Suicide in adolescence and related psychological variables and executive functions: a comparison with healthy controls

Objectives

This study aimed to compare adolescents with a history of suicide attempts and a healthy control group in terms of sociodemographic characteristics, psychological variables, and executive functions, and to identify factors associated with suicidal behavior. Additionally, subgroup analyses were conducted within the case group based on the severity of suicidal ideation to examine its relationship with psychological variables.

Methods

This cross-sectional, case–control study included adolescents aged 12–18 years who presented with a suicide attempt and a control group matched for age and sex without any psychiatric diagnosis. Participants were assessed using the Cognitive Flexibility Scale, Satisfaction with Life Scale, Rosenberg Self-Esteem Scale, and Serial Digit Learning Test (SDLT). The Beck Scale for Suicide Ideation was administered only to the case group. Sociodemographic data were also collected. Statistical analyses were performed using chi-square tests for categorical variables and independent samples t-test or Mann–Whitney U test for continuous variables, depending on data distribution. A cut-off score of 6 on the Beck Scale was used for subgroup analyses within the case group.

Results

Adolescents with a history of suicide attempts demonstrated significantly lower scores in cognitive flexibility (43.83 ± 9.22 vs. 48.60 ± 6.27, p = 0.011), life satisfaction (17.76 ± 7.78 vs. 22.90 ± 7.25, p = 0.004), and self-esteem (14.39 ± 6.59 vs. 19.00 ± 5.60, p = 0.002) compared to the control group. No statistically significant difference was observed between groups in executive functioning as measured by the Serial Digit Learning Test (SDLT) (p = 0.154).

Sociodemographic analyses indicated that a history of psychiatric treatment (p < 0.001) and disrupted family structure (p = 0.001) were significantly more prevalent in the suicide attempt group, while no significant differences were found in age, gender, medical illness, or family psychiatric history (p > 0.05).

Within the case group, subgroup analyses based on suicidal ideation severity revealed that individuals with higher Beck Scale scores (≥6) had significantly lower cognitive flexibility (35.38 ± 6.23 vs. 45.72 ± 8.46, p = 0.0037) and life satisfaction (12.71 ± 8.64 vs. 19.13 ± 7.40, p = 0.0294) compared to those with lower scores. However, self-esteem (p = 0.5414) and SDLT scores (p = 0.8779) did not differ significantly between subgroups.

Conclusions

The findings demonstrate that low cognitive flexibility, low life satisfaction, and low self-esteem are significant psychological risk factors associated with suicide attempts in adolescents. Furthermore, an increase in the severity of suicidal ideation appears to be linked to decreased cognitive flexibility and life satisfaction. [1], [2] These results highlight the importance of considering not only psychopathology but also cognitive and psychosocial factors in assessing suicide risk. Interventions aimed at increasing cognitive flexibility, improving self-esteem, and enhancing life satisfaction can contribute to reducing the risk of suicide in this population. Additionally, family-related factors should be considered, and family-based interventions can play a protective role. Adolescence is both a high-risk period for suicidal behavior and a life stage where effective intervention is crucial.[3]Overall, suicide attempts in adolescence represent a multifactorial phenomenon requiring comprehensive assessment and prevention strategies.

References

Z, Y., Song, J., Wu, C., et al. (2014). Effects of life satisfaction and psychache on risk for suicidal behaviour: A cross-sectional study based on data from Chinese university students. BMJ Open, 4, e004096. https://doi.org/10.1136/bmjopen-2013-004096 MacPherson, H. A., Kim, K. L., Seymour, K. E., Wolff, J., Esposito-Smythers, C., Spirito, A., & Dickstein, D. P. (2022). Cognitive flexibility and impulsivity deficits in suicidal adolescents. Research on Child and Adolescent Psychopathology, 50(12), 1643–1656. https://doi.org/10.1007/s10802-022-00952-y Pan, L., & Phillips, M. R. (2014). Toward identification of neural markers of suicide risk in adolescents. Neuropsychopharmacology, 39, 236–237. https://doi.org/10.1038/npp.2013.233