Table 1.
Summary of study methods and results.
| Study | Sample | EF measure(s) | Suicide measure(s) | Significant Findings |
|---|---|---|---|---|
| Mixed samples | ||||
| Bartfai et al., 1990 | 9 adult men with a recent suicide attempt; control groups = healthy controls (no suicide or psychopathology history; n = 8), chronic pain patients (n = 7) | WCST (S), Stroop (I), COWAT letter & S-a verbal fluency tasks (F), Design Fluency Test (F) | Defined suicide attempts broadly as “purposely inflicted self-harm”; additional details not provided | Attempters scored lower than healthy controls (but not chronic pain patients) on COWAT letter fluency and the Design Fluency Test |
| Ellis et al., 1992 | 20 adults admitted inpatient for self-injurious acts; control group = 27 adults at the same facility with no past suicidality | WCST (S), Trails (S) | Details about assessment of suicidality not provided | Marginal group difference on Trails A, with the suicidal group performing better than controls |
| Horesh, 2001 | 37 adolescents admitted inpatient for a suicide attempt; control group = 23 adolescents admitted for other reasons | CPT (I) | Child Suicide Potential Scale | Suicide attempter group made more commission errors |
| Dougherty et al., 2004 | 50 adults recruited via advertisements - 20 reported one suicide attempt, 10 reported multiple attempts, and 10 had no attempt history | Immediate & Delayed Memory Test (?) | Lifetime Parasuicide Count-2; attempt defined “as a self-harm behavior with a definite intent to die” | Single attempters made more commission errors than controls (on both the immediate and delayed portions of the task), while multiple attempters made the most |
| Raust et al., 2007 | 30 adults who made a suicide attempt but were currently euthymic recruited before discharge from an inpatient facility; control group = 19 healthy adults (no personal or family history of psychopathology) recruited from a blood donation center | Stroop (I), Go/No- go (I), Hayling sentence completion test - part B (I), spatial n-back (U) | Defined as “an attempt by the subject to kill him or herself, resulting in a need for (medical) hospitalization”; additional details not provided | Suicidal patients performed worse than controls on most measures of inhibition, including Hayling test part B, Stroop reaction times, and Go/No-go accuracy (with the exceptions of Hayling errors, Stroop interference, and Go/No-go reaction times), as well as the n-back |
| Ayalon & Litwin, 2009 | 1,712 older adults (national Israeli sample) – 111 reported experiencing passive SI in the past month (dichotomous) | Category fluency (F) | Interview item about passive SI – “in the past month, have you felt that you would rather be dead?” | No significant relationship |
| Dougherty et al., 2009 | 56 adolescents with a history of NSSI – 31 also had made at least one suicide attempt; recruited from any inpatient psychiatric facility | GoStop Task (I) | Lifetime Parasuicide Count-2; Scale for Suicidal Ideation | No significant group differences |
| Andover et al., 2011 | 173 adult male inmates in maximum-security prisons referred for neuropsychological evaluations - 90 reported having made an attempt | Trails (S), COWAT – letter & category (F) | Single interview item - “have you ever tried to kill yourself?” | No significant group differences |
| Burton et al., 2011 | 77 adults recruited from an inpatient facility currently being treated for a suicide attempt (37) or SI (40) | WCST (S), Trails (S), Stroop (I), COWAT – letter & category (F) | Recent SI and behavior confirmed through chart review | Greater Stroop interference predicted attempter status, as did better WCST performance |
| Dour et al., 2011 | 87 adolescents recruited via advertisements; ~60% met diagnostic criteria for at least one psychiatric disorder | DKEFS Tower Task – move-accuracy ratio (?) | Self-Injurious Thoughts & Behaviors Interview - assessed attempts in the past year | EF task performance did not directly predict attempts, but these scores and self-reported emotional reactivity interactively did |
| Miranda et al., 2012 | 45 young adults selected from a larger screening (n = 1011) - 13 participants had made a suicide attempt, while the remaining 32 had not; ~24% met diagnostic criteria for at least one mood or anxiety disorder | WCST (S) | Suicide Behavior Screening (baseline); Scale for Suicidal Ideation used to measure past week SI (at baseline and 6 month follow-up) | No significant difference in perseverative errors between attempters and non-attempters at baseline, but these errors predicted SI at follow-up; also, there was a interaction between perseverative errors and attempt history predicting SI at follow-up |
