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. Author manuscript; available in PMC: 2026 Jun 25.
Published in final edited form as: Psychiatry Res. 2023 Feb 23;322:115132. doi: 10.1016/j.psychres.2023.115132

Clinical features of individuals with schizotypal personality disorder with and without suicidal ideation

Leo Sher 1,2, Katelyn N Challman 1,2, Emma C Smith 1,2, Antonia S New 1,2, M Mercedes Perez-Rodriguez 2, Margaret M McClure 2, Marianne Goodman 1,2, René S Kahn 1,2, Erin A Hazlett 1,2
PMCID: PMC13293235  NIHMSID: NIHMS1877543  PMID: 36841053

Abstract

This study compared demographic and clinical features in a sample of 384 participants: healthy controls (HC; n=166) and individuals with schizotypal personality disorder (SPD) with (n=50) and without (n=168) suicidal ideation (SI) to examine specific risk factors for suicidality in SPD. Compared to the non-SI group, the SI group showed significantly greater severity of depression, aggression, impulsivity, affective lability, schizotypal features, poorer social adjustment, and had fewer social contacts. Individuals in the SI group were also more likely to have a history of a suicide attempt and comorbid borderline personality disorder in comparison to the non-SI group. Logistic regression analysis indicated that severity of depression and the number of social contacts drove the difference between the SI and non-SI groups. Compared with both SPD subgroups, the HC group was significantly less depressed, aggressive, impulsive, affectively labile, had fewer schizotypal features, was better socially adjusted, and had more social contacts. This study indicates that overall, the SI group is a more severely impaired group of individuals with SPD compared to the non-SI group. Better educating medical professionals about the diagnosis and management of SPD and its associations with suicidality is warranted.

Keywords: schizotypal personality disorder, suicidal ideation, depression, social adjustment

1. Introduction

Schizotypal personality disorder (SPD) is classified in DSM-5 as a Cluster A personality disorder (American Psychiatric Association, 2022). Cluster A personality disorders are described as odd or eccentric conditions. SPD is associated with significant disability and many psychiatric comorbidities. Patients with SPD are less in touch with reality, and their thoughts and speech are more disorganized than in other personality disorders. SPD is regarded as a schizophrenia-spectrum disorder (Battaglia & Torgersen, 1996). Studies of SPD are frequently focused on the neurobiology of schizophrenia-spectrum symptoms (Hazlett et al., 2011; Siever & Davis, 2004). There has been comparatively less work on the phenomenology of SPD as a clinical syndrome by itself. The lifetime prevalence of SPD in the United States has been estimated to be 4% with slightly greater rates among men (4.2%) than women (3.7%) (Pulay et al., 2009).

Studies have demonstrated that SPD is associated with suicidal ideation (SI) and behavior (Joiner & Rudd, 2002; Lentz et al., 2010; O’Hare et al., 2021; Sher 2021). A nationally representative study in the U.S. showed that a diagnosis of SPD predicts occurrence of lifetime suicide attempts after adjusting for significant risk factors and sociodemographic parameters (Lentz et al., 2010). A recent study showed that schizotypal traits in early adolescence predict subsequent SI and suicide attempts from age 18 to 38 years (O’Hare et al., 2021). Joiner & Rudd (2002) observed that symptoms of SPD were associated with suicidality after adjusting for symptoms of depression in a large group of young adults referred to a management program for individuals with high suicide risk.

SI is a significant predictor of future suicidal acts and suicide death in various psychiatric disorders (Drake et al., 1984; Fosse et al., 2017; Galfalvy et al., 2008; Large et al., 2011; Mann et al., 2008; Vilhjalmsson et al., 1998). Large et al. (2011) performed a meta-analysis of controlled studies of death by suicide within a year of discharge from psychiatric hospitals and found that SI was associated with post-discharge suicides. More recently, Fosse et al. (2017) also observed that the presence of SI was associated with future suicide death in the general patient population admitted to an acute psychiatric ward. Another study examined correlates of past suicide attempts in patients with mood, schizophrenia spectrum, or personality disorders and found that a recent past suicide attempt was best predicted by current SI (Mann et al., 2008). Another research group also observed that SI frequently precedes death by suicide in patients with schizophrenia (Drake et al., 1984). Predictive clinical models about suicide in psychiatric disorders are considering SI a risk factor that interacts with some other conditions and can influence the occurrence of a suicidal act (Galfalvy et al., 2008). SI precedes planning, which may result in a suicide attempt leading to death.

