Cognition and Suicide Risk Among Individuals With First-Episode Psychosis: A 6-Month Follow-Up

Heather M. Wastler, Aubrey M. Moe, Jacob G. Pine, Nicholas J.K. Breitborde

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: There is emerging evidence that greater cognition is associated with increased risk for suicide among individuals with psychosis. Given this association, concerns have been raised that cognitive interventions might actually increase risk for suicide in this population. Therefore, the present study investigated the cross-sectional and longitudinal relationship between cognition and suicide risk among individuals with first-episode psychosis. Method: Sixty-five participants completed measures of suicide risk, depression, and cognition at baseline and 6 months. Within-subject mediation analysiswas used to examine the indirect effect of cognition on suicide risk. Within-subject moderation analysis was used to examine whether participation in cognitive enhancing intervention (e.g., computerized drill-and-practice cognitive remediation and metacognitive remediation therapy) moderated changes in suicide risk. Results: Consistent with prior studies, our cross-sectional results suggest that greater cognition is associated with increased risk for suicide. However, this effect was limited in scope, as we found that verbal learning was the only cognitive domain associated with suicide risk in our sample. Results from our longitudinal analyses show that changes in depressive symptoms, but not changes verbal learning, mediate changes in suicide risk during the first 6 months of treatment. In addition, participation in cognitive enhancing interventions did not moderate changes in suicide risk. Conclusions and Implications for Practice: Our results suggest that cognition is a correlate, or a proxy risk factor, rather than a causal risk factor for suicide. Although these findings contradict previously raised concerns that cognitive interventions might unintentionally increase risk for suicide, ongoing assessment is warranted and additional research is needed

Original languageEnglish (US)
Pages (from-to)27-33
Number of pages7
JournalPsychiatric Rehabilitation Journal
Issue number1
StatePublished - May 20 2021


  • Co-ordinated specialty care
  • Cognition
  • Psychosis
  • Suicide risk

ASJC Scopus subject areas

  • Health Professions (miscellaneous)
  • Rehabilitation
  • Psychiatry and Mental health


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