Cognition, Metacognition, and Stigma in Patients With Suicidal Ideation

Worldwide 10 to 20 million individuals attempt suicide every year. The suicide rate in India is 10.3. In the last three decades, the suicide rate has increased by 43% but the male female ratio has been stable at 1.4: 1. Majority (71%) of suicide in India are by persons below the age of 44 years which imposes a huge social, emotional and economic burden. Those having suicide ideas, about one third of them act with a suicide attempt, and 60% of these transitions occur within the first year after onset of suicidal thoughts.

Executive functioning and Suicide Studies reported that deficits in some executive functions are correlated with an elevated risk for suicide attempts. Executive dysfunction may interfere with an individual's ability to understand that they are at risk for suicide as well as with their ability to cope with that risk. Although past studies have identified the role of cognitive factors in suicide, little has been done to explore the cognitive processes involved in suicidal thinking in adults (Ong et al. 2016). Neuropsychological alterations can lead to inaccurate perception, interpretation, and response to environmental information, which could be a risk factor for suicide (Fernández-Sevillano et al. 2021).

Metacognition is an essential process regarding decision making and coping with stressful life events. It describes the awareness of person's cognitions in relation to suicide (thoughts, beliefs and attributions). The suicidal person feels helpless and decides that death is only solution. The person has narrowed all his/her options solely to death. Knowing these patterns will give some guidance in talking to a suicidal person. It is significant for assessing to try to accept and understand feelings "meta-emotion" and thought/attributions "meta-cognition" the person is expressing (Abdulla et al. 2018).

Stigma is most often defined as a mark of disgrace or infamy; a stain or reproach, as on one's reputation. In suicide investigators talk about public and self-stigma. Both forms of stigma can separately cause social isolation, demoralization, hopelessness and other consequences that interfere with the previous functioning. Because of the high incidence of psychological changes after stigma it is crucial for the bereaved to have close mental health services. But stigma is a barrier to treatment seeking. After suicide attempt most survivors feel stigmatized but it is not yet known which factors modify the perception of stigma (Sabina et al. 2017).

The purpose of the present study is to explore the relationships between executive functioning metacognition, and stigma in suicidal ideation and suicide attempters in the Indian setup, where there is a lacuna in research regarding the same.