| Chamberlain et al., 2013 | 304 younger adults recruited through advertisements to participate in a larger study – 45 were considered high risk for suicide (based on reported SI) and 16 had made an attempt | Stop-signal (I) | Suicidality module of Mini International Neuropsychiatric Inventory | No significant group differences |
| Loyo et al., 2013 | 50 adults with symptoms of depression and anxiety - 25 had made a suicide attempt in the past 3 months; control group = 25 volunteers with no distress | WCST (S), Stroop (I), Behavior Rating Inventory of Executive Function, Adult version (S, I, ?) | Self-reported history of suicide attempts (defined as “conscious, self-destructive act carried out with the express intent of dying”); Plutchik Risk of Suicide Scale | Attempt group scored worse than both comparison groups on the BRIEF shifting scale, and worse than healthy controls (but not distressed controls) on Stroop interference and several other BRIEF scales; most of the BRIEF scales were correlated with suicide risk |
| Miranda et al., 2013 | 56 young adults recruited for the 96 who participated in the baseline portion of Miranda et al., 2012 after being contacted again 2–3 years later - 22 reported making an attempt | WCST (completed during baseline for Miranda et al., 2012) (S) | See Miranda et al., 2012 for details about assessment of attempt history; Scale for Suicidal Ideation | WCST perseverative errors significantly predicted SI at the follow-up assessment (2–3 years later); this relationship was partially mediated by brooding rumination |
| Mood disorders | ||||
| King et al., 2000 | 47 older adults with MDD; recruited from inpatient psychiatric facility -18 were admitted for a suicide attempt (excluded those with a past attempt; n = 10) | WCST (S), Trails (S), verbal fluency – ‘F words’, Ruff Figural Fluency Test (F) | Defined attempt broadly as “an intentional self- damaging act”; additional details not provided | No significant group differences but attempter status and age interactively predicted Trails B sequencing, such that attempters got slower with age but nonattempters did not |
| Keilp et al., 2001 | 50 adults currently in an MDE but not on psychotropic medication, recruited through referrals - 29 reported past attempts (15 classified as high lethality); control group = 22 healthy volunteers (no diagnosable pathology) recruited through advertisements | WCST (S), Trails (S), Stroop (I), CPT (I), FAS letter & animal category fluency (F), Baddeley A not B reaction time task (?) | Detailed history of suicidal behavior obtained through a structured interview; attempts rated for severity based on Beck’s medical damage scale, with scores of 5–7 considered ‘high lethality’ | High lethality attempter group scored worse than all 3 other groups across EF measures; follow-up analyses revealed that this pattern held for A not B reaction time; high lethality group also scored worse than low lethality and depressed nonattempters on letter fluency and WCST failure to maintain set, worse than depressed nonattempters on category fluency, and worse than controls on Stroop interference |
| Audenaert et al., 2002 | 20 adults with MDD but no comorbid psychopathology admitted for a suicide attempt in the past week; control group = 20 healthy volunteers (no history of psychopathology or psychotropic medications) | COWAT – letter & category fluency (F) | Details about assessment of suicidality not provided (unclear whether previous attempts were considered) | Suicide attempter group scored worse than controls on both fluency tasks |
| Martinez-Aran et al., 2004 | 108 adults with bipolar I or II disorder recruited from a hospital treatment program – number with past attempts not reported (sample mean = 0.7) | WCST (S), Trails (S), Stroop (I), COWAT – letter & category fluency (F) | Self-reported number of past suicide attempts | No significant correlations between EF scores and past suicide attempts |
| Marzuk et al., 2005 | 53 adults currently in an MDE recruited from an inpatient facility; 25 reported ongoing SI | WCST (S), Trails (S), Stroop (I), COWAT –verbal fluency (F), Five Point Test (F) | Scale for Suicidal Ideation; past suicide attempts assessed via self-report (number, dates, circumstances) | Group with ongoing SI scored worse on Trails B minus A and WCST perseverative errors |
