An ecological momentary cognitive assessment study of over-attribution of threat and suicide risk factors in people with serious mental illness

Emma M Parrish; Amy Pinkham; Raeanne C Moore; Philip D Harvey; Eric Granholm; Scott Roesch; Thomas Joiner; Colin A Depp

doi:10.1016/j.schres.2024.02.028

An ecological momentary cognitive assessment study of over-attribution of threat and suicide risk factors in people with serious mental illness

Schizophr Res. 2024 Apr:266:136-144. doi: 10.1016/j.schres.2024.02.028. Epub 2024 Feb 24.

Authors

Emma M Parrish¹, Amy Pinkham², Raeanne C Moore³, Philip D Harvey⁴, Eric Granholm⁵, Scott Roesch⁶, Thomas Joiner⁷, Colin A Depp⁸

Affiliations

¹ San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
² The University of Texas at Dallas, Dallas, TX, USA.
³ University of California San Diego, Department of Psychiatry, San Diego, CA, USA.
⁴ University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL, USA.
⁵ University of California San Diego, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
⁶ San Diego State University Department of Psychology, San Diego, CA, USA.
⁷ Department of Psychology, Florida State University, Tallahassee, FL, USA.
⁸ University of California San Diego, Department of Psychiatry, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA. Electronic address: cdepp@health.ucsd.edu.

PMID: 38401412
DOI: 10.1016/j.schres.2024.02.028

Abstract

Introduction: People with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder) are at increased risk of suicidal ideation (SI). Over-attribution of social threat, or attributing threatening emotions to neutral faces, may contribute to social isolation through increased social avoidance and decreased social approach motivation. These factors are related to suicide, as well as perceived burdensomeness (PB) and thwarted belongingness (TB). This study examined how over-attribution of threat relates to PB, TB, and social motivations.

Method: N = 273 participants with SMI were assessed for current SI and behavior, and were stratified into SI (N = 130) vs. non-SI (N = 143) groups. Participants completed smartphone surveys (via ecological momentary assessments [EMA]) 3×/day for 10 days. They also completed the Mobile Ecological Test of Emotion Recognition (METER) 1×/day. Linear mixed models and multi-level mediation tested the relationships between over-attribution of threat, METER performance, PB/TB, and social motivations.

Results: Participants with and without SI did not significantly differ in over-attribution of threat or METER performance. In separate models, there was a relationship of over-attribution of threat with increased PB (B = 1.00, SE = 0.21, t = 4.72, p < .001), reduced social approach motivation (B = -0.74, SE = 0.22, t = -3.33, p < .001), and increased social avoidance (B = 0.90, SE = 0.24, t = 3.70, p < .001), all significant when adjusting for facial affect recognition ability. A model examining social motivations as a mediator between over-attribution of threat and PB/TB was not significant.

Conclusion: These results suggest that over-attribution of threat relates to interpersonal constructs related to SI irrespective of facial affect abilities. This study may inform understanding of social cognitive processes related to suicide in SMI.

Keywords: Bipolar disorder; Interpersonal theory of suicide; Schizophrenia; Social cognition; Social motivation; Suicidal ideation.

MeSH terms

Cognition
Ecological Momentary Assessment
Humans
Interpersonal Relations
Psychotic Disorders*
Risk Factors
Suicidal Ideation
Suicide* / psychology