Multiple lines of evidence suggest that SI is associated with depressed mood (Bethell & Rhodes, 2008; Bowen et al., 2015; Bruce et al., 2004; Han et al., 2014; Sher et al., 2017). SI is also linked to reduced social integration and support (Arenson et al., 2021; Bartels et al., 2002; Rowe et al., 2006; Turvey et al., 2002). Studies also indicate that higher impulsivity and aggression, and a history of suicide attempts are associated with the presence of SI (Conner et al., 2004; Luise et al., 2022; Miotto et al., 2003; Neufeld & O’Rourke, 2009; Nissel, 1998; Rihmer & Benazzi, 2010; Sher et al., 2005).

In this study, we examined: (1) which clinical symptom severity assessments distinguish SPD individuals with suicidal ideation from those without. We hypothesized that while the two subgroups would not differ in overall symptom severity, SPD individuals with suicidal ideation are more depressed, impulsive, aggressive, less socially integrated, and more likely to have a history of one or more suicide attempts in comparisons to those without; (2) how individuals with SPD with and without SI differ from healthy individuals. We hypothesized there would be a spectrum of SPD individuals with SI being more abnormal on outcome measures than those without SI.

2. Methods

2.1. Participants

Our sample consisted of 384 study participants: 166 healthy controls (HC group) and 218 individuals with SPD. One hundred sixty-eight participants with SPD did not report suicidal ideation at the time of evaluation (non-SI group) and 50 did report suicidal ideation (SI group). The three (HC, non-SI and SI) groups were demographically matched and there were no between-group differences in age, gender, race, or levels of education (Table 1). Additionally, there were no differences between the non-SI and SI groups with regard to the proportion of individuals with a history of the psychotropic medications use (46.7% vs. 30.8%, df=1, χ2=0.94, p=0.33).

Table 1. Demographic characteristics of healthy controls (HC group) and individuals with SPD with (SI group) and without (non-SI group) suicidal ideation.

HC group (n=166) Non-SI group (n=168) SI group (n=50) Analysis
Mean or N SD or % Mean or N SD or % Mean or N SD or % df F/χ2 p value
Age 38.40 12.07 39.72 11.61 39.44 12.57 2 0.53 0.59
Gender: % women 65 39.2% 63 37.5% 13 26% 2 2.94 0.23
Race:
Black 66 40.5% 82 48.8% 15 30.0%
White 63 38.0% 56 33.3% 25 50.0% 10 10.27 0.42
Asian 17 10.2% 10 6.0% 4 8.0%
Indian/Native 2 1.2% 1 0.6% 0 0%
American
Mixed 15 9.0% 14 8.3% 4 8.0%
Unknown 4 2.0% 5 3.0% 2 4.0%
Education:
Years of education 14.80 2.29 14.45 2.76 14.25 2.16 2 1.26 0.29
Education:
% of participants with at least Bachelor’s Degree 75 45.2% 93 55.4% 29 58.0% 2 4.49 0.11
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a

– the HC group is different from the non-SI group at p<0.001

b

– the HC group is different from the SI group at p<0.001

Participants were recruited through advertisements in local newspapers and internet postings (Craig’s List), or via referral from outpatient mental health clinics at Mount Sinai. For each participant, diagnosis was established by a clinical psychologist with expertise in evaluation of personality disorders, using the Structured Clinical Interview for DSM-IV Axis I disorders (First et al., 2002; SCID-I) and Structured Interview for DSM-IV Personality Disorders (Pfohl et al., 1997; SIDP-IV). Following structured diagnostic interviews, all diagnoses were confirmed during a consensus meeting with a senior member of the diagnostic team and reliability for the SPD diagnosis is kappa=0.73 for our group. Physicians screened participants for medical and neurological illness via history, prior to participation. Exclusion criteria included: history of head trauma, neurological disease, organic mental syndrome, mental retardation, current substance use disorder (except for tobacco smoking) or acute medical illness. This study was approved by the Institutional Review Board at Icahn School of Medicine at Mount Sinai and all participants signed informed consent.

2.2. Assessments

Depressive symptoms were assessed with the Beck Depression Inventory (BDI) (Beck et al., 1961), a 21-question multiple-choice self-report questionnaire which is composed of items relating to symptoms of depression. Scores range from 0 to 63 and higher scores denote greater severity of depression.

