Assessing suicidal ideation in individuals at clinical high risk for psychosis

Abstract

Background The majority of individuals with schizophrenia and other psychotic illnesses have had suicidal ideation at some point during the illness. However, little is known about the variation in level and intensity of suicidal ideation and symptoms in the attenuated stage of psychotic illness. Our aims were to assess prevalence of suicidal ideation in this at risk group, and to examine the severity and intensity of suicidal ideation, and their relation to symptoms. Methods Suicidal ideation was assessed in 42 clinical high-risk participants using the Columbia Suicide Severity Rating Scale (C-SSRS). We hypothesized prevalence rates would be similar to what was found in previous studies, and individuals with suicidal ideation would have higher positive and negative symptoms, with poorer functioning. We assessed levels of severity and intensity of suicidal ideation related to these symptoms, and examined how depressive symptoms affected these relationships. Results Nearly half (42.9%) of participants reported having current suicidal ideation. We found no relationship to positive symptoms. However, severity and intensity of suicidal ideation was found to be related to negative symptoms and level of functioning. When controlling for depressive symptoms during exploratory analysis, this relationship still emerged. Conclusions This study adds to the literature demonstrating the complex nature of suicidal ideation in psychotic illness. The C-SSRS has shown to be helpful in determining relationships between severity and intensity in suicidal ideation in relation to specific symptoms in a research setting.

Suicidal Thinking and Behavior in Adolescents at Ultra‐High Risk of Psychosis: A Two‐year Longitudinal Study

“…Differently to our results, Gill et al. () observed that UHR people with suicidality showed greater severity of negative symptoms than those without suicidal behavior and that controlling for depressive symptoms did not substantially diminish the relationship. Together with these suggestions, our findings confirm the importance of differentiating between depressive and negative symptoms in UHR individuals, particularly for determining risk of suicide (other than conversion to psychosis) and in treatment planning.…”

“…In this regard, positive correlations were found between BDI‐II item 9 score and three main psychopathological features: (1) depression severity (both in its cognitive and somatic‐affective components), (2) some specific items of the CAARMS related to Huber's basic symptoms (BS) (i.e., subjective emotional disturbance, subjective complaints of impaired autonomic functioning, and subjective tolerance to normal stress), and (3) CAARMS factor 1 (“Negative‐interpersonal dimension”). Differently from some previous studies (Bang et al., ; Gill et al., ; Niendam et al., ), this pattern coheres with findings of a previous study (Gill et al., ), who showed higher depression severity in UHR individuals with suicidal ideation in comparison with those without suicidal ideation. Moreover, in the current study, more severe levels of depressive symptoms correctly were the single most important psychopathological factor that predicted suicidal ideation in UHR+ adolescents (75% of correct dichotomized BDI‐II item 9 ascription in the logistic regression model).…”

Suicide in the Early Stage of Schizophrenia

“…The early stages of psychosis were also labeled as “ultra high risk (UHR),” “at risk mental state (ARMS),” and “clinical high risk (CHR).” It is well known that self-harm behaviors and suicidality are highly prevalent in the UHR population, with rates similar to those observed in samples diagnosed with psychotic disorders ( 20 ). In addition, about 50% of young people recognized to be CHR for psychosis have reported current suicidal thoughts ( 21 , 22 ). The prevalence of suicidal ideation among these samples is 42.9%, and there may also be less severe parasuicidal ideation ( 22 ).…”

“…In addition, about 50% of young people recognized to be CHR for psychosis have reported current suicidal thoughts ( 21 , 22 ). The prevalence of suicidal ideation among these samples is 42.9%, and there may also be less severe parasuicidal ideation ( 22 ).…”

“…Contradictory gender patterns in suicidal behaviors among patients with FEP have been found. Some of these showed no relation with suicide risk, suggesting that the severity of a clinical condition could “override” gender differences in suicidal behaviors ( 4 , 22 , 34 ). In some studies, males seem to be more suicidal than females ( 41 – 43 ), whereas some other reports show that female patients at FEP may show higher risk of suicide and suicidal behaviors ( 12 , 30 , 32 ).…”