Blunted affect and suicide in schizophrenia: A systematic review

Individual negative symptoms have rarely been examined with regard to their relationship with suicide in schizophrenia, which continues to affect up to 13% of people with the disorder. Symptoms such as blunted affect, which can be an enduring hallmark of schizophrenia, may impact suicide through increasing isolation, leading to poor functional recovery and diminished quality of life. A systematic review following PRISMA guidelines and pre-registered on PROSPERO (CRD4219143373) was conducted; EMBASE, PsychInfo, and MedLine were searched until January 2020. Eight hundred and fifty-six articles were identified from the databases and 2 papers were identified from other resources. Twelve papers met inclusion criteria for the review. Nine out of twelve papers report a positive direct or indirect association between blunted affect and suicide in schizophrenia and three papers showed no association. The majority of included studies suggest that blunted affect may be indirectly related to suicide through risk factors such as emotional withdrawal, depressive symptoms, hopelessness, low self-esteem and negative evaluation. Future studies should include assessment of blunted affect as a potential mediator in the generation of suicidal behaviour in patients with such factors.