Systematic review of the link between social cognition and suicidal ideation and behavior in people with serious mental illness

People with serious mental illness (SMI; psychotic and affective disorders with psychosis) are at an increased risk of suicide, yet there is limited research on the correlates of suicide in SMI. Social cognitive impairments are common among people with SMI and several studies have examined social cognition and suicidal ideation (SI) and behavior. This systematic review aims to evaluate the links between various domains of social cognition, SI, and suicidal behavior in SMI. Electronic databases (PubMed and PsycInfo) were searched through June 2023. Records obtained through this search (N=618) were screened by two independent reviewers according to inclusion criteria. Relevant data were extracted, and study quality was assessed. Studies (N=16) from twelve independent samples were included in the systematic review (N=2,631, sample sizes ranged from N=20 to N=593). Assessments of social cognition and SI and behavior varied widely between studies. Broadly, effects were mixed. Better emotion recognition of negative affect was linked to SI and a history of suicide attempts, though there is little consistent evidence for the relationship of emotion recognition and SI or behavior. On the other hand, better theory of mind ability was linked to SI and a history of suicide attempts. Furthermore, negative attributional bias was linked to current SI, but not a history of SI or attempt. This review suggests mixed associations between social cognition, SI, and behavior in SMI. Future research should evaluate additional mediators and moderators of social cognition and suicide, employing prospective designs.