Depression moderates the relationships between hallucinations, delusions, and suicidal ideation: The cumulative effect of experiencing both hallucinations and delusions

Abstract

Suicide is a leading cause of preventable death in the United States and worldwide, with symptoms of depression and psychosis relating to increases in risk for ideation, attempt, and completion. This study examined moderating effects of depression in the relationships between three categories of psychotic symptoms (experiencing only hallucinations, only delusions, and both hallucinations and delusions) and suicidal ideation. Data (n = 12,195) were obtained from the cross-sectional Collaborative Psychiatric Epidemiology Surveys data which include large general population-based samples of households in the United States. Data were examined using Structural Equation Modeling (SEM) in Mplus 8. Approximately 19% of the sample met criteria for major depression and 13% reported having the experience of suicidal ideation. Only 16% of the sample reported having a diagnosis of schizophrenia and/or a psychotic disorder. Depression functioned as a moderator and among those who experienced depression, increases in all psychotic symptom categories significantly related to increased likelihood of experiencing suicidal ideation. Among those who were not depressed, increases in two psychotic symptom categories (only hallucinations and both hallucinations and delusions) were significantly related to greater likelihood of experiencing suicidal ideation. Findings emphasize the high-risk for ideation among individuals who experience hallucinations or delusions, with the cumulative effect of experiencing both hallucinations and delusions being most harmful in relation to the likelihood of experiencing suicidal ideation; particularly so among those who were depressed. Assessment of risk factors for suicidal ideation is imperative given its relationship to the potential of suicide attempt and/or completion.