Psychotic Experiences as a Predictor of the Natural Course Of, Suicidal Ideation: A Swedish Cohort Study

Abstract

Psychotic experiences are far more prevalent in the population than psychotic disorders and are associated with a wide range of depressive, anxiety and behavioral disorders, as well as increased risk for psychotic disorder. Recently, psychotic experiences have been highlighted as a potentially valuable clinical marker of risk for suicidal behavior. There have been few studies to date, however, to assess psychotic experiences as a predictor of suicidality over time. We wished to assess whether young persons with suicidal ideation at baseline assessment who reported psychotic experiences were at higher risk for persistence of suicidal ideation at follow-up than young persons who also reported suicidal ideation at baseline but who did not report co-occurring psychotic experiences. A total of 2,263 adolescents were assessed at age 13 to 14 years for psychotic experiences, suicidal ideation and internalizing and externalizing psychopathology. Participants were re-assessed at ages 16 to 17 years and 19 to 20 years. Among 13-to 14-year olds with suicidal ideation, co-occurring psychotic experiences did not predict an increased odds of persistence of suicidal ideation to age 16 to 17 years (OR50.94, 95% CI: 0.19-4.78). Among 16-to 17-year olds with suicidal ideation, however, co-occurring psychotic experiences predicted a 6-fold increased odds of persistence of suicidal ideation to age 19 to 20 years (OR55.53, 95% CI: 1.33-23.00). Psychotic experiences are an important but under-recognized marker of risk for persistence of suicidal ideation, in particular from mid-adolescence. An increased emphasis on the clinical assessment of psychotic experiences in mental health services should be a priority.

Genome‐wide analysis of adolescent psychotic‐like experiences shows genetic overlap with psychiatric disorders

“…Evidence is accruing that psychotic‐like experiences manifested prior to adulthood form part of a wider phenotype or prodrome related to psychiatric disorders such as schizophrenia and depression. This study joins the existing evidence that individuals with a family history of schizophrenia score higher on psychotic‐like experience scales (Jeppesen et al, ; Zavos et al, ), psychotic‐like experiences are associated with the same environmental risk factors as schizophrenia (Linscott & Van Os, ), psychotic‐like experiences are on a phenotypic and etiological continuum across the severity continuum (Taylor et al, ; Zavos et al, ), and psychotic‐like experiences predict later psychiatric disorders (Cederlöf et al, ; Fisher et al, ; Kelleher, Cederlöf, & Lichtenstein, ; Kelleher et al, ; Werbeloff et al, ; McGrath et al, ; Zammit et al, ). The next step is to consider how psychotic‐like experiences can be harnessed in a practical sense as a (small effect size) red flag for risk in early intervention and prevention strategies.…”

“…Adolescence is just prior to a peak time of onset for several psychiatric disorders, particularly schizophrenia, bipolar disorder, and major depression (Laursen, Munk‐Olsen, Nordentoft, & Mortensen, ). Psychotic‐like experiences predict many types of psychiatric disorders and suicidal ideation with significant odds ratios of 1.3–5.6 (Cederlöf et al, ; Fisher et al, ; Kelleher et al, ; McGrath et al, ; Werbeloff et al, ; Zammit et al, ).…”

The link between self‐compassion and psychotic‐like experiences: A matter of distress?

“…To account for this, the term psychotic‐like experiences (PLEs) describes phenomena resembling positive psychotic symptoms in the absence of illness (Kelleher & Cannon, ) common in the general population (van Os, Linscott, Myin‐Germeys, Delespaul, & Krabbendam, ). As such, PLEs can be understood as a continuous phenotype ranging from non‐distressing normal (Yung et al ., ) and healthy (Claridge, ) experiences to subclinical symptoms indicating psychosis proneness (Kelleher, Harley, Murtagh, & Cannon, ), which are associated with impaired functioning, poorer quality of life (Fusar‐Poli et al ., ) and increased suicidal ideation (Kelleher, Cederlöf, & Lichtenstein, ). This concept allows differentiating between people with PLEs in terms of their need for help or distress associated with their PLEs.…”

Psychotic symptoms and suicidal ideation in child and adolescent bipolar I disorder

“…In comparison to mixed findings in adult samples, the relationship between psychotic symptoms and suicide‐related outcomes among children and adolescents is more consistently supported . Children and adolescents with psychotic symptoms have high rates of suicide attempts, ranging from 12% to 38% .…”