DOI: 10.1192/j.eurpsy.2026.12067 ISSN: 0924-9338

Exploring the association between cognitive performances, early life traumas, and lifetime suicide attempts in Major Depressive Disorder: an analysis of the PROMPT study

P. Paribello, V. T. Wahner, M. Pinna, M. Contu, C. Pisanu, A. Squassina, A. Minelli, M. Manchia, B. T. Baune,
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Introduction

Suicidal behaviour in Major Depressive Disorder (MDD) arises from the interplay of cognitive, environmental, and biological factors. Cognitive performances may modulate vulnerability, yet longitudinal evidence remains limited.

Objectives

To test whether cognitive performances assessed with the Brief Assessment of Cognition in Affective Disorders (BAC-A) are associated with lifetime suicidality, adjusting for early trauma and clinical covariates, within the European multicentre Personalised Prognostic Models in Depression (PROMPT) study.

Methods

We analysed 292 adults with moderate-to-severe MDD (Cagliari n = 102, Münster n = 119, Poznań n = 71), aged 18–65 years, diagnosed per DSM-5 criteria (Montgomery–Åsberg Depression Rating Scale ≥ 20). BAC-A was administered at baseline, week 8, and week 12. Suicidality was measured using the Columbia Suicide Severity Rating Scale (C-SSRS), selecting items 1 (passive ideation), 3 (active ideation without plan), and 5 (lifetime attempts). Linear mixed-effects models tested non-affective recall as the dependent variable, including suicidality, timepoint, and their interaction as fixed effects, and adjusting for age, sex, education, depression severity, site, early trauma, substance use, ECT or ketamine treatment, and current use of psychotropics. Holm’s correction addressed multiple comparisons.

Results

Table 1 presents the main demographic and clinical characteristics of lifetime active suicide ideation (n = 292 with available data for analyses). Participants with lifetime active ideation (C-SSRS item 3) showed significantly lower non-affective recall (estimate = –1.02, Holm-corrected p = 0.042), independent of depression severity and trauma. Age, education, site, and antipsychotic use predicted overall cognition, while no time interactions emerged.

Table 1.

Main demographic and clinical characteristics by C-SSRS item 3 lifetime status

Table 1. long description.

Variable
No (n = 174)
Yes (n = 118)
Age (years), median [IQR]
52 [37–62]
41 [29–55]
Female sex %
62.6 54.2
Education ≥ High School %
59.0 62.1
MADRS score, median [IQR]
22 [19–26] 27 [23–33]
CTQ total, median [IQR]
40 [32–52] 47 [35–59]
Antipsychotic use %
26.4 51.7
TRD current episode %
32.2 46.6
Recruitment site (Münster/Cagliari/Poznań %)
24.7/52.3/23.0 64.4/9.3/26.3

Figure 1, 2 and 3. Error margins plot for the association of BAC-A Non-affective recall over the three selected timepoints, divided based on CSSR-S status and recruitment sites.

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Image 1: long description.

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Image 3: long description.

Conclusions

In our sample, impaired non-affective recall appears to represent a stable correlate of lifetime C-SSRS active suicidal ideation in MDD, independent of depression severity and early trauma. Broader cognitive variance was explained by age, education, recruiting site, and treatment factors. These findings support cognitive performance as a potential marker of vulnerability to suicidal behaviour.

Disclosure of Interest

None Declared

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