Symptoms of Depression, Positive Symptoms of Psychosis, and Suicidal Ideation Among Adults Diagnosed With Schizophrenia Within the Clinical Antipsychotic Trials of Intervention Effectiveness

Abstract

Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms of depression are consistently supported factors involved in suicidal ideation, findings on the role of positive symptoms of psychosis have been mixed with limited understandings of risk. Accordingly, this study aimed to identify the pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), and suicidal ideation. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1,460). Suicidal ideation and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). The data were analyzed using Structural Equation Modeling (SEM). As symptoms of depression and positive symptoms of psychosis independently increased, on average there were associated increases in suicidal ideation. The present study provides support for the relationship between positive symptoms of psychosis, specifically hallucinations and delusions, and suicidal ideation. Future prospective longitudinal study designs are needed to further increase understandings of the roles that hallucinations, delusions, and additional symptoms of schizophrenia play in both suicidal ideation and attempt to ultimately inform evidence-based interventions aiming to reduce suicidal death.

Self-harm and suicide attempts in Schizophrenia

“…Specifically, hallucinations and delusions play an important role in suicidal ideation (Bornheimer and Jaccard, 2016). Although there have been mixed findings with respect to positive symptoms affecting suicidal behavior, several authors opined that hallucinations predicted suicidal plans and ideation (Kjelbyet al, 2015), (Bertelsen et al, 2007).…”

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

“…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.…”

“…Each item is scored on a 7-point scale based on the level of psychopathology. In this study, patients with a total positive symptom subscale score reaching or exceeding 15 were defined as having psychotic symptoms [29,30].…”

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

“…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).…”