Is poor premorbid functioning a risk factor for suicide attempts in first-admission psychosis?

Abstract

Background While poor premorbid functioning is associated with poorer outcomes in psychotic illnesses, little is known about whether it is also a risk factor for suicide attempts. Objective The current study examined the association of premorbid functioning and suicide attempts in a county-wide cohort of first-admission inpatients. Method Data were derived from participants of the Suffolk County Mental Health Project ( n = 444) over the course of 48-month follow-up. Premorbid functioning was estimated and categorized (good vs. poor/declining) using the Premorbid Adjustment Scale (PAS). Results Poorer premorbid functioning was significantly associated with increased likelihood of a suicide attempt prior to first psychiatric hospital admission. Specifically, 33.0% of participants with poor/declining premorbid functioning had a history of suicide attempts compared to 23.5% with good premorbid functioning. Among participants with a prior attempt ( n = 126), poor premorbid functioning was significantly associated with an increased likelihood of additional attempts during the four years after first hospitalization. Conclusion Identifying those with poor premorbid functioning and prior histories of attempts could help clinicians target high-risk patients. Thus, greater attention to persons with both risk factors may form the basis for early interventions aimed towards reducing the risk for subsequent suicide attempts.