| Swann et al., 2005 | 48 adults with a bipolar disorder, recruited from an inpatient facility - 24 reported at least one suicide attempt | Immediate and Delayed Memory Test (?) | Details of attempt history obtained through clinical records and interviews with participants and significant others | Attempters made more commission errors than non-attempters on the immediate (but not delayed) memory portion of the task; attempters also responded more quickly on the immediate memory portion |
| Harkavy-Friedman et al., 2006 | 51 adults with a bipolar disorder, all with a history of at least one suicide attempt, recruited from outpatient clinics and emergency rooms | Trails (S), Stroop (I), Go/No-go (I), CPT (I), N-back (U), FAS letter fluency (F), Baddeley A not B reaction time (?) | Details about assessment of attempt history not provided – sample was from a treatment study for suicide attempters | All bipolar attempters performed worse than controls on the n-back and go/no-go tasks; also, bipolar II group performed worse than controls on A not B reaction time and letter fluency, and worse than both other groups on Stroop errors |
| Dombrovski et al., 2008 | 32 older adults with a unipolar mood disorder with a suicide attempt or SI serious enough to require hospitalization in the past 3 months; control group = 32 age, gender, and education matched adults with MDD | Executive Interview (EXIT-25) (?) | Suicide item from the Hamilton Rating Scale for Depression; attempts rated for severity using Beck’s medical damage scale | Suicidal group performed worse on the EXIT25; 10 of 32 in suicidal group scored above established cutoff for significant functional impairment, compared to 3 of 32 in the control group |
| Keilp et al., 2008 | 178 adults currently in an MDE but unmedicated; recruited through clinician referrals - 95 reported past attempts (42 had a high lethality attempt); control group = 66 healthy volunteers (no psychopathology) recruited through advertisements | Stroop (with negative priming trials) (I), CPT (I) | Detailed history of suicidal behavior obtained through a structured interview; attempts rated for severity using Beck’s medical damage scale | Stroop interference scores were worse in all the clinical groups relative to controls, and worse in the high lethality attempt group relative to low lethality and depressed nonattempters; Stroop interference was also correlated with SI prior to admission and number of attempts |
| Westheide et al., 2008 | 29 adults with MDD without psychotic features admitted inpatient for a suicide attempt in the past 3 months – 14 had ongoing SI; control group = 29 healthy adults with no past psychiatric problems, recruited through advertisements | Go/No-go (I), delayed alternation task (?) | Suicide attempt characteristics were assessed using the Suicide Intent Scale; lethality of last attempt rated by attending physician; Scale for Suicidal Ideation | Suicidal patients with current SI (but not those without current SI) scored worse than controls on go/no-go gain scores and commission errors |
| Yen et al., 2008 | 96 adults with bipolar I disorder but in remission – 9 had experienced SI or made an attempt in the past year | WCST (S), Trails (S), CPT (I), COWAT (F) | 2 suicide items from the Violence & Suicide Assessment Scale | No significant group differences |
| Malloy-Diniz et al., 2009 | 39 adults with bipolar I disorder, recruited from outpatient clinic - 18 had at least one past suicide attempt; control group = 50 healthy adults matched on age, education level, and IQ | WCST (S), Stroop (I), CPT (I) | Suicide attempt history obtained through semi- structured interview, medical records review, and confirmation from family | No significant differences between those with and without an attempt (though patients scored worse than controls on most measures); number of attempts correlated with Stroop errors, but only on part of the task |
| Dombrovski et al., 2010 | 51 older adults with MDD (but no psychotic features) - 15 had a suicide attempt history, 12 with a history of SI requiring a higher level of treatment; control group = 14 with no diagnosable psychopathology | Stockings of Cambridge test (?) | Current and lifetime suicidality assessed using the SCID, other clinical interviews, review of medical records, and the Scale for Suicidal Ideation | No significant group differences on the EF task |
| Gilbert et al., 2011 | 67 adults with a bipolar disorder, recruited from inpatient and outpatient clinics – 28 categorized as attempters | WCST (S), Trails (S), Stroop (I), letter & category fluency (F) | Prior attempts assessed using the Columbia Suicide History Form | EF factor scores (derived through principle components analysis) did not differentiate groups, nor did individual task performance indices |
