Early maladaptive schemas, suicidal ideation, and self-harm : A meta-analytic review

Background
Understanding the risk factors for suicidality is essential to the prevention of death by suicide and the effective treatment of suicidal ideation and self-harm. The objective of this review was to summarise the evidence on the associations between suicidal ideation, suicidal or non-suicidal self-harm, and early maladaptive schemas.

Method
A systematic review and meta-analysis was completed based on the PRISMA statement. Searches were conducted via PubMed, PsycInfo, and CINAHL. Included studies were peer-reviewed and reported on the bivariate association between one or more of the 18 schemas and either suicidal ideation or self-harm behavior.

Results
We included 17 studies reporting more than 200 associations. Suicidal ideation demonstrated a large mean correlation with Defectiveness Shame (r = .50 [.43, .57]), moderate correlations with Social Isolation (r = .43 [.34, .50]), Failure (r =. 35 [.27, .42]), and Dependence Incompetence (r = .33 [.13, .51]), and small correlations with Subjugation (r = .26, [.13, 38]) and Emotional Inhibition (r = .29 [.13, .44]). Self-harm demonstrated small correlations with Emotional Deprivation (r = .21, [.13, .29]), Social Isolation (r = .29, [.18, .38]), and Emotional Inhibition (r = .19, [.13, .24]).

Limitations
Confidence in the findings is limited by high heterogeneity across several analyses and the inability to investigate possible moderators due to the low number of included studies.

Conclusions
Believing that one is isolated, unlovable, or incapable is associated with an increased risk of suicidal thoughts. The findings correspond with the risk factors identified by the Interpersonal Theory of Suicide: thwarted belonging and burdensomeness.