias towards suicide (as such increases in attentional bias were taken as a suicide indicator). Despite of this, it is important to consider that the test was only performed once (the IAC test) and that all of the subjects that participated in the study were people who had self-reported that they had psychological problems and, therefore, required treatment. The test was not conducted on a regular subject with no background of mental illness.  Furthermore, the followup test, which was conducted throughout the course of six months and indicated increased attentional bias towards suicide, was also conducted on people who had reported suffering from mental illness. 

Taking everything above mentioned into consideration, it follows that the variation of the IAC test that Professor Nock developed is partially reliable and valid at best.  True, his study evidenced consistent results across the sample that he used and he was able to prove that attentional bias towards suicide was present and that it increased through time. This, however, is not enough to ascertain if a person has suicidal tendencies, let alone predict the inminence of suicide. In fact, Nock himself recognizes that despite the successful development of the test that can measure a subject’s predisposition to associate his own thought/life with death/suicide, it is still premature to venture that an effective, valid, and reliable test for detecting suicide risk and preventing suicide has been obtained:

More specifically, an implicit association with death/suicide may represent one of the final steps in the pathway to suicide that is activated when a person is deciding how to respond to extreme distress. Notably, however, this study provides no evidence that such implicit cognitions are causally related to suicide attempts, or even precede them (Nock et al., 2010, p. 5).

This test, based on the conducted research and complementary analysis, evidences that the test IAC, a test developed for measuring suicide risk, cannot be considered as a universal test for measuring or predicting the likelihood of occurrence of suicide in a patient. Suicide is, perhaps, the most complex kind of mental illness that currently challenges psychologists all over the world. Even after decades of continued research and psyhological testing, “diagnostic tests for accurately predicting individual level risk remain elusive” (Fowler, 2012, p. 87). More research is needed before making any universal assertions regarding breakthroughs in the study of suicide. Notwithstanding all of this, Nock’s contributions are valuable insomuch they have allowed for a more in-depth understanding of how suicidal tendencies develop in those suffering from apparent cases of mental illness. The problem here is that there is still no test that can successfully identify if a person has suicidal tendencies or not. What is more, there is no test that can safely predict when a person is likely to commit suicide. Suicide is a spontaneous occurrence, and this makes it difficult for any test to measure, identify, and/or predict suicidal tendencies in a subject that does not have a long record of mental illness or has reported mental illness out of his own accord. The mind has proven to be a puzzle that the field of psychology is yet to decipher. 

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