| Martino et al., 2011 | 85 adults with bipolar I or II disorder but currently euthymic, recruited from an outpatient treatment clinic - 22 had made at least one attempt | WCST (S), Trails (S), phonological & semantic fluency (F) | Defined an attempt as “a self-damaging act carried out with some intent to die”; assessed using the SCID | No significant group differences |
| Richard-Devantoy et al., 2011 | 20 older adults hospitalized for a current episode of MDD – 10 made a suicide attempt in the past 10 days, excluded those with previous attempts | Trails (S), Stroop (I), Go/No-go (I) | Specific details about assessment of attempt history not provided, though structured interviews (e.g., SCID) were administered | Suicidal group scored worse on the go/no-go task |
| McGirr et al., 2012 | 63 older adults with MDD without psychotic features, recruited from an inpatient facility or outpatient clinic – 34 had made an attempt (14 classified as high lethality); control group = 30 older adults with no history of psychiatric problems or treatment | WCST (S) | Suicide attempt history obtained through chart review, interviews, and confirmation from family; characterized attempts using the Beck Lethality and Suicide Intent Scales | High lethality group performed worse than the other 3 groups on conceptual understanding, and worse than the low-lethality group and controls on total errors and perseverative errors |
| Richard-Devantoy et al., 2012 | 40 older adults in a current MDE, recruited from inpatient facility - 20 had made an attempt in the past 10 days; control group = 20 older adults with no history of depression, suicide attempts, or current psychotropic medications, recruited through advertisements | Trails (S), Rule Shift Cards test (S), Stroop (I), Go/No- go (I), Hayling sentence completion task (I), verbal fluency test (F), Reading With Distraction task (?), Baddeley dual-task performance (?) | Suicide attempt history obtained via the treating psychiatrist, using information obtained during clinical interviews, chart review, and information from family or acquaintances | Attempters performed worse than healthy controls on all of the EF task indices, and worse than depressed controls on go/no-go scores and Stroop errors, as well as some (but not all) indices from the Trails, reading with distraction, rule shift cards, and Hayling tasks; number of attempts correlated with Stroop interference |
| Keilp et al., 2013 | 152 adults currently in an MDE but unmedicated, recruited through clinician referrals - 72 had a past attempts (27 classified as high lethality); control group = 66 healthy volunteers (no diagnosable psychopathology) recruited through advertisements | WCST (S), Trails (S), Stroop (I), CPT (I), Go/No-Go (I), N-back (U), Baddeley A not B reaction time (?) | Prior attempts assessed using the Columbia Suicide History Form; attempts rated for severity based on Beck’s medical damage scale | Attempters performed worse than depressed nonattempters and controls on the n-back and Stroop interference; both depressed groups scored worse than controls on letter and category fluency; Stroop interference correlated with number of attempts and SI prior to admission |
| Richard-Devantoy et al., 2013 | 66 adults with a history of mood disorder(s) who were currently euthymic – 35 had made a serious suicide attempt in the past, while the remaining 31 had not made attempts; control group = 37 adults with no history of mood disorders or suicide attempts | Verbal working memory task (U), semantic & phonemic fluency (F) | Defined an attempt as a” self-injurious act with a clear intent to end one’s own life”, and a serious attempt as one that led to ICU admission or qualified as violent using criteria proposed by Asberg; additional assessment details not provided | Serious suicide attempt group scored lower than both control groups on verbal working memory and semantic fluency; serious attempters also scored worse than healthy controls (but not patient controls) on the phonemic fluency |
| Psychotic disorders | ||||
| Potkin et al., 2002 | 188 adults with schizophrenia or schizoaffective disorder at high risk for suicide (made an attempt in past 3 years or SI with depression or command hallucinations) recruited from a large suicide prevention trial | Trails (S), CPT (I), COWAT verbal fluency (F), category naming (F) | Clinical Global Impression of Severity of Suicidality made by treating psychiatrist; adapted version of the Scale for Suicidal Ideation | No significant correlations between EF performance and lifetime suicide attempts, attempts in the past 36 months, global severity ratings, or recent SI |
