Psychological pain and decision-making in schizophrenia: associations with lifetime suicide attempt history and suicidal ideation

26/05/2026

AI Summary

Higher psychological pain independently associated with lifetime suicide attempt history in schizophrenia (OR 1.075; 95% CI [1.026-1.127]).
Lower Iowa Gambling Task performance independently associated with lifetime suicide attempt history (OR 0.932; 95% CI [0.887-0.979]).
Iowa Gambling Task performance showed a significant indirect effect between psychological pain and current suicidal ideation (effect = 0.031; 95% CI [0.011-0.062]).

TL;DR (AI Generated)

Objective: This cross-sectional study aimed to evaluate the direct and indirect associations between psychological pain, decision-making and suicidality in patients with schizophrenia, with particular emphasis on lifetime suicide attempt history and current suicidal ideation severity.

Methods: One hundred outpatients with schizophrenia (50 with and 50 without lifetime suicide attempt history) were assessed using the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Beck Suicide Ideation and Hopelessness Scales, Psychological Pain Scale, Iowa Gambling Task (IGT), Wisconsin Card Sorting Test, and Stroop Test.

Results: Higher psychological pain (OR = 1.075, 95% CI [1.026-1.127], p = 0.041), a greater number of lifetime psychiatric hospitalisations (OR = 1.300, 95%CI [1.065-1.586], p = 0.010), and lower IGT total score (OR = 0.932, 95%CI [0.887-0.979], p = 0.005) were independently associated with lifetime suicide attempt history.

Basic summary

Cogn Neuropsychiatry. 2026 May 26:1-15. doi: 10.1080/13546805.2026.2678597. Online ahead of print.

ABSTRACT

Objective: This cross-sectional study aimed to evaluate the direct and indirect associations between psychological pain, decision-making and suicidality in patients with schizophrenia, with particular emphasis on lifetime suicide attempt history and current suicidal ideation severity.

Methods: One hundred outpatients with schizophrenia (50 with and 50 without lifetime suicide attempt history) were assessed using the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Beck Suicide Ideation and Hopelessness Scales, Psychological Pain Scale, Iowa Gambling Task (IGT), Wisconsin Card Sorting Test, and Stroop Test. Multivariable logistic regression was used for lifetime suicide attempt history, and PROCESS Model 4 was used to test the indirect effect of IGT on suicidal ideation.

Results: Higher psychological pain (OR = 1.075, 95% CI [1.026-1.127], p = 0.041), a greater number of lifetime psychiatric hospitalisations (OR = 1.300, 95%CI [1.065-1.586], p = 0.010), and lower IGT total score (OR = 0.932, 95%CI [0.887-0.979], p = 0.005) were independently associated with lifetime suicide attempt history. IGT also showed a significant indirect effect in the association between psychological pain and suicidal ideation (effect = 0.031, 95%CI [0.011-0.062]).

Conclusion: Psychological pain and poorer decision-making performance were associated with suicidality-related outcomes in schizophrenia.

PMID:42186887 | DOI:10.1080/13546805.2026.2678597

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