Suicide-Relevant Information Processing in Unipolar and Bipolar Depression: An Eye-Tracking Study

Suicide-relevant attentional biases are found in suicide attempters (SAs) with depression. Wenzel and Beck provide a theoretical framework that suggests suicide-related attention biases confer vulnerability to suicide. In this study, we integrated eye-tracking dynamics of suicide-related attentional biases with self-report measures to test their model. A free-viewing eye-tracking paradigm, which simultaneously presented four images with different valences (suicide-related, negative, positive, neutral), was examined in 76 SAs with unipolar or bipolar depression, 66 nonsuicidal depressive participants (ND), and 105 healthy never-depressed healthy control participants (HC). Structural equation modeling (SEM) was used for the theory testing. SA gazed more at suicide-relevant stimuli throughout the 25-s trial compared with ND. SA and ND initially detected suicide-related stimuli faster than HC. Groups did not differ on how often they initially gazed at suicide images or how fast they disengaged away from them. Eye-tracking indices of attentional biases, together with self-reported hopelessness, adequately fit an SEM consistent with Wenzel and Beck's cognitive theory of suicide-related information processing. Potentially, suicide-related attention biases could increase vulnerability to suicidal ideation and eventual suicidal behaviors.