First-episode psychosis, stress and abuse linked to increase of suicidal behaviors

Those with first-episode psychosis demonstrated more suicidal behavior compared with healthy controls, while perceived stress and emotional abuse were linked to an increase in suicidal ideation and risk, according to a recent study.

“Suicide is a major public health concern,” Marta Diago, of the Saint Joan of God Research Institute in Spain, and colleagues wrote in Psychiatry Research. “The population with the highest relative risk of suicide are those who suffer from mental disorders, and among them, people diagnosed with schizophrenia and other psychotic disorders.”

Diago and fellow researchers sought to compare suicidal behavior between first-episode psychosis (FEP) and healthy controls, and to study the relationship between the five types of childhood trauma and suicide risk in first-episode psychosis, controlling for confounding sociodemographic, clinical and psychosocial variables.

The PROFEP study included 95 participants (29 women, 66 men) aged 13 to 46 years, diagnosed with FEP, alongside 92 healthy control participants. Childhood trauma was evaluated using the 28-item self-report Childhood Trauma Questionnaire-Short Form. Suicidal behavior was assessed via the Suicide Risk Scale of Plutchik, a 15-question self-reporting tool, in which higher scores indicated a higher risk for suicide. Researchers also set a cut-off point of 5 on the Calgary Depression Scale for Schizophrenia in participants with FEP older than 17, and a cut-off point of 19 on the scale of the Children Depression Inventory for children and adolescents.

Results showed that patients with FEP presented more suicidal behavior (ideation, attempt, and suicide risk) than the control group, reported higher scores in suicidal ideation and scored higher in behaviors of suicide risk than controls.

Emotional abuse was the most relevant type of childhood trauma in suicide ideation and suicide risk. After controlling for other relevant variables, researchers found perceived stress was a strong predictor of suicide ideation, suicide attempt and suicide risk. Depression did not have any effect in suicide behavior.

“It is essential that mental-health professionals receive training in exploring and intervening suicide risk and childhood trauma, as well as in the management of perceived stress and anxiety,” Diago and colleagues wrote.