| Kim et al., 2003 | 333 adults with schizophrenia recruited from hospital settings - 200 reported an attempt or SI during the course of their illness, and 101 endorsed suicidality in the past month | WCST (S), Consonant Trigram Test (U), COWAT verbal fluency (F), Category Instance Generation (F) | Information about current and lifetime suicidality obtained through a structured clinical interview | Participants with lifetime suicidality scored better on the Consonant Trigram Test, WCST perseverative errors, and Category Instance Generation |
| Nangle et al., 2006 | 78 adults with schizophrenia or schizoaffective disorder, all were currently being treated as outpatients - 28 classified as having at least one past attempt | Trails (S), CPT (I), n-back (U), COWAT verbal fluency (F) | Suicide attempt history obtained using the mood module of the SCID, confirmed through chart review and interviews with family/providers | Attempters scored significantly better than non-attempters on 0-back portion of n-back task, Trails B time, and COWAT verbal fluency; n-back and verbal fluency effects remained significant after controlling for age and positive symptoms |
| Barrett et al., 2011 | 174 adults with a schizophrenia spectrum disorder recruited for a larger translational study – 53 had made an attempt (24 made multiple attempts), 51 reported current suicidality | DKEFS category & set shifting tasks (S), Stroop (I) | Self-reported suicide attempts from SCID; current suicidality assessed using the Inventory of Depressive Symptoms | No significant differences between groups; currently suicidal participants made more DKEFS set- shifting errors, but this effect went away when controlling for current positive symptoms |
| Delaney et al., 2012 | 310 adults with schizophrenia or schizoaffective disorder – 75 had made an attempt, 63 had experienced SI only | CANTAB intra- dimensional/extra- dimensional (S) & spatial working memory (?) tasks | Past and current SI and attempts assessed using the SCID mood module | Combined SI and single attempt group performed better on the CANTAB Intra-dimensional/extra- dimensional but this effect went away when covarying depression |
| Huber et al., 2012 | 152 adults hospitalized during a first episode of psychosis - 28 classified as ‘severely suicidal’ at admission (i.e., hospitalization for imminent suicide risk required) | WCST (S) | Suicidality defined as “SI, intent, or having attempted suicide”; data extracted during a structured file audit | WCST composite (categories completed and perseverative errors) negatively associated with suicidality at admission |
| Other | ||||
| Espinosa et al., 2010 | 42 older adolescents and adults with temporal lobe epilepsy, recruited from an outpatient (epilepsy) clinic – 24 classified as risk for suicide (risk score > 7), and 12 had a suicide attempt | WCST (S) | Plutchik Risk of Suicide Scale | Perseverative errors predicted suicide risk and attempts, as did other and total errors; findings held in regression analyses accounting for disease duration, depression, and family history of psychopathology |
| Homaifar et al., 2012 | 47 adult veterans diagnosed with traumatic brain injury – 18 had made a suicide attempt | WCST (S), Immediate & Delayed Memory Test (?) | Attempt history assessed using the Columbia Suicide History Form | WCST perseverative errors predicted attempter status |
| Legris et al., 2012 | 42 adult women with Borderline Personality Disorder (number who had made suicide attempts not reported); control group = 41 healthy adults | Stroop (I), Stop signal (I) | Suicide Behavior Questionnaire, Revised | Stroop interference was correlated with overall suicide risk and lifetime suicide attempt - remained true in regression analyses which included depression severity |
EF task coding abbreviations: S = shifting, I = inhibition, U = updating, F = fluency, ? = unknown or multiple dimensions
Other abbreviations: CANTAB = Cambridge Neuropsychological Test Automated Battery; COWAT = California Oral Word Association Test; CPT = Continuous Performance Test; DKEFS = Delis-Kaplin Executive Function System; MDD(E) = Major Depressive Disorder (Episode); NSSI = non-suicidal self-injury; SCID = Structured Clinical Interview for DSM Disorders; SI = suicidal ideation; Stroop = Color-Word Stroop; Task Trails = Trails Making Test (A and) B; WCST = Wisconsin Card Sort Task