This study examined two Death-Implicit Association Test versions targeting associations between the self-concept (standard identity D-IAT; iD-IAT) and internal versus external control (adapted control D-IAT; cD-IAT) and death among suicide attempters. Additionally, correlations with explicit psychological variables and psychometrics were explored. 116 psychiatric inpatients (58.1 % female; age M = 33.6, SD = 12.4) were classified as single versus multiple and recent versus lifetime suicide attempters. Implicit associations were measured using the iD-IAT and cD-IAT. Self-report measures included constructs relevant to suicidal behaviour. Recent attempters showed weaker self-life (t(114) = 2.18, p = .016) and internal control-life (t(114) = 2.26, p = .013) associations than lifetime attempters. Multiple attempters exhibited weaker internal control-life associations than single attempters (t(114) = 2.25, p = .007). The iD-IAT correlated with suicidal ideation (r_s(114) = 0.20, p = .032), depression (r_s(114) = 0.20, p = .033) and external control (r_s(114) = 0.21, p = .021), the cD-IAT with suicidal ideation (r_s(114) = 0.25, p = .006) and depression (r_s(114) = 0.26, p = .006). The cD-IAT predicted multiple attempts (χ²(1116) = 3.88, p = .049), showed higher internal consistency (r_sb =. 31, p = .001) and predictive validity in detecting multiple (AUC = 0.64; p = .013) and recent (AUC = 0.62; p = .028) attempters than the iD-IAT. The cD-IAT shows preliminary potential to differentiate suicidal behaviour based on recency and frequency, offering a tentative step toward understanding cognitive vulnerabilities of at-risk subgroups, warranting further refinement, validation and prospective analyses.

Background/Objectives: The initial systematic review of “Concurrent Disorder Management Guidelines. Systematic Review” assessed the quality of the concurrent disorders’ clinical management guidelines in 2020, including the guidelines in the field from 2000 to 2020. Twenty-four guidelines were identified and assessed with AGREE II (Appraisal of Guidelines for Research and Evaluation). As dual disorder needs increased specifically among the younger population, requiring significant healthcare resources, more efficient approaches targeting complex concurrent disorders are essential. Since 2020, multiple new guidelines have been developed in response to new developments in the field of substance use disorder management. This systematic review update aimed to identify and appraise all new available concurrent disorder management guidelines to strategize the management of concurrent disorders, support better outcomes and further research directions. Methods: The review was registered, and protocol is available in the international register—PROSPERO. Literature searches were performed by two independent authors in electronic databases and the gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2020 and 2025. Sources that were not formal clinical guidelines, not addressed to physicians for adult age group, addressed to intellectual/developmental disability, or written in languages other than English were excluded. Results: The initial search resulted in 5003 records. A total of eight new guidelines were identified and assessed with AGREE II, highlighting the consistent gap in the evidence-based management recommendations. Conclusions: The appraised guidelines had similar quality to the 2020 findings, supporting dual or combined treatment; however, all guidelines had multiple domains not developed rigorously and with methodological limitations. Levels of complexity and staging of treatment were not considered in recommendations. Average domain scores were very low, with the lowest being applicability and editorial independence. Development of high-quality, rigorously developed, evidence-based guidelines, addressing staging, resource implications, and patient involvement is recommended as the evidence base remains underdeveloped.

Suicidal ideation and behaviour (SIB) occur across various psychiatric disorders. Although certain disorders are associated with elevated rates of SIB, diagnostic labels alone provide limited information about suicide-related presentations. Psychological pain has been proposed as an important experiential process operating across diagnostic boundaries, but its relationship with psychiatric comorbidity remains poorly understood. This study examined associations between psychiatric diagnoses, the number of co-occurring diagnoses, and psychological pain across clinical groups differing in suicide-related presentations. N = 233 psychiatric inpatients were recruited (recent suicide attempters [SUAT], recent suicide ideators [SUID], clinical controls [CLIN]). Psychiatric diagnoses were assessed using the Mini-International Neuropsychiatric Interview; psychological pain was measured using the Mee-Bunney Psychological Pain Assessment Scale. Analyses evaluated group differences in the number of diagnoses and psychological pain, their association, and diagnostic patterns. SUAT and SUID had higher mean numbers of diagnoses than CLIN; these did not differ between SUAT and SUID. Psychological pain differed across all groups and was positively associated with the number of diagnoses across the sample and within each group. Affective-anxiety and alcohol-dysthymic profiles were associated with suicide-related status. The number of diagnoses did not reflect differences between suicide-related groups. Although suicidal groups displayed greater diagnostic complexity than non-suicidal controls, differences between ideation and attempt were not mirrored by the number of diagnoses. Psychological pain differentiated all groups and was associated with the number of diagnoses. These findings suggest that psychological pain captures aspects of suicide-related clinical states not fully represented by diagnostic descriptions alone.