Suicide ideation status was determined based on patients’ responses to the 9th BDI question. Individuals who answered, “I don’t have any thoughts of killing myself” were classified as suicide non-ideators, i.e., the non-SI group. Those who responded, “I have thoughts of killing myself, but I would not carry them out,” “I would like to kill myself,” or “I would kill myself if I had the chance” were classified as suicide ideators, i.e., the SI group. The BDI score of item 9 was left out of the total score of the BDI.

The Buss–Perry Aggression Questionnaire (BPAQ) was used to measure aggressiveness (Buss & Perry, 1992). The BPAQ consists of 29 items. Scores range from 29 to 145 and higher scores indicate higher aggressiveness.

Impulsivity was measured with the Barratt Impulsivity Scale (BIS) (Barrat, 1965; Patton et al., 1995), a 34-item questionnaire that assesses impulsiveness. Scores range from 30 to 120 and higher scores signify greater impulsivity.

Affective lability was assessed using the Affective Lability Scale (ALS) (Aas et al., 2015; Harvey et al., 1989). The ALS has 54 items and evaluates an individual's predisposition to rapid shifts between the different emotional states of anxiety, depression, anger, and hypomania. Scores range from 0 to 162 and higher scores signify greater affective lability.

Social functioning of participants was rated using the Social Adjustment Scale (SAS), an instrument to rate performance in five domains including work, social and leisure activities, relationship with extended family, marital, and parental role (Weissman & Bothwell, 1976). Scores range from 54 to 283 and higher scores on the SAS scale indicate lower levels of social adjustment.

The Social Network Index (SNI) is calculated based on the responses to twelve questions (Berkman & Syme, 1979). This index counts the number of social roles in which the respondent has regular contact. Scores range from 0 to 75 and higher scores indicate a larger number and greater diversity of social roles which signifies a higher level of social functioning.

Schizotypal traits were measured using the Schizotypal Personality Questionnaire (SPQ) (Raine, 1991), a 74-item self-report questionnaire designed for measuring schizotypal characteristics. Scores range from 0 to 74 and higher scores on this scale indicate greater severity.

A childhood maltreatment history was evaluated using the Childhood Trauma Questionnaire (CTQ) (Bernstein & Fink, 1998). The CTQ is a standardized, retrospective 28-item inventory that measures the severity of different types of childhood trauma: emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. Scores range from 28 to 140 and higher scores denote greater childhood adversity.

We calculated a symptom severity score for each of the SPD patients: (a) Each of the nine DSM-IV symptom criteria for SPD was rated on a 4-point scale (0=absent, 1=somewhat present, 2=definitely present/prototypic, 3=severe/pervasive) and the total was calculated as an overall symptom severity score (Hazlett et al., 2011). As required for a DSM-IV diagnosis of SPD, the patients met at least five of the nine SPD criteria with a rating ≥ 2.0.

2.3. Statistical analysis

Demographic and clinical features of the SI and non-SI SPD groups and the HC group were compared using one-way ANOVA, t-test, and Pearson’s chi-square, as appropriate. To determine what drives the difference between the SI and non-SI groups, we fit a logistic regression model with suicidality as a dependent variable and the following clinical parameters as independent variables: SPQ, BDI, ALS, BPAQ, BIS, SNI, and SAS scores, history of suicide attempt (yes/no; ascertained from the SCID interview), and borderline personality disorder (BPD) diagnosis (yes/no; ascertained from the SIDP interview). In order to assess model discrimination, a Hosmer and Lemeshow Goodness-of-Fit test was used. Statistical analyses were conducted with SPSS 26.

3. Results

As expected, the HC group had significantly lower BDI, BPAQ, BIS, ALS, SPQ, SAS and CTQ scores, and higher SNI scores in comparison to both SPD groups (Table 2).

Table 2. Clinical features of healthy controls (HC group) and individuals with SPD with (SI group) and without (non-SI group) suicidal ideation.

