Suicidal behaviour is a complex and multifaceted phenomen in which several biological, psychological, clinical, and sociocultural aspects are intertwined. Hypomentalizing, or lack of mentalizing, is sociocognitive capacity defined as a difficulty to recognize internal experiences as well as inadequately understanding others’ feelings and motivations. This improper emotion regulation could lead to maladaptive behaviours related to suicide attempt (SA). However, a scarce amount of studies have further explored how hypomentalizing is associated with SA over time.
Andreo-Jover et al. (2026) aimed at investigating whether hypomentalizing was associated with the risk of SA over a 12-month period. Using data from the SURVIVE project, a large clinical cohort of individuals who had recently SA (n = 1,373), the authors aimed to clarify its role as a potential psychological risk marker. Participants were assessed shortly after a SA and followed for one year. Spanish-validated measures were used to assess hypomentalizing and several suicidality domains (e.g., ideation, plans, behaviours).
Could hypomentalizing predict suicide attempt within a one-year follow-up?
The authors found that, of the overall sample, 22.5% (n = 310) reattempted suicide during the one-year follow-up period. These participants showed higher hypomentalizing levels, both at baseline and follow-up, greater suicidal ideation and planning, and more previous SA.
Regarding the effects of hypomentalizing on SA over time, bivariate analyses showed a positive correlation between these two variables; thus, indicating lower levels of emotional recognition and regulation with higher suicidal severity. Nevertheless, the effects of hypomentalizing turned non-significant in the multivariate analysis. Indeed, the authors found that SA after one-year follow-up was predicted by follow-up suicidal ideation and planning, number of previous attemps, and younger age.
Clinical relevance of hypomentalizing in suicide prevention and intervention
This interesting study illustrates how hypermentalizing appears to be a relevant vulnerability marker of SA. However, as suicide is a complex and nuanced behaviour, hypomentalizing does most likely operate alongside severity indicators. These findings aligns with theories linking social cognition deficits to suicidal behavior, particularly in the transition from ideation to action. Therefore, evaluating sociocognitive areas, including hypomentalization, may result in effective suicide prevention and enhanced intervention programmes (e.g., cognitive behavioural therapy – CBT -). Additionally, it is important to establish a continuous monitoring of dynamic clinical variables during suicide follow-up, such as planification and ideation.
In conclusion, hypomentalizing is associated with suicide reattempt risk, but its predictive value is indirect and context-dependent. Therefore, hypomentalization should be considered as part of a multifactorial risk framework, rather than a standalone predictor.
