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Association between Cognitive Functioning, Suicidal Ideation and Suicide Attempts in Major Depressive Disorder, Bipolar Disorder, Schizophrenia and Related Disorders: A Systematic Review and Meta-Analysis
66 Pages Posted: 17 Jan 2024
More...Abstract
Backgrounds: Suicidal ideation and behavior contribute significantly to global disability. Treatable mental disorders, such as psychotic, major depressive, and bipolar conditions, contribute to a substantial portion of suicide risk, often accompanied by documented neurocognitive deficits. We report the association between cognitive function and suicidal ideation/suicide attempts (SI/SA) in individuals with schizophrenia/schizoaffective disorder, bipolar disorder (BD), and major depressive disorder (MDD).
Methods: A systematic search was conducted on PubMed, Ovid and Scopus databases for primary studies published from inception to November 1, 2023. Data extraction was performed by two screeners/reviewers (G.H.L. and S.W.). Eligible articles that reported on the effect size of association between cognition and SI/SA were pooled using a random effects model.
Results: A total of 41 studies were included for analysis. There is a pooled negative association between executive functioning and SI/SA in schizophrenia/schizoaffective disorder (SA: Corr=-0·78, 95% CI [-1·00, 0·98]; SI: Corr=-0·06, 95% CI [-0·85, 0·82]) and MDD (SA: Corr=-0·227, 95% CI [-0·419, -0·017]; SI: Corr=-0·14, 95% CI [-0·33, 0·06]). Results are mixed for BD, with a significant pooled positive association between SA and global executive functioning (Corr=0·08, 95% CI [0·01, 0·15]), but a negative association with emotion inhibition. Mixed findings are also observed for processing speed, attention, and learning and memory, transdiagnostically, indicating the need for further investigation. There was a low risk of bias for the obtained studies. The pooled analyses revealed substantial between-study heterogeneity.
Interpretations: Suicidal ideation and attempts are complex phenomena not easily explained by a single factor. The interplay of cognitive disturbances, particularly in reward-based functioning, may underlie suicidality in individuals with mental disorders. Disturbances in impulse control, planning, and working memory may contribute to self-injurious behavior and suicide. Therapeutics addressing general cognitive deficits and reward learning may offer therapeutic benefits for aspects of suicidality. FundingThis paper received no funding.
Funding: This paper received no funding.
Declaration of Interest: Dr. Joshua D Rosenblat has received research grant support from the Canadian Institute of Health Research (CIHR), Physician Services Inc (PSI) Foundation, Labatt Brain Health Network, Brain and Cognition Discovery Foundation (BCDF), Canadian Cancer Society, Canadian Psychiatric Association, Academic Scholars Award, American Psychiatric Association, American Society of Psychopharmacology, University of Toronto, University Health Network Centre for Mental Health, Joseph M. West Family Memorial Fund and Timeposters Fellowship and industry funding for speaker/consultation/research fees from iGan, Boehringer Ingelheim, Janssen, Allergan, Lundbeck, Sunovion and COMPASS. He is the Chief Medical and Scientific Officer of Braxia Scientific and the medical director of the Canadian Rapid Treatment Centre of Excellence (Braxia Health). Kayla M. Teopiz has received fees from Braxia Scientific Corp. Dr. Taeho Greg Rhee was supported in part by the National Institute on Aging (#R21AG070666; R21AG078972; R01AG088647), National Institute of Mental Health (#R01MH131528), and National Institute on Drug Abuse (#R21DA057540). Dr. Rhee serves as a review committee member for Patient- Centered Outcomes Research Institute (PCORI) and Substance Abuse and Mental Health Services Administration (SAMHSA) and has received honoraria payments from PCORI and SAMHSA. Dr. Rhee has also served as a stakeholder/consultant for PCORI and received consulting fees from PCORI. Dr. Rhee serves as an advisory committee member for International Alliance of Mental Health Research Funders (IAMHRF). Dr. Rhee is currently a co-Editor-in-Chief of Mental Health Science and has received honorarium payments annually from the publisher, John Wiley & Sons, Inc. Dr. Roger Ho received funding from the National University of Singapore iHeathtech Other Operating Expenses (A-0001415-09-00). Dr. Nina Schweinfurth-Keck received speaker/consultation fees from Idorsia Ltd., Janssen, Lundbeck, OM Pharma, Schwabe Pharma AG. Dr. Maj Vinberg has received consultancy fees from Lundbeck and Janssen Cilag the past three years. Iria Grande has received grants and served as consultant, advisor or CME speaker for the following identities: ADAMED, Angelini, Casen Recordati, Esteve, Ferrer, Gedeon Richter, Janssen Cilag, Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare, Viatris outside the submitted work. She also receives royalties from Oxford University Press, Elsevier, Editorial Médica Panamericana. She thanks the support of the Spanish Ministry of Science and Innovation (MCIN) (PI23/00822) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII- Subdirección General de Evaluación y confinanciado por la Unión Europea (FEDER, FSE, Next Generation EU/Plan de Recuperación Transformación y Resiliencia_PRTR ); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2021 SGR 01358), CERCA Programme / Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022). Dr. Roger S. McIntyre has received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Alkermes, Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Neurawell, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Viatris, Abbvie and Atai Life Sciences. Dr. S. Roger McIntyre is a CEO of Braxia Scientific Corp. Gia Han Le, Sabrina Wong, Sipan Haikazian, Danica E. Johnson, Sebastian Badulescu, Angela T.H. Kwan, Hartej Gill, Joshua D. Di Vincenzo, Sonya Liao, Bing Cao, and Giacomo d’Andrea declare no competing interests.
Keywords: Major Depressive Disorder, Bipolar Disorder, Schizophrenia, Cognition, Suicidality, Suicidal Ideation, Suicide Attempts
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