Suicidality Connected with Mentalizing Anomalies in Schizophrenia

Deficits in social cognition contribute to the severe difficulties in daily functioning of schizophrenic patients, although they have never been connected with suicidality. Theory of mind (ToM) tasks explore basic social abilities and have been found to be defective in schizophrenia. The relationship between ToM anomalies and suicidal history was studied in a sample of 57 stabilized outpatients. Logistic regression analysis showed an association between poor performance on second-order ToM tasks and a greater likelihood of suicidality in schizophrenic patients (OR = 4.02, 95% CI 1.18-13.62), which was independent of current clinical and neuropsychological status, with the exception of poor premorbid adjustment in infancy and adolescence. We caution against potential biases from mixing cross-sectional ToM scores with lifetime suicidal records and retrospective assessments of premorbid adjustment through repeated testing of patients and their relatives. Hence, the present findings suggest that ToM deficits may contribute to the high risk of suicide in schizophrenia.