The role of premorbid personality and social cognition in suicidal behaviour in first-episode psychosis: A one-year follow-up study

Background: High suicide attempt (SA) rates have been reported in first-episode psychosis (FEP) patients, particularly during the first year after the illness onset. Despite previous studies establishing several risk factors for suicidal behaviour in FEP, premorbid personality and social cognition have not been sufficiently investigated to date. Objective: To test whether personality traits and social cognition are associated with SAs in FEP over a 12-month follow-up. Method: Sixty-five FEP patients were evaluated at first contact with mental health services. The presence of SAs was recorded at six and twelve months after first presentation. Bivariate and multivariate analyses explored the influence of a range of sociodemographic and clinical variables, including premorbid personality and social cognition-related Theory of Mind (ToM) measures, on SAs. Results: SAs were associated with greater severity of symptoms at first hospitalization with psychotic symptoms (OR = 2.18, 95% CI = 1.25–3.82), schizoid personality traits (OR = 1.62, 95% CI = 1.02–2.57) and impairment in a first-order false belief task (OR = 4.26, 95% CI = 1.05–17.31) in the multivariate models. Conclusions: Symptom severity at illness onset, premorbid schizoid personality traits and ToM impairment emerged as predictors of SA in this FEP sample, which, if replicated, may be useful in identifying high-risk groups and implementing more targeted suicide prevention programs in FEP