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Psychosis tied to increased risk for suicidal behavior

Adolescents who exhibited psychotic symptoms were at a 10-fold increased risk for suicidal behavior, researchers reported.

“The immediate clinical relevance of these findings is that all patients presenting at risk for suicidal behavior should receive a thorough assessment of psychotic symptoms and not just a screening to rule out psychotic disorder,” the researchers wrote.

Ian Kelleher, PhD, of the department of psychiatry at the Royal College of Surgeons in Ireland, and colleagues examined data from two independently conducted case-control clinical interview studies in Ireland. The Adolescent Brain Development (ABD) study examined the prevalence of psychotic symptoms in the general adolescent population, sampling 1,131 students aged 11 to 13 years from 16 schools, and the Challenging Times (CT) study was designed to investigate the prevalence of psychiatric disorders and suicidal behavior among 743 students aged 13 to 15 years from eight schools. For both studies, researchers used the Schedule for Affective Disorders and Schizophrenia for School-aged Children, Present and Lifetime versions.

Psychotic symptoms were associated with a 10-fold increased odds of any suicidal behavior, including suicidal ideation, plans or acts, in both the ABD (OR=10.23; 95% CI, 3.25-32.26) and CT (OR=10.5; 95% CI, 3.14-35.17) studies. Adolescents with depressive disorders who also had psychotic symptoms had a nearly 14-fold increased odds of more severe suicidal behavior — defined in the study as suicide plans or acts — compared with adolescents who had depressive but not psychotic symptoms (OR=13.7; 95% CI, 2.1-89.6). Among all adolescents with suicidal ideation, students who reported psychotic symptoms had a nearly 20-fold increased odds of planning or committing suicide vs. those with suicidal ideation who did not have psychotic symptoms (OR=19.6; 95% CI, 1.8-216.1).

Kelleher and colleagues said the most obvious mechanism underlying the increased suicide risk is hallucinations, which may motivate the individual to harm or kill himself.

However, according to the researchers, further research is needed to understand the relationship between psychotic symptoms and suicide risk, “which may involve a number of neurobiological, neurocognitive, and other factors, knowledge of which may help to inform public health strategies and lead to a reduction in future attempted and completed suicides.”

Disclosure: The researchers report no relevant financial disclosures.