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

## TL;DR

This study investigates whether difficulty in understanding others' mental states (hypomentalizing) is linked to more lethal suicide attempts.

## Contribution

The study is one of the first to examine the relationship between hypomentalizing and suicide attempt lethality in a large clinical cohort.

## Key findings

- Hypomentalizing was not significantly associated with higher suicide attempt lethality.
- Hypomentalizing increased the risk of suicide planning.
- Suicide planning predicted higher suicide attempt lethality.

## Abstract

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.

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

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.

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 valueEffect sizeAge, mean (SD)38.65 (15.65)41.91 (15.37)≤0.001
-0.209aFemale sex, N (%)392 (72.7)571 (68.6)0.1160.044bEducational years, mean (SD)12.45 (2.99)12.43 (3.41)0.8900.0076aEmployed, N (%)220 (41.2)332 (40)0.6920.012bSuicide Ideation, N (%)475 (88.1)742 (89.2)0.5410.016bSuicide Planning, N (%)159 (39.2)400 (58.1)≤0.001
0.183bNumber of attempts, mean (SD)3.28 (5.48)3.63 (5.74)0.269-0.169aRFQ, mean (SD)4.68 (1.27)4.56 (1.32)0.0870.095a
Table 2.Logistic regression analyses for high SA lethality (N=1371).
Univariate analysisMultivariate analysisOR
p valueORp valueAge1.014 (1.007-1.021)≤0.001
1.014 (1.005-1.022)0.001
Female sex0.820 (0.646-1.042)0.105Educational years0.998 (0.965-1.031)0.890Employed0.952 (0.763-1.187)0.660Suicide ideation1.111 (0.790-1.562)0.545Suicide planning2.150 (1.674-2.761)≤0.001
2.183 (1.697-2.808)≤0.001
Number SA1.012 (0.990-1.034)0.277RFQ0.929 (0.854-1.011)0.088

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

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

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.

None Declared