The interactive effects of negative symptoms and social role functioning on suicide ideation in individuals with schizophrenia

Abstract

Findings regarding the protective effect of social role functioning on suicide ideation in individuals with schizophrenia have been mixed. One reason for such inconsistencies in the literature may be that individuals with prominent negative symptoms of schizophrenia may not experience a desire for social closeness, and therefore social role functioning may not influence suicide risk in these individuals. The aim of this study was to examine the moderating effects of self-reported desire for social closeness and interviewer-rated negative symptoms on the relationship between social role functioning and suicide ideation. Our sample consisted of 162 individuals who had been diagnosed with schizophrenia-spectrum disorders; all participants completed self-report questionnaires and clinician-administered interviews, and moderation hypotheses were tested with a non-parametric procedure. The results indicated that motivation and pleasure-related negative symptoms moderated the relationship between social role functioning and suicide ideation; self-reported desire for social closeness and negative symptoms related to expression did not have such a moderating effect. Specifically, better social role functioning was associated with less suicide ideation only in those individuals who had low motivation and pleasure-related negative symptoms; no significant relationship was observed between social role functioning and suicide ideation among those with elevated motivation and pleasure-related negative symptoms. These findings suggest that assessing for negative symptoms and social role functioning may inform suicide risk assessments in individuals with schizophrenia, and improving social role functioning may reduce suicide ideation among those with few motivation and pleasure-related negative symptoms.

Can Anhedonia Be Considered a Suicide Risk Factor? A Review of the Literature

“…Jahn and colleagues [35] studied 162 patients affected by schizophrenia or schizoaffective disorder and found that motivation and pleasure scores as rated by the Clinical Assessment Interview for negative symptoms (CAINS) were not directly associated with recent suicidal ideation. However, motivation and pleasure-related scores moderated the relationship between social role functioning and suicide ideation.…”

“…The most consistent association was found for patients with affective disorders (7 of 7 studies reported a significant positive association) and for patients with PTSD (3 of 3 studies reported a positive association). For the two studies of patients with schizophrenia, one found no association (Jahn et al [35]) and the other found a negative association (Loas et al [18]). For patients who had attempted suicide (and who were undiagnosed), one study found a positive association [39], one a positive association but only for depressed attempters [33], and one found a negative association [13].…”

Psychosis as a risk factor for suicidal thoughts and behaviors: a meta-analysis of longitudinal studies

“…Moreover, some studies reported that negative symptoms (e.g. diminished emotional expression) were inversely related to suicide risk (Fenton et al 1997; Bertelsen et al 2007; Chang et al 2014); others found that negative symptoms significantly conferred risk (Havaki-Kontaxaki et al 1994; Steblaj et al 2007), with some reporting a non-significant relationship (Nordentoft et al 2002; Hawton et al 2005; Jahn et al 2016). Similar debates exist regarding positive symptoms such as delusions and hallucinations (Kelleher et al 2012; Chang et al 2014; DeVylder et al 2015).…”

Self‐Stigma Mediates the Impact of Insight on Current Suicide Ideation in Suicide Attempters with Schizophrenia: Results of a Moderated Mediation Approach

“…In the broader literature, it is sufficiently documented that one important and common risk factor for death by suicide among individuals with schizophrenia is suicide ideation, which often serves as an outcome in studies of suicide risk (Fulginiti & Brekke, ; Jahn et al., ; Kasckow et al., ) and as a viable and recommended target for suicide prevention efforts among individuals with schizophrenia (Fialko et al., ; Fulginiti & Brekke, ). Many well‐regarded empirical studies have reported that various illness‐related risk factors, including a history of suicide attempts, depression, hopelessness, lower self‐esteem, and poorer QoL, may predict suicide ideation and attempts in schizophrenia (Hor & Taylor, ; Popovic et al., ).…”