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

Abstract

Background Schizophrenia is associated with premature mortality, partly through increased suicide rates. Aims To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability). Method We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset. Results In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour. Conclusions Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.

Strengthening associations between psychotic like experiences and suicidal ideation and behavior across middle childhood and early adolescence

“…Initial models indicated age by PLEs interactions with SI and SB for both perceptual distortions and delusional ideation, suggesting both types of PLEs are associated with both SI and SB. However, when both perceptual distortions and delusional ideation were entered into the same model, an age by PLEs interaction with SI only remained for delusional ideation, consistent with some psychosis research (de Cates et al, 2021). This suggests possible stronger associations between delusional ideation with SI.…”

“…Suicide is the second leading cause of death in children aged 10 to 14 (Curtin & Heron 2019) with a crude rate of 2.57 per 100 000 in the United States (CDC, 2022, June 17). A recent advisory from the U.S.…”

Machine learning and the prediction of suicide in psychiatric populations: a systematic review

“…Several of the strongest predictors in ML studies are well-known risk factors for suicide, such as previous suicide attempts, previous hospitalizations, and severity of depression [ 28 , 38 , 51 , 89 , 91 , 94 , 96 , 99 ]. Moreover, the presence of psychosis and a higher amount of pharmacological treatments, especially antipsychotics, resulted to be highly predictive features in many investigations [ 4 , 63 , 64 , 91 , 100 , 101 ]. Interestingly, also presence of psychiatric comorbidities was one of the most valuable predictive features, in particular substance or alcohol use disorders [ 57 , 61 , 71 , 72 , 92 ].…”

The Role of Verbal Auditory Hallucinations in Influencing and Retrospectively Predicting Physical Harm Prevalence in Early Psychosis

“…Depression is a common comorbid condition for those experiencing early-course psychosis [16], with as many as 80% of FEP patients reporting one or more periods of depression [17]. The presence of this low mood in the context of FEP can help explain the relationship between suicidality [18] or selfharm [19] and psychosis symptoms. Hearing voices in the context of psychosis is associated with increased suicidal thoughts and attempts [18] and self-harm [20].…”

“…The presence of this low mood in the context of FEP can help explain the relationship between suicidality [18] or selfharm [19] and psychosis symptoms. Hearing voices in the context of psychosis is associated with increased suicidal thoughts and attempts [18] and self-harm [20]. Again, command hallucinations specifically have been implicated as elevating the risk of self-harm [21] and suicidality [22].…”