Prevalence and predictors of suicidality and non-suicidal self-harm among individuals at clinical high-risk for psychosis: Results from a community-recruited sample.

Matthias Schwannauer,Olga Karagiorgou,Peter J Uhlhaas,Kate Haining,Joachim Gross,Andrew I Gumley,Stephen M Lawrie,Ruchika