Mentalization and Social Cognition in Adolescents After Suicide Attempt

Overview

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.

Detailed description

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.

Interventions

• Other Test
  Clinical Assessment of Social Cognition, including : * PERSO: measurement of social reasoning, through the analysis and interpretation of social situations, the understanding of the emotions and intentions of others, as well as the adaptation of responses to the relational context; * Movie for the Assessment of Social Cognition (MASC): video task measuring understanding of the mental states, intentions and emotions of others (theory of mind), * Ambiguous Intentions Hostility Questionnaire (AIHQ
• Other Questionnaires
  To explore the associations between performance on the most discriminative social cognition measures (derived from the Clinical Assessment of Social Cognition \[ClaCoS\] battery) and several secondary variables that may influence socio-cognitive functioning or the characteristics of the suicide attempt, including: * Suicidal intent, assessed using the Suicide Intent Scale (SIS) * Anxiety symptoms, assessed using the Screen for Child Anxiety Related Emotional Disorders (SCARED) * Depressive symp

Primary outcome measures

• Level of performance in social cognition in the two groups of adolescents hospitalized following a suicide attempt, distinguishing: adolescents who made a violent suicide attempt and those who made a non-violent suicide attempt [Time frame: 1 day]

Secondary outcome measures (8)

• Severity of suicidal intention [Time frame: 1 day]
• Level of socio-economic precariousness [Time frame: 1 day]
• Level of anxiety [Time frame: 1 day]
• Level of depressive disorder [Time frame: 1 day]
• Evaluation of attachment styles [Time frame: 1 day]
• Level of sleep disturbances [Time frame: 1 day]
• Evaluation of socio-developmental / social-cognition skills [Time frame: 1 day]
• Severity of nightmares [Time frame: 1 day]

Eligibility criteria

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

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Diagnostic

Study locations

France · 1 center

• Hôpital Necker-Enfants Malades — Paris

Publications

• Szeifert N, Balint L, Sebok B, Gonda X. Risk factors for violent suicide attempts: Hungarian cross-sectional study. Eur Psychiatry. 2025 Jun 11;68(1):e85. doi: 10.1192/j.eurpsy.2025.10042. PMID 40495519
• Sastre-Buades A, Alacreu-Crespo A, Courtet P, Baca-Garcia E, Barrigon ML. Decision-making in suicidal behavior: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2021 Dec;131:642-662. doi: 10.1016/j.neubiorev.2021.10.005. Epub 2021 Oct 5. PMID 34619171
• Pompili M, Innamorati M, Forte A, Longo L, Mazzetta C, Erbuto D, Ricci F, Palermo M, Stefani H, Seretti ME, Lamis DA, Perna G, Serafini G, Amore M, Girardi P. Insomnia as a predictor of high-lethality suicide attempts. Int J Clin Pract. 2013 Dec;67(12):1311-6. doi: 10.1111/ijcp.12211. PMID 24246209
• Perrain R, Dardennes R, Jollant F. Risky decision-making in suicide attempters, and the choice of a violent suicidal means: an updated meta-analysis. J Affect Disord. 2021 Feb 1;280(Pt A):241-249. doi: 10.1016/j.jad.2020.11.052. Epub 2020 Nov 12. PMID 33220560
• Parrish EM, Steenkamp L, Chalker SA, Moore RC, Pinkham A, Depp CA. Systematic Review of the Link Between Social Cognition and Suicidal Ideation and Behavior in People With Serious Mental Illness. Schizophr Bull Open. 2024 Mar 27;5(1):sgae007. doi: 10.1093/schizbullopen/sgae007. eCollection 2024 Jan. PMID 38617732
• Paus T, Keshavan M, Giedd JN. Why do many psychiatric disorders emerge during adolescence? Nat Rev Neurosci. 2008 Dec;9(12):947-57. doi: 10.1038/nrn2513. Epub 2008 Nov 12. PMID 19002191
• Mendle, J. (2014). Why Puberty Matters for Psychopathology. Child Development Perspectives, 8(4), 218-222. https://doi.org/10.1111/cdep.12092
• Oliphant RYK, Smith EM, Grahame V. What is the Prevalence of Self-harming and Suicidal Behaviour in Under 18s with ASD, With or Without an Intellectual Disability? J Autism Dev Disord. 2020 Oct;50(10):3510-3524. doi: 10.1007/s10803-020-04422-6. PMID 32125568

Identifiers

NCT: NCT07688798 · APHP251891 · 2025-A02756-43

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