Risk Factors for Deliberate Self-harm and Suicide Among Adolescents and Young Adults With First-Episode Psychosis

Abstract

Little is known about the risk factors for deliberate self-harm (DSH) and suicide among adolescents and young adults with first episode psychosis (FEP) and the longitudinal course of DSH following the initial onset of illness. This study identifies risk factors for DSH and suicide death among Medicaid-covered adolescents and young adults with FEP along with the periods of greatest risk for DSH after diagnosis. A retrospective longitudinal cohort analysis was performed using Medicaid claims data merged with death certificate data for 19 422 adolescents and young adults (aged 15–24 years) diagnosed with the onset of FEP between 2010 and 2017. DSH per 1000 person-years and standardized mortality rates for suicide were determined. Hazard ratios of DSH and suicide were estimated by Cox proportional hazard models. During follow-up, 2148 (11.1%) individuals had at least one self-harm event and 22 (0.1%) died by suicide. The hazards of DSH were significantly higher for those with a previous DSH, suicidal ideation, child abuse and neglect, comorbid medical and psychiatric diagnoses, and prior mental health care. The median follow-up time for those who had DSH was 208.0 days (SD: 526.5 days) in adolescents and 108.0 days (SD: 340.0 days) in young adults. Risk of DSH was highest in the first 3 months following FEP. Individuals with FEP are at high risk for self-harm and suicidal behavior, and recognition of who among these individuals and when following illness onset they are at greatest risk may guide more precise clinical recognition and intervention.

Suicidal behaviour in first‐episode psychosis: The relevance of age, perceived stress and depressive symptoms

“…Age and perceived stress emerged as two of the most relevant variables related to suicidal behaviours. Age was related to suicidal ideation and suicidal attempt, what gives further support to the importance of suicide awareness in young populations (Barrett et al, 2010; Bertelsen et al, 2007; Moe et al, 2021; Pelizza et al, 2020; Pelizza et al, 2021; Suokas et al, 2010). Stress was linked to suicidal ideation and an increased presence of suicidal risk, as previous studies have reported (Abdollahi et al, 2015; Chen & Kuo, 2020; Klonsky et al, 2018).…”

“…Patients with psychotic disorders, and especially those diagnosed with schizophrenia, have an increased risk of suicide compared to the general population (Hawton et al, 2005). Around 30%-40% of people with psychosis present suicidal ideation (Fenton et al, 1997;Fialko et al, 2006;Moe et al, 2021), between 20% and 40% have had at least a suicide attempt (Harkavy-Friedman, 2006), and it is estimated that between 4% and 13% will consummate a suicide attempt (De Hert et al, 2001;Simms et al, 2007). Currently, there is sufficient evidence that indicates that suicide is the leading cause of premature death in schizophrenia (Saha et al, 2007).…”

Variability in suicidal ideation during treatment for individuals at clinical high risk for psychosis: The importance of repeated assessment

“…Suicide is one of the most devastating outcomes for individuals with psychosis, with rates that are 13× greater than the general population (Too et al, 2019). Several studies have shown that suicide risk is greatest during the early stages of illness (e.g., Moe et al, 2021; Ventriglio et al, 2016). Additionally, suicide risk is elevated among individuals at CHR‐P, with 66% reporting recent suicidal ideation and 11% reporting lifetime suicidal behaviour (Taylor et al, 2015).…”

An examination of the relationship between positive schizotypy and suicide risk using five distinct samples.

“…Individuals with schizophrenia are at particularly high-risk for suicide (Caldwell & Gottesman, 1990), with suicide rates that are approximately 13 times greater than the general population (Too et al, 2019). A number of studies have demonstrated that suicide risk among individuals with schizophrenia is greatest during the first few years, or even months, after receiving a diagnosis (e.g., Coentre et al, 2017; Moe et al, 2021; Nordentoft et al, 2015; Pompili et al, 2011; Ventriglio et al, 2016). There is also emerging evidence that suicide risk might develop before illness onset, with studies showing elevated rates of suicidal thoughts and behaviors among individuals deemed clinical high-risk (CHR) for psychosis (e.g., Haining et al, 2021; Pelizza et al, 2020; Taylor et al, 2015).…”

“…Individuals with schizophrenia are at particularly high-risk for suicide (Caldwell & Gottesman, 1990), with suicide rates that are approximately 13 times greater than the general population (Too et al, 2019). A number of studies have demonstrated that suicide risk among individuals with schizophrenia is greatest during the first few years, or even months, after receiving a diagnosis (e.g., Coentre et al, 2017;Moe et al, 2021;Nordentoft et al, 2015;Pompili et al, 2011;Ventriglio et al, 2016).…”