Suicidal ideation and behaviour in patients with persecutory delusions: Prevalence, symptom associations, and psychological correlates

Freeman, Daniel; Bold, Emily; Chadwick, Eleanor; Taylor, Kathryn M.; Collett, Nicola; Diamond, Rowan; Černis, Emma; Bird, Jessica C.; Isham, Louise; Forkert, Ava; Carr, Lydia; Causier, Chiara; Waite, Felicity

doi:10.1016/j.comppsych.2019.07.001

Cited by 41 publications

(19 citation statements)

References 37 publications

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“…Network analysis also showed that once all other variables were controlled, the presence of self-harm was solely associated with paranoia, with this edge contributing to 22% of the predictability of self-harm (beyond the intercept model). This relationship is consistent with findings from the adult literature ( Freeman et al, 2019b ) and evidence that self-harm is associated with psychotic experiences in general in adolescents ( Hielscher et al, 2019 ; Martin et al, 2015 ). The co-occurrence of paranoia with so many different psychiatric symptoms could also be an indicator of more severe presentations, with adolescents who report persistent paranoia having greater levels of symptoms and social impairments over time.…”

Section: Discussionsupporting

confidence: 91%

Paranoia in patients attending child and adolescent mental health services

Bird

Fergusson

Kirkham

et al. 2021

Aust N Z J Psychiatry

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Objective: Paranoia may be particularly prevalent during adolescence, building on the heightened social vulnerabilities at this age. Excessive mistrust may be corrosive for adolescent social relationships, especially in the context of mental health disorders. We set out to examine the prevalence, symptom associations, and persistence of paranoia in a cohort of young people attending child and adolescent mental health services. Method: A total of 301 patients (11–17 years old) completed measures of paranoia, affect, peer difficulties and behavioural problems. Clinicians also rated each participant’s psychiatric symptoms. Patterns of association were examined using linear regressions and network analyses. In total, 105 patients repeated the measures several months later. Results: Most of the adolescents had affective disorders ( n = 195), self-harm/suicidality ( n = 82), or neurodevelopmental conditions ( n = 125). Few had suspected psychosis ( n = 7). Rates of paranoia were approximately double compared with previous reports from the general population. In this patient sample, 35% had at least elevated paranoia, 15% had at least moderate paranoia, and 6% had high paranoia. Paranoia had moderate associations with clinician-rated peer difficulties, self-harm, and trauma, and small associations with clinician-rated social anxiety, depression, generalised anxiety, and educational problems. Network analyses showed paranoia had the strongest unique relationship with peer difficulties. Paths from peer difficulties to anxiety, self-harm, post-traumatic stress disorder symptoms, and behavioural problems were all via paranoia. Both self-harm and post-traumatic stress disorder were solely associated with paranoia in the network. Paranoia remained persistent for three-quarters and was associated with greater psychological problems over time. Conclusion: Paranoia is relatively common and persistent across a range of clinical presentations in youth. When paranoia occurs alongside emotional problems, important peer interactions may be adversely affected. Wider consideration of paranoia in adolescent patients is needed.

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Section: Discussionsupporting

confidence: 91%

Paranoia in patients attending child and adolescent mental health services

Bird

Fergusson

Kirkham

et al. 2021

Aust N Z J Psychiatry

Self Cite

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“…In the general population, the association between psychotic experiences, and suicidal thoughts and behaviours, is robust even after accounting for potential confounders ( Hielscher et al, 2018 ), increasing the risk of self-harm approximately threefold ( DeVylder et al, 2015 ; Honings et al, 2016 ). In one community study of people with non-affective psychosis, three quarters had suicidal ideation, and 4.5% had attempted suicide in the preceding four weeks ( Freeman et al, 2019 ). Suicidal thoughts were associated with higher levels of depression, persecutory thoughts, hallucinations, poor sleep, anger and negative cognitions.…”

Section: Introductionmentioning

confidence: 99%

Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

Cates

Catone

Marwaha

et al. 2021

Schizophrenia Research

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Background Schizophrenia is associated with premature mortality, partly through increased suicide rates. Aims To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability). Method We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset. Results In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour. Conclusions Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.

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“…The participants were unable to rid themselves of their paranoid thoughts and auditory hallucinations, and if they did, their desire to die would grow and they were easily inclined toward death. Suicide rates are high among people with schizophrenia (Cassidy et al, 2018;Melle et al, 2017) and especially high among those in the early stages of the disorder (Freeman et al, 2019), and more people may experience suicidal ideation like the participants in this study than actually reported. The feeling of wanting to die, which began immediately after the onset, was a great difficulty for them.…”

Section: Discussionmentioning

confidence: 54%

Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study

Nagata

Kitaoka

Kawamura

2021

Nursing & Health Sciences

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This descriptive study used a qualitative inductive approach to investigate the subjective experiences and perceptions of people with schizophrenia living in the community during times of difficulty and how they coped. We conducted semi-structured interviews with nine community-dwelling people with schizophrenia and used the KJ method developed by Kawakita Jiro to structure the data obtained. We identified 10 symbols with his method: bewilderment at the onset; helplessness and longing for death; solitude linked to death; precarious daily life; relationships at risk; fear of being stigmatized; pillars of emotional support; will to overcome; hope to never give up; and living with the illness. The results suggest that community mental health nurses should provide support so their patients can continue to have pillars of emotional support and the will to overcome difficulties, as well as continue to use their coping methods, even when experiencing many difficulties. It is important that nurses understand and share in their patients' difficult experiences and hopes when providing support toward their recovery.

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Suicidal ideation and behaviour in patients with persecutory delusions: Prevalence, symptom associations, and psychological correlates

Cited by 41 publications

References 37 publications

Paranoia in patients attending child and adolescent mental health services

Paranoia in patients attending child and adolescent mental health services

Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study

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