Moderating effects of positive symptoms of psychosis in suicidal ideation among adults diagnosed with schizophrenia

Abstract

Background Suicide is among the leading causes of death for adults diagnosed with schizophrenia, with risk estimates being over eight folds greater than the general population. While the majority of research to date focuses on the role of symptoms of depression in suicide risk, there is a lack of consensus and understanding of the relationship between positive symptoms of psychosis and both suicidal ideation and attempt. The current study examined pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), hopelessness, and suicidal ideation among a population of adults diagnosed with schizophrenia. Methods Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1460) at baseline. Suicidal ideation, hopelessness, and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). Data were analyzed with Structural Equation Modeling (SEM) using Mplus 7. Results Symptoms of depression, positive symptoms of psychosis, and hopelessness independently predicted suicidal ideation. Hopelessness significantly mediated the relationship between symptoms of depression and suicidal ideation. Lastly, positive symptoms of psychosis were found to moderate the relationship between symptoms of depression and suicidal ideation. Conclusions The current study provides evidence for the role that positive symptoms of psychosis (specifically hallucinations and delusions) play in suicidal ideation, pointing towards the implication that beyond symptoms of depression, positive symptoms must be evaluated for and treated.

Potential metabolic monitoring indicators of suicide attempts in first episode and drug naive young patients with major depressive disorder: a cross-sectional study

“…We also found relationships between HDL-C and anxiety, depression, and psychotic symptoms. Previous studies reported that the increase of positive symptoms as well as the symptoms of depression can increase the risk of suicidal ideation [28,29]. Further, Capron et al reported that anxiety can amplify the stress response, which in turn can increase the suicidal tendency [33].…”

“…The Positive and Negative Syndrome Scale (PANSS) was employed to find whether there is a connection between suicide attempt and psychotic symptom in patients with MDD or not, because the independent increase of positive symptoms of psychosis as well as the symptoms of depression can lead to the increase of suicidal ideation [28,29]. Each item is scored on a 7-point scale based on the level of psychopathology.…”

Suicidal ideation in individuals at ultra‐high risk for psychosis and its association with suspiciousness independent of depression

“…This finding is in line with previous studies, which have shown that experiences of suspiciousness may serve as a psychosis‐specific risk factor for suicide in psychotic patients (Bolton et al, ; Johnson et al, ; Palmier‐Claus et al, ; Taylor et al, ). Suspiciousness has been found to be associated with depressed mood, one of the most well‐established risk factors for suicide, in patients with overt psychosis (Bornheimer, ; Freeman et al, ; Messias, Kirkpatrick, Ram, & Tien, ). However, suspiciousness also seems to play an independent role beyond depression in the formation of suicidal ideation through various psychological processes including catastrophizing (Startup, Freeman, & Garety, ), threat beliefs (Freeman, Garety, Kuipers, Fowler, & Bebbington, ) and negative self‐cognitions (Collett, Pugh, Waite, & Freeman, ).…”

“…In recent years, there have been mixed findings on whether the positive symptoms of schizophrenia contribute to the increased risk of suicide. Several studies have shown that the risk for suicide in patients with schizophrenia is significantly associated with the presence of psychotic symptoms, including delusions and hallucinations (Bertelsen et al, 2007;Bornheimer, 2016;Bornheimer & Jaccard, 2016;Nordentoft et al, 2002;Tarrier et al, 2006;Taylor et al, 2010), though this is not always the case (Hawton et al, 2005;Verdoux et al, 2001;Walsh et al, 2001). Since experiences of delusions and hallucinations may serve as a specific risk factor for suicide in affected individuals, recently developed psychological models of suicide have attempted to incorporate the impact of positive psychotic symptoms on the mind underlying suicidal ideation (Bolton, Gooding, Kapur, Barrowclough, & Tarrier, 2007;Bornheimer & Nguyen, 2016;Johnson, Gooding, & Tarrier, 2008).…”

Self‐Stigma Mediates the Impact of Insight on Current Suicide Ideation in Suicide Attempters with Schizophrenia: Results of a Moderated Mediation Approach

“…Hopelessness, which is considered an empirically established characteristic of depression, has been reported to be an even greater risk factor for suicidal behavior than is depression (Bornheimer, ; Popovic et al., ). The Beck Hopelessness Scale (BHS) is a 20‐item true–false self‐report instrument used to assess the degree of pessimism exhibited by a person (Beck & Steer, ).…”