Mentalization and Social Cognition in Adolescents After Suicide Attempt

Mentalization and Social Cognition in Adolescents After Suicide Attempt

This study investigates the risk of violent suicide attempts in adolescents, with a particular focus on social cognition and sleep disturbances, to better understand the cognitive and behavioral mechanisms involved and to inform more targeted prevention strategies.

Violent suicide attempts are defined as the use of methods with a high immediate lethal potential. They are associated with distinct clinical profiles and specific risk factors, including an increased risk of recurrence and completed suicide.

Although the association between suicidal behavior and psychiatric disorders is well established, evidence regarding the underlying neurocognitive factors remains inconsistent. In particular, little is known about the role of social cognition in suicidal risk among adolescents. Research in this area is limited, leaving an important gap in our understanding of the cognitive processes that may contribute to the emergence of suicidal thoughts and behaviors during adolescence.

In addition, studies conducted in community-based adolescent cohorts have shown that insufficient sleep duration is independently associated with increased suicidal ideation and suicidal behavior, even after accounting for depressive symptoms.

This research examines violent suicide risk in adolescents through the study of social cognition and sleep disturbances, with the aim of clarifying the cognitive and behavioral mechanisms involved and informing more targeted prevention strategies. Violent suicide attempts are defined as attempts involving methods associated with a high risk of fatal outcome. Such attempts have been associated with distinct clinical characteristics and risk profiles, including a greater risk of recurrence and completed suicide. Although the association between suicidal risk and psychiatric history is well documented, evidence regarding the neurocognitive factors involved remains limited and inconsistent. Social cognition refers to the cognitive processes involved in perceiving, interpreting, and responding to social information. Adolescence is a critical developmental period for social cognition, characterized both by ongoing maturation of socio-emotional and prefrontal brain networks and by increasing social demands, including greater reliance on peer relationships, heightened sensitivity to social evaluation, and the emergence of more complex interpersonal interactions. These developmental changes may influence how adolescents interpret and respond to interpersonal stressors associated with suicidal vulnerability. However, the relationship between social cognition and suicidal risk in adolescents remains poorly understood, and relatively few studies have specifically investigated the cognitive mechanisms that may contribute to the emergence of suicidal thoughts and behaviors in this population. Finally, studies conducted in community adolescent samples suggest that insufficient sleep duration is associated with increased suicidal ideation and suicidal behaviors, independently of depressive symptoms.

Inclusion Criteria:

• Adolescents aged 12 to 16 years, inclusive
• Having made a violent or non-violent suicide attempt
• Hospitalized in the Department of Child and Adolescent Psychiatry at Necker Children's Hospital
• No intellectual disability (IQ > 70)
• Sufficient proficiency in French to complete the study assessments; at least one parent or legal guardian must also have sufficient proficiency in French
• Written informed consent obtained from the holders of parental authority and assent obtained from the adolescent
• Covered by a health insurance scheme

Exclusion Criteria:

• Current psychotic disorder or documented history of a psychotic disorder
• Current manic or hypomanic episode
• Severe neurological or medical condition likely to significantly affect cognitive performance
• Moderate-to-severe substance use disorder requiring specialized treatment
• Acute intoxication or withdrawal state at the time of assessment- Written informed consent obtained from parents or legal guardians and assent obtained from the adolescent