Cognitive Flexibility and Suicidal Attempt in Adolescents: Associations with Psychiatric Factors

Objective: This study aimed to examine the relationship between suicide attempts and cognitive flexibility in adolescents and to evaluate the determining role of psychiatric factors in this association. Methods: A case-control study design was employed, including 30 female adolescents with a history of suicide attempt within the past year and 30 age- and gender-matched controls. Participants were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), the Strengths and Difficulties Questionnaire (SDQ), the Revised Child Anxiety and Depression Scale (RCADS), the Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S), and the Cognitive Flexibility Scale (CFS). Results: Adolescents with suicide attempts showed significantly higher levels of depressive symptoms, anxiety, and disruptive behaviors. While cognitive flexibility scores did not differ significantly between groups, within the suicidal attempt group, lower cognitive flexibility was significantly associated with higher emotional and behavioral problems. Regression analysis revealed that depression and anxiety symptoms were significant predictors of reduced cognitive flexibility only among adolescents with suicide attempts. Conclusion: The findings suggest that suicidal behavior in adolescents may be linked not only to psychiatric symptoms but also to deficits in executive functioning. However, reduced cognitive flexibility appears to act as a potential risk factor only within the suicidal attempt group, underscoring the need for interventions that address executive functions in the prevention of adolescent suicide risk.