Despite advances in understanding and treating suicidal behavior, suicide rates in this country have not fallen over the last decade. While previous research has identified several risk factors for suicidal behavior, the level of predictio afforded by these variables is inadequate. One major limitation of current risk factors is that the are almost exclusively based on patient report. Unfortunately, the utility of patient report may be compromised by factors such as patient resistance to reporting honestly regarding suicidal ideation and behavior or limited patient self- awareness related to cognitive and experiential risk factors associated with suicide. Recently, two areas of research have shown promise in identifying potent risk factors for suicidal behavior that may address these limitations. First, research in the area of implicit cognitive processes has shown that individuals at-risk for suicide and self-harm behavior have objectively detectable suicide-related associations of which they may not be aware or willing to disclose explicitly. Second, the application of ecological momentary assessment technology to self-harm behavior has produced encouraging results, with two studies indicating that shifts in affectivity, of which patients are largely unaware, are better predictors of future episodes of self-harm than dispositional measures alone. The BEST-AIM study proposes the first, fully powered, investigation of implicit and experiential measures of suicide risk in a high-risk sample of patients admitted to a psychiatric hospital due to significan suicide risk.
Suicidal ideation and behavior are a serious public health concern in the United States. Current treatments for suicide show limited efficacy, possibly due to patients'limited understanding of the implicit cognitions and non- obvious experiential factors that underpin their suicidal thoughts and behavior. The present study proposes a multimethod assessment of implicit and experiential risk-factors for suicide, a procedure that should provide incremental predicative utility above traditional measures of risk and provide multiple avenues for future clinical intervention.