# Effects of Cyberball on cognitive vulnerability for suicide in youth with a history of multiple suicide attempts

## TL;DR

This study examined how social exclusion affects cognitive vulnerabilities for suicide in young people with multiple suicide attempts, finding no significant impact on decision-making or cognitive control.

## Contribution

The study introduces a novel approach to understanding how interpersonal stress influences suicide risk in high-risk youth using the Cyberball paradigm.

## Key findings

- Cyberball-induced social exclusion did not significantly affect decision-making or cognitive control in participants.
- High variability was observed among individuals in their responses to social exclusion and overinclusion.
- Significant group differences were found in changes in anger, loneliness, sadness, and depression.

## Abstract

While the precipitants for suicide are varied, interpersonal stressors are commonly identified. We hypothesized that interpersonal stressors increase suicide risk by exacerbating cognitive vulnerabilities in decision-making, cognitive control, and implicit associations between the self and death/suicide.

Interpersonal stress was modeled using the Cyberball paradigm in forty youth (16-24y) with a history of multiple (≥2) suicide attempts. Participants were randomized to either a social exclusion or overinclusion condition. Changes in mood and cognition were assessed before and after Cyberball using visual analog scales, the Game of Dice Task, the Iowa Gambling Task, the Balloon Analog Risk Test, the Word Color Stroop Test, and the Death/Suicide Implicit Association Test.

Social exclusion and overinclusion did not significantly impact decision-making, cognitive control or implicit association of the self with death/suicide, though high inter-individual variability was observed. Group differences were observed in the change in anger (t(34) = 2.47, p = 0.02), loneliness (t(34) = 2.56, p = 0.015), sadness (t(34) = 2.56, p = 0.02), and depression (t(34) = 2.25, p = 0.03).

As compared to social overinclusion, Cyberball-induced social exclusion did not significantly influence performance on cognitive tasks associated with suicide risk. Future research may consider within-subject designs comparing exclusion and inclusion paradigms, using alternative acute stress manipulations or powering studies to detect smaller effect sizes when studying interpersonal stress in youth at high-risk for suicide.