HC group (n=166) Non-SI group (n=168) SI group (n=50) Analysis
Mean or N SD or % Mean or N SD or % Mean or N SD or % df t/F/χ2 p value
Schizotypal Personality Questionnaire (SPQ) 11.12 12.82 30.93 13.64 43.60 13.59 2 91.65 p<0.001a,b,c
Beck Depression Inventory (BDI) 3.76 4.90 11.41 8.61 23.86 9.41 2 95.95 p<0.001a,b,c
Affective Lability Scale (ALS) 26.95 28.20 62.35 29.59 83.66 30.79 2 70.98 p<0.001a,b,c
Buss Perry Aggression Questionnaire (BPAQ) 56.44 17.70 72.46 20.20 90.88 24.09 2 42.68 p<0.001a,b,c
Barratt Impulsiveness Scale (BIS) 56.92 12.35 65.60 10.66 71.75 10.50 2 23.03 p<0.001a,b,d
Social Network Index (SNI) - Number of people in social network 14.80 8.96 10.11 8.91 5.97 3.97 2 11.13 p<0.001a,b,d
Social Adjustment Scale (SAS)* 50.95 15.92 61.88 26.61 75.06 38.37 2 8.64 p<0.001b,d,e
Childhood Trauma Questionnaire (CTQ) 47.72 13.98 58.55 16.20 61.68 18.77 2 11.41 p<0.001a,b
History of suicide attempt N/A N/A 11 8.9% 8 23.5% 1 5.33 0.02
Comorbid borderline personality disorder N/A N/A 36 21.6% 21 42.0% 1 8.30 0.004
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a

- the HC group is different from the non-SI group at p<0.001

b

- the HC group is different from the SI group at p<0.001

c

- the non-SI group is different from the SI group at p<0.001

d

- the non-SI group is different from the SI group at p<0.05

e

- the non-SI group is different from HC group at p<0.05

*

Higher SAS scores indicate lower levels of social functioning.

As expected, the non-SI and SI groups did not differ in overall SPD symptom severity (12.72±2.62 vs. 12.71±2.50, df=216, t=−0.29, p=0.98). However, the SI group had higher levels of depression (BDI), aggression (BPAQ), impulsivity (BIS), affective lability (ALS), schizotypal traits (SPQ), and lower levels of social functioning (SAS) and social networking (SNI) in comparison to the non-SI group. Individuals in the SI group were also more likely to have a history of suicide attempt and comorbid BPD in comparison to the non-SI group. We did not observe a difference in CTQ scores between the non-SI and SI groups.

The logistic regression analysis comparing the non-SI and SI groups found the odds of having suicidal ideation to be 1.2-fold higher for each one-point increase in the BDI total score, after adjusting for SPQ, ALS, BPAQ, BIS, SAS, SNI scores, history of suicide attempt and comorbid BPD. The 95% confidence interval around this odds ratio is (1.07,1.31) (Table 3). The odds of having suicidal ideation were 1.12 (1/0.89) lower for each one-point increase in the SNI score, after adjusting for SPQ, BDI, ALS, BPAQ, BIS, SAS, history of suicide attempt and comorbid BPD. The 95% confidence interval around this odds ratio is (0.80, 1.0). The Hosmer and Lemeshow goodness-of-fit criteria show good model fit since we fail to reject the null hypothesis (p=0.9).

Table 3. Logistic regression analysis of suicidal ideation.

Odds Ratio 95% Wald Confidence Limits Standard Error Wald Chi-Square p value
Schizotypal Personality Questionnaire (SPQ) 1.02 0.96 1.08 0.03 0.47 0.40
Beck Depression Inventory (BDI) 1.19 1.07 1.31 0.05 11.32 0.001
Affective Lability Scale (ALS) .98 0.96 1.01 0.01 1.37 0.24
Buss Perry Aggression Questionnaire (BPAQ) 1.02 0.98 1.08 0.02 0.73 0.38
Barratt Impulsiveness Scale (BIS) 1.0 0.93 1.07 0.03 0.02 0.92
Social Network Index (SNI) 0.89 0.80 1.00 0.05 4.03 0.04
Social Adjustment Scale (SAS) 1.00 0.97 1.01 0.01 0.13 0.72
History of suicide attempt 4.02 0.82 19.83 0.81 2.93 0.09
Comorbid borderline personality disorder 0.87 0.19 3.87 0.76 0.03 0.85
Hosmer and Lemeshow Goodness-of-Fit Test
Chi-Square df p
3.48 8 0.9
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4. Discussion

To our knowledge, this is the first study to examine the clinical features of individuals with SPD with and without suicidal ideation and include a healthy control group. As hypothesized, SPD individuals with SI have higher levels of depression, aggression, impulsivity, affective lability, schizotypal traits, and lower levels of social functioning and social networking in comparison to the non-SI group. The SI group is more likely to have a history of suicide attempt and comorbid BPD in comparison to the non-SI group. Logistic regression analysis indicates that the depression and social networking assessments drive the difference between the SI and non-SI groups. The findings also indicate that both the non-SI and SI SPD groups are significantly impaired in comparison to the HC group.

