Investigating the role of hallucinatory experiences in the transition from suicidal thoughts to attempts

Abstract

Objective Psychotic experiences, including auditory hallucinatory experiences (HEs), are strongly associated with both suicidal thoughts and behaviour. This study examined their role in the ideation‐to‐attempt transition in adolescents, including their direct and indirect effect via potential mediators. Method Participants were from an Australian prospective longitudinal cohort of 1669 adolescents (12–17 years); of which a subsample endorsing baseline suicidal ideation (n = 216) was the focus of most analyses. Suicidal thoughts and behaviours were measured using the Self‐Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess auditory HEs. Potential mediators of interest were psychological distress and Interpersonal Theory of Suicide (IPTS) constructs. Results Among adolescents reporting suicidal ideation at baseline (n = 216), 6.5% had attempted suicide during follow‐up. The size of auditory HEs’ univariate effect suggests a possible strong relationship with increased risk of incident suicide attempts (OR = 2.40; 95%CI = 0.76–7.56); however, there was inadequate statistical power to produce a precise estimate. When HEs were accompanied by distress there was a nine‐fold increased risk of acting on suicidal thoughts. Distress was independently associated with risk of attempt transition (OR = 4.09), whereas IPTS constructs were poor explanatory variables in most models. Conclusion Adolescents with psychological distress and auditory HEs are at high risk of incident suicide attempts. Further investigations on the role of negative/distressing content of hallucinations in the ideation‐to‐attempt transition are warranted.

Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

“…Future work could include assessment of the two less common psychotic variables within the APMS relating to thought agency and delusional mood, and exploration of cross-sectional and longitudinal associations between these and self-harm thoughts and acts. Another interesting line of enquiry would be to examine psychotic experiences as potential predictors of transition from ideation to acts, and the relative strength of this relationship ( Hielscher et al, 2020 ).…”

Exploring the relation between psychosis‐like experiences and suicidal ideation, plans, and attempts among college students in the United States

“…Though there is an established relation between PLEs and SI and SA in the general young adult population (Yates et al, 2018), particularly when coupled with psychological distress (Hielscher et al, 2018, 2019, 2020; Martin et al, 2015), there is a gap in the field's understanding of the differential risk of each subtype of PLEs, with most studies not examining independent associations with each individual PLE (Hielscher et al, 2018). The research that exists is mixed, with some findings suggesting that hallucinatory experiences contribute to increased odds of SI and SA (Cederlöf et al, 2017; DeVylder & Hilimire, 2015; Hielscher et al, 2019; Koyanagi et al, 2015; Nishida et al, 2010).…”

“…Though there is an established relation between PLEs and SI and SA in the general young adult population (Yates et al, 2018), particularly when coupled with psychological distress (Hielscher et al, 2018, 2019, 2020; Martin et al, 2015), there is a gap in the field's understanding of the differential risk of each subtype of PLEs, with most studies not examining independent associations with each individual PLE (Hielscher et al, 2018). The research that exists is mixed, with some findings suggesting that hallucinatory experiences contribute to increased odds of SI and SA (Cederlöf et al, 2017; DeVylder & Hilimire, 2015; Hielscher et al, 2019; Koyanagi et al, 2015; Nishida et al, 2010). Other results indicate delusional subtypes like persecutory ideation (Capra et al, 2015; Cederlöf et al, 2017; Koyanagi et al, 2015; Nishida et al, 2010) and unusual thought content (Cederlöf et al, 2017; Nishida et al, 2010; Saha et al, 2011; Thompson et al, 2020) as primary contributors to the risk of SI and SA among clinical and non‐clinical samples.…”

“…Other results indicate delusional subtypes like persecutory ideation (Capra et al, 2015; Cederlöf et al, 2017; Koyanagi et al, 2015; Nishida et al, 2010) and unusual thought content (Cederlöf et al, 2017; Nishida et al, 2010; Saha et al, 2011; Thompson et al, 2020) as primary contributors to the risk of SI and SA among clinical and non‐clinical samples. Indicated PLEs differ across studies (Capra et al, 2015; Cederlöf et al, 2017; Hielscher et al, 2019; Koyanagi et al, 2015; Thompson et al, 2020), likely due to inconsistent samples, definitions of constructs and measures of PLEs and suicide risk. Additional research is needed to elucidate whether certain subtypes of PLEs predict greater odds of experiencing SI and SA.…”

“…Research is needed to uncover the risk factors that are specifically tied to SA to prevent deaths by suicide. There is some evidence that PLEs may increase the risk of SA among those who endorse SI (DeVylder et al, 2015; Fujita et al, 2015; Hielscher et al, 2019; Kelleher et al, 2012). In contrast, other studies have not found increased odds of attempts due to PLEs among individuals with SI (Bromet et al, 2017).…”