Department of Psychology, San Diego State University, San Diego, CA, United States.
Department of Psychiatry, UC San Diego, La Jolla, CA, United States.
Schizophr Res. 2018 Feb;192:340-344. doi: 10.1016/j.schres.2017.06.013. Epub 2017 Jun 24.
Previous literature suggests that better cognitive ability and insight are associated with greater lifetime risk of suicide attempts in schizophrenia, counter to the direction of association in the general population. However, the conjoint association between distinct cognitive domains, insight, and suicidality has not been assessed.
In a cross-sectional study, 162 adults with schizophrenia or schizoaffective disorder completed cognitive testing via the MATRICS battery, symptom and cognitive insight assessments, along with the Columbia Suicide Severity Rating Scale. We then contrasted participants based on history of suicidality by cognitive domains and insight measures and conducted multivariate analyses.
Although a history of any passive ideation was not associated with cognitive ability or insight, verbal learning was positively associated with a greater history of suicidal attempt and prior ideation with a plan and intent. Higher cognitive insight, and the self-reflectiveness subscale insight, was also associated with history of passive or active suicidal ideation. Cognitive insight and cognitive ability were independent from each other, and there were no moderating influences of insight on the effect of cognitive ability on suicide related history. Exploratory analyses revealed that history of planned attempts were associated with greater verbal learning, whereas histories of aborted attempts were associated with poorer reasoning and problem-solving.
Although cross-sectional and retrospective, this study provides support that greater cognitive ability, specifically verbal learning, along with self-reflectiveness, may confer elevated risk for more severe suicidal ideation and behavior in an independent fashion. Interestingly, poorer problem-solving was associated with aborted suicide attempts.
既往文献表明，精神分裂症患者认知能力和洞察力越好，一生中尝试自杀的风险就越高，这与普通人群的关联方向相反。然而，不同认知领域、洞察力与自杀倾向之间的联合关联尚未得到评估。
在一项横断面研究中，162 名患有精神分裂症或分裂情感障碍的成年人通过 MATRICS 成套测验、症状和认知洞察力评估以及哥伦比亚自杀严重程度评定量表完成认知测试。然后，我们根据认知领域和洞察力测量的自杀史将参与者进行对比，并进行了多变量分析。
尽管有过任何被动自杀意念的历史与认知能力或洞察力无关，但言语学习与更多的自杀尝试史和有自杀计划和意图的既往自杀意念呈正相关。较高的认知洞察力，以及自我反省洞察力，也与被动或主动自杀意念的历史有关。认知洞察力和认知能力是相互独立的，洞察力对认知能力与自杀相关历史的影响没有调节作用。探索性分析表明，有自杀计划史与更好的言语学习有关，而有自杀未遂史与较差的推理和解决问题能力有关。
尽管本研究是横断面和回顾性的，但它提供了支持，即更好的认知能力，特别是言语学习，以及自我反省，可能会以独立的方式增加更严重自杀意念和行为的风险。有趣的是，较差的解决问题能力与自杀未遂有关。