Our finding that the SI group has higher depression scores than the non-SI group supports observations that SI is frequently associated with depression (Bowen et al., 2015; Bruce et al., 2004; Han et al., 2014; Rhodes & Bethell, 2008; Sher et al., 2017; Wongpakaran et al., 2021). Considerable evidence indicates that depression is the largest contributor to suicidal thoughts (Bowen et al., 2015; Bruce et al., 2004; Han et al., 2014). For example, an epidemiological study in the U.S. showed that the prevalence of SI among adults with major depression was 26.3% (Han et al., 2014). Many patients with SI do not meet criteria for major depression, although these people frequently have depressive symptoms (Rhodes & Bethell, 2008).

Determining that SPD individuals with SI have poor social adjustment and networking in comparison to non-SI individuals indicates that the level of social functioning and the number of social contacts may affect suicidality. It should be noted that in this study, the SNI score is one of the two factors that drive the difference between the SI and non-SI groups. Three studies reported that low frequency of social contacts was associated with higher levels of SI (Bartels et al., 2002; Rowe et al., 2006; Turvey et al., 2002). A recent study showed that social network size and perceived social support each significantly predicted both chronicity and severity of SI over nine years of follow up (Arenson et al., 2021). Other researchers also observed that lower perceived availability of social support, less active engagement in the community, and a lower sense of belonging were all associated with thoughts of suicide (Cui et al., 2022; Handley et al., 2012; Joo & Roh, 2016; Oon-arom et al., 2021). According to the interpersonal-psychological theory of suicidal behavior, a sense of low belongingness/social alienation is a major contributing factor to suicidality” (Joiner et al., 2009).

Social relationships are an especially important issue for individuals with SPD because they usually do not have close friends or confidants and are very uncomfortable relating to people (American Psychiatric Association, 2022; Sher, 2021). Social functioning is a major determinant of the quality of life (Bystritsky et al., 2001; Serafini et al., 2020). Decreased social adjustment and social functioning are probably important contributors to the pathophysiology of suicidality among patients with SPD.

The finding that aggression and impulsivity scores are higher among SPD individuals with SI is consistent with observations that these factors are associated with SI (Conner et al., 2004; Luise et al., 2022; Miotto et al., 2003; Neufeld & O'Rourke, 2009; Nissel, 1998; Rihmer & Benazzi, 2010; Sher et al., 2005). It has been demonstrated that aggression is a significant factor in predicting SI in adolescents (Nissel, 1998). Another study showed that both men and women who reported suicidal thoughts had significantly higher scores on the Aggression Questionnaire than did those who denied SI (Miotto et al., 2003). Our previous study suggested that severity of SI in major depression with comorbid alcoholism was related to associated aggressive traits (Sher et al., 2005). A study of 15- to 20-year-old males found that impulsivity was strongly associated with SI after accounting for alcohol dependence and other aggression-related constructs (Conner et al., 2004). It should be noted that impulsivity is related to aggression, mostly a subtype of aggression marked by angry, impulsive responses to perceived acute stressful situations (Seroczynski et al., 1999).

The results show that SI is associated with higher affective lability in individuals with SPD. Previous studies reported that affective instability is associated with SI and suicide risk (Bowen et al., 2015; Koenigsberg et al., 2002; Palmier-Claus et al., 2012; Rizk et al., 2019). For example, a study found that both men and women with higher affective instability were more likely to experience suicidal thinking (Furberg & Cutler, 1989). In another study, ALS scores predicted variability and severity of SI (Rizk et al., 2019). A systematic review and meta-analysis identified 20 research reports that described a significant association between affective instability and SI (Palmier-Claus et al., 2012). It has been suggested that affective instability is somewhat overlooked as a risk factor for suicide (Bowen et al., 2015).

Our finding that the SI group has higher SPQ scores in comparison to the non-SI group is in agreement with several research reports indicating that SPD or schizotypal personality traits are risk factors for suicidality (Gong et al., 2022; Harford et al., 2018; Lentz et al., 2010; Sher et al., 2021). For example, a study that investigated the psychiatric correlates of SPD in a representative U.S. epidemiologic sample, using data from the National Epidemiological Survey on Alcohol and Related Conditions found that patients with SPD were more likely to attempt suicide in contrast to the general population (Lentz et al., 2010). Teraishi et al. (2014) administered the SPQ to patients with schizophrenia with or without a history of suicide attempts, and controls. The authors found that high schizotypy was associated with lifetime suicide attempts. Also, we recently observed that military veterans with schizophrenia and suicidal behavior had higher SPQ scores compared with veterans with schizophrenia but without suicidal behavior (Sher et al., 2021).

In line with previous findings (Beck et al., 1997; Sher et al., 2006; Sher et al., 2017; Sher et al., 2018; Valtonen et al., 2005), the current study in patients with SPD revealed that individuals with a previous history of suicide attempt continue to show higher SI in comparison to individuals without a history of suicide attempt. This indicates that SI may be a persistent trait which also elevates their risk for future suicidal behavior, highlighting the need for further research to better characterize who may be at greatest risk for suicide across individuals with SPD.

Our observation that SPD individuals with comorbid BPD are more likely to have SI is consistent with evidence suggesting that BPD is associated with SI and suicidal behavior (Gregory et al., 2021; Gross et al., 2002; Sansone & Sansone, 2004; Winsper et al., 2016). For example, it has been shown that among psychiatric inpatients admitted for suicidality, those with BPD had greater SI compared to patients without BPD (Gregory et al., 2021). Another study demonstrated that BPD is associated with SI among young people 19 years of age and under (Winsper et al., 2016). Suicidal behavior is one of the DSM-5 criteria for BPD (American Psychiatric Association, 2022) and comorbid BPD may contribute to suicidality among patients with SPD.

5. Limitations

There are some study limitations. The first is the use of self-report scales. However, it is unlikely that the reported between-group differences in our samples (SI group vs. non-SI group vs. HC) would be a result of some type of bias in answering the questionnaires. Secondly, the participants were recruited in an urban area which may limit the generalizability of the findings to the general population. Strengths of the study are the large sample size, an unmedicated SPD group, and rigorous clinical assessment of all participants using a structured diagnostic interview.

6. Conclusion

Our findings indicate that depression, poor social integration, impulsive-aggressive traits, affective lability, high levels of schizotypy, a history of suicide attempt, and co-occurring BPD increase suicide risk in individuals with SPD. Our study suggests that suicide prevention in individuals with SPD requires a comprehensive evaluation. A comprehensive assessment of clinical features may improve identification of suicide risk. The use of suicide risk screening scales may also help to recognize elevated suicide risk.

As noted above, the phenomenology of SPD as a clinical syndrome has received relatively little attention. One of the issues is that SPD may be difficult to diagnose. Identifying SPD or schizotypal traits in the clinical setting can be challenging because SPD symptoms overlap with symptoms of several more familiar psychiatric conditions such as depression or social anxiety disorder. This misdiagnosis could interfere with treatment of persons with SPD. Better educating medical professionals about the diagnosis and management of personality disorders, including SPD and its associations with suicidal behavior is warranted.

The SI group is an overall more severely impaired group of individuals with SPD and the severity of impairment probably leads to depression and social alienation and increases the risk of suicidality. Our findings underscore the importance of the psychosocial and pharmacological management of depressive symptoms to reduce suicidal behavior in people with SPD. Non-pharmacological treatments such as physical exercise also may be helpful in decreasing depression and suicidality (Belvederi Murri et al., 2019). Our findings highlight the significance of social networks and perceived social support in suicide intervention strategies in SPD patients. Clinicians should consider the size and impact of a social network when safety planning and making clinical decisions regarding individuals with SPD.

Highlights:

  • The SI SPD group has greater impairment compared with the non-SI SPD group.

  • Depression and social networking drive the difference between SI and non-SI groups.

  • Both SI and non-SI SPD groups are impaired in comparison to the HC group.

Acknowledgements

This study was supported by NIMH R01 MH121411 and a VA Research Career Scientist Award (1 IK6 CX001738) to EAH.

Role of the Funding Source

Funding for this study was provided by NIMH R01 MH121411 and a VA Research Career Scientist Award (1 IK6 CX001738) to EAH; the NIMH and VA had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Footnotes

Author Statement Contributors

Authors LS and EAH designed the study. Author LS managed the literature searches and analyses. Author LS undertook the statistical analysis. Authors LS and EAH wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest: None

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