Assessment of relationship between suicide behavior, early maladaptive schemas and social cognitive functions in individuals with major depressive disorder

Introduction: Suicide risk related to depressive disorder is 20 times higher than the general population. This fact makes it important to determine the risk factors that may cause suicide in depression. Similar to the development of early maladaptive schemas identified by Young, suicidal behavior is also known to be predisposed by individual personality traits and interaction with the environment. Cognitive schemas that are active in the depressive may impair social cognitive functions by affecting the social information processes. This study examines the relationship between early maladaptive schemas and mental state decoding in the context of social cognition that may have an effect on suicidal behavior in depressive patients. Materials and Methods: Patients with major depressive disorder according to DSM 5 diagnostic criteria participated in the study. Depressive patients with suicidal behavior in the last 6 months (SDP, n = 36), depressive patients without suicidal behavior (DP, n = 40) and healthy controls (HC, n = 36) were included. A sociodemographic data form was applied to all participants. Subsequently, the participants were assessed with Young Schema Questionnaire Short Form-3 (YSQ-SF3), Reading Mind in the Eyes (RMET), Suicidal Behaviors Questionnaire (SBQ) and Beck Depression Scale (BDI). Results: SDP group and DP group had significantly higher scores on in 14 schema dimensions than the HC group. There was no significant difference in schema dimensions when comparing SDP group and DP group. The mean scores of "approval seeking"; "self-sacrifice" and "punitiveness" schema dimensions were evaluated as clinically important in the depressive patient groups. There was a significant positive correlation between the SBQ scores and the "failure", "pessimism", "social isolation-mistrust", "abandonment", "enmeshment-dependence", "defectiveness" schema dimensions in DP and SDP groups. RMET total test score, positive valence score and neutral valence score were significantly lower in DP group and SDP group than HC group. In SDP group, RMET negative valence score was significantly lower than HC group, but no significant difference was found between DP group and HC group. There was no significant difference in all RMET scores between SDP and DP groups. In SDP group, there was a significant negative correlation between the "pessimism" schema dimension and RMET total score, positive valence score, and negative valence score. A significant negative correlation was found between "unrelenting standards" schema dimension and the RMET neutral valence score in the DP group. Conclusion: Cognitive schemas may play a role in the development of major depressive disorder and suicidal thoughts. Mental state decoding in depressive patients is impaired. It has been found that early maladaptive schemas may create bias in defining emotions in accordance with the contents of existing schemas. Key Words: major depressive disorder, mental state decoding, early maladaptive schemas, social cognition