Attentional bias toward suicide-relevant information in suicide attempters: A cross-sectional study and a meta-analysis

J Affect Disord. 2016 May 15;196:101-8. doi: 10.1016/j.jad.2016.02.046. Epub 2016 Feb 18.


Objective: Previous studies using a modified Stroop test suggested that suicide attempters, in contrast to depressed patients with no suicidal history, display a particular attentional bias toward suicide-related cues. However, negative results have also been reported. In the present study, we collected new data and pooled them as part of a meta-analysis intended to shed further light on this question.

Method: We conducted 1) a cross-sectional study comparing performance on the modified Stroop task for suicide-related, positively-valenced and negatively-valenced words in 33 suicide attempters and 46 patient controls with a history of mood disorders; 2) a systematic review and a meta-analysis of studies comparing performance on the modified Stroop task among patients with vs. without a history of suicidal acts in mood disorders.

Results: The cross-sectional study showed no significant difference in interference scores for any type of words between suicide attempters and patient controls. A meta-analysis of four studies, including 233 suicide attempters and 768 patient controls, showed a significant but small attentional bias toward suicide-related words (Hedges'g=0.22, 95%CI [0.06-0.38], Z=2.73, p=0.006), but not negatively-valenced words (Hedges'g=0.06, 95%CI [-0.09-0.22], Z=0.77, p=0.4) in suicide attempters compared to patient controls.

Limitations: Positively-valenced words and healthy controls could not be assessed in the meta-analysis.

Conclusion: Our data support a selective information-processing bias among suicide attempters. Indirect evidence suggests that this effect would be state-related and may be a cognitive component of the suicidal crisis. However, we could not conclude about the clinical utility of this Stroop version at this stage.

Keywords: Depression; Interference; Selective attention; Stroop test; Suicidal behavior.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Attentional Bias*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Information Seeking Behavior*
  • Male
  • Middle Aged
  • Stroop Test
  • Suicide / psychology*
  • Suicide, Attempted / psychology*
  • Young Adult