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Cognitive functioning predicts suicidal behavior in first-episode psychosis

Research published in European Psychiatry found that global cognitive functioning and severe depressive symptoms were the most robust predictors of suicidal behavior in patients after their first episode of non-affective psychosis.

“To the best of our knowledge, no previous longitudinal studies have examined the relationships between neuropsychological functioning changes in [first-episode psychosis] patients and the presence of [suicidal behavior],” Rosa Ayesa-Arriola, PhD, department of psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Spain, and colleagues wrote. “Nevertheless, it has been suggested that neuropsychological functioning remains stable over time in [first-episode psychosis] patients.”

Researchers examined the predictors of suicidal behavior in 517 patients with first-episode psychosis, with adjustment for sociodemographic, clinical and neurocognitive variables, as well as the clinical and neurocognitive functioning differences between those with/without history of suicide attempts over a 3-year follow-up period.

The investigators evaluated patients at baseline, 1 year and 3 years after the first episode of psychosis, using bivariate and multivariate analyses to determine the impact of sociodemographic, clinical and neurocognitive variables as predictors of suicidality. At 1- and 3-year follow-up, they performed repeated measures analyses of variance to test changes in clinical and neurocognitive outcomes.

Analysis revealed global cognitive functioning (OR = 1.83; 95% CI, 1.25-2.67) and severe depressive symptomology (OR = 1.17; 95% CI, 1.07-1.28) predicted suicidal behavior in these patients, suggesting that poorer cognitive performance in first-episode psychosis emerges as a risk factor for suicidal behavior during the early stages of illness. Results from the longitudinal analyses showed patients with suicidal behavior at follow-up also had higher levels of remission regarding positive psychotic symptoms and depression. The authors also found that patients with a history of suicidal behavior experienced worse global cognitive functioning and visual memory than those without past suicidal behavior.

“In the light of our findings it seems that [first-episode psychosis] patients may benefit from early intervention programs which include cognitive remediation interventions,” Ayesa-Arriola and colleagues wrote in their study. “Further follow-up studies are required to investigate the possible benefits from specific procedures focused in basic cognitive processes in the prevention of suicidal behavior.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.