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Psychopathology, psychosis increased adolescent suicide risk

Adolescents with psychopathology who reported psychotic symptoms were at nearly 70 times the risk for suicide, according to recent study results.

"[T]he findings of the current study point to psychotic symptoms as a valuable means of identifying individuals who are clinically at highest risk for suicidal behavior," researchers wrote.

In a prospective cohort study, 1,112 adolescents aged 13 to 16 years from counties Cork and Kerry in Ireland were assessed for self-reported psychopathology, psychotic symptoms and suicide attempts. Study participants completed validated questionnaires at baseline and at 3- and 12-month follow-up.

Seven percent of the cohort reported psychotic symptoms at baseline. Among those adolescents, 7% said they attempted suicide at 3 months vs. 1% of adolescents who did not experience psychotic symptoms (OR=10.1; 95% CI, 2.24-45.49), and 20% reported a suicide attempt at 12 months compared with 2.5% of the remaining population (OR=11.27; 95% CI, 4.44-28.62).

Among adolescents with psychopathology who reported experiencing psychotic symptoms, 14% attempted suicide by 3 months (OR=17.91; 95% CI, 3.61-88.82) and 34% by 12 months (OR=32.67; 95% CI, 10.42-102.41).

To account for the possibility that some adolescents who did not report psychotic symptoms at baseline but may have experienced those symptoms nearer the time of their suicide attempt, the investigators assessed suicide attempts occurring within 2 weeks of contact for a follow-up assessment, or "acute suicide attempts."

Adolescents with psychopathology who did not experience psychotic symptoms were not at a significantly increased risk for suicide (OR=1.09; 95% CI, 0.15-8.06) compared with the rest of the cohort. However, the OR for suicide attempts among those who reported psychopathology and psychotic symptoms was 67.5 (95% CI, 11.41-399.21).

"In absolute terms, individuals with psychotic symptoms made up less than a quarter of the total group with psychopathology but accounted for nearly 80% of the acute suicide attempts in this group," the researchers wrote. "Assuming a causative relationship for suicide attempts, the population-attributable fraction for psychotic symptoms would be 56% in the whole sample and 75% in the subsample with psychopathology."

The researchers said future research should focus on the relationship between psychotic symptoms and suicidal behavior and possible clinical interventions.

Disclosure: The researchers report no relevant financial disclosures.