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

•No significant difference observed in interference scores between suicide attempters and patient controls.•However: a meta-analysis showed a significant but small bias towards suicide-related but not negative words in attempters.•Indirect evidence suggests that this specific information-processing bias may be related to the depressive state.

ObjectivePrevious 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.MethodWe 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.ResultsThe 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.LimitationsPositively-valenced words and healthy controls could not be assessed in the meta-analysis.ConclusionOur 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.