Psychotic Symptoms in Adolescence Index Risk for Suicidal Behavior

Abstract

CONTEXT Recent evidence from both clinical and population research has pointed to psychotic symptoms as potentially important markers of risk for suicidal behavior. However, to our knowledge, there have been no epidemiological studies to date that have reported data on psychotic symptoms and suicidality in individuals who have been clinically assessed for suicidal behavior. OBJECTIVES To explore associations between psychotic symptoms in nonpsychotic adolescents and risk for suicidal behavior in (1) the general population, (2) adolescents with psychiatric disorder, and (3) adolescents with suicidal ideation. DESIGN Two independently conducted case-control clinical interview studies. SETTING Population-based studies in Ireland. PARTICIPANTS Study 1 included 212 adolescents aged 11 to 13 years. Study 2 included 211 adolescents aged 13 to 15 years. Participants were recruited from schools. MAIN OUTCOME MEASURES Suicidal behavior and psychotic symptoms, assessed by semi-structured diagnostic clinical interview. RESULTS Psychotic symptoms were associated with a 10-fold increased odds of any suicidal behavior (ideation, plans, or acts) in both the early and middle adolescence studies (odds ratio [OR], 10.23; 95% CI, 3.25-32.26; P < .001 and OR, 10.5; 95% CI, 3.14-35.17; P < .001, respectively). Adolescents with depressive disorders who also experienced psychotic symptoms were at a nearly 14-fold increased odds of more severe suicidal behavior (suicide plans and suicide acts) compared with adolescents with depressive disorders who did not experience psychotic symptoms (OR, 13.7; 95% CI, 2.1-89.6). Among all adolescents with suicidal ideation, those who also reported psychotic symptoms had a nearly 20-fold increased odds of suicide plans and suicide acts compared with adolescents with suicidal ideation who did not report psychotic symptoms (OR, 19.6; 95% CI, 1.8-216.1). CONCLUSIONS Psychotic symptoms are strongly associated with increased risk for suicidal behavior in the general adolescent population and in adolescents with (nonpsychotic) psychiatric disorder. In both studies, an absolute majority of adolescents with more severe suicidal behavior (suicidal plans and acts) reported psychotic symptoms when directly questioned about this as part of a psychiatric interview. Assessment of psychotic symptoms should form a key part of suicide risk assessment.

Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study

“…The study members with these early psychotic symptoms also had a range of other outcomes in adulthood including anxiety, depression and substance dependence, with only one escaping reasonably unscathed. Worryingly, these children were also more likely to attempt or complete suicide during adolescence or adulthood, consistent with a recent study of Irish adolescents (Kelleher et al 2012c). …”

From Phenomenology to Neurophysiological Understanding of Hallucinations in Children and Adolescents

“…26 In a community-based study of adolescents, those with psychiatric disorders who reported psychotic experiences (predominantly AVH) had a far higher prevalence of suicidal behavior than those with psychopathology who did not report psychotic experiences. 25 Adolescents with a diagnosis of MDD who reported psychotic experiences, eg, had a 14-fold increase in suicide plans or attempts compared to adolescents with the same diagnosis who did not report psychotic experiences. In a prospective cohort study, AVH were also investigated as a clinical predictor of future suicide attempts in community-based adolescents.…”

“…24 Additionally, psychotic symptoms predicted more severe psychopathology from a number of perspectives in addition to multimorbidity, in terms of both global and cognitive functioning. 25 …”

A systematic review and meta‐analysis of mental health service use in people who report psychotic experiences

“…The presence of self‐reported psychotic‐like experiences (PEs), which do not reach the threshold for a diagnosable psychotic disorder, may be associated with an elevated risk for developing psychotic disorders in the future (Fusar‐Poli et al, 2013). However, limited evidence also suggests that PEs are associated with impacts on mood, functioning, and suicidality, indicating that these symptoms might carry wider implications for public mental health than for the development of psychosis alone (Armando et al, 2012; Fusar‐Poli et al, 2014; Kelleher et al, 2012a; Kelleher et al, 2014a; Yung et al, 2006). This leads us to hypothesise that people with PEs could be greater consumers of mental health services, including primary care, compared to those without (DeVylder et al, 2014).…”