Suicidality and social cognition: the association between hypomentalizing and suicide lethality

Abstract

Introduction

Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.

Objectives

This study aimed to explore the association between hypomentalizing and SA lethality.

Methods

Our study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.

Results

Descriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).Table 1.

Means Comparison for low and high lethality (N=1371)

	Low lethality N=539	High lethality N=832	p value	Effect size
Age, mean (SD)	38.65 (15.65)	41.91 (15.37)	≤0.001	-0.209a
Female sex, N (%)	392 (72.7)	571 (68.6)	0.116	0.044b
Educational years, mean (SD)	12.45 (2.99)	12.43 (3.41)	0.890	0.0076a
Employed, N (%)	220 (41.2)	332 (40)	0.692	0.012b
Suicide Ideation, N (%)	475 (88.1)	742 (89.2)	0.541	0.016b
Suicide Planning, N (%)	159 (39.2)	400 (58.1)	≤0.001	0.183b
Number of attempts, mean (SD)	3.28 (5.48)	3.63 (5.74)	0.269	-0.169a
RFQ, mean (SD)	4.68 (1.27)	4.56 (1.32)	0.087	0.095a

Table 2.

Logistic regression analyses for high SA lethality (N=1371).

	Univariate analysis		Multivariate analysis
	OR	p value	OR	p value
Age	1.014 (1.007-1.021)	≤0.001	1.014 (1.005-1.022)	0.001
Female sex	0.820 (0.646-1.042)	0.105
Educational years	0.998 (0.965-1.031)	0.890
Employed	0.952 (0.763-1.187)	0.660
Suicide ideation	1.111 (0.790-1.562)	0.545
Suicide planning	2.150 (1.674-2.761)	≤0.001	2.183 (1.697-2.808)	≤0.001
Number SA	1.012 (0.990-1.034)	0.277
RFQ	0.929 (0.854-1.011)	0.088

Conclusions

While the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.

Disclosure of Interest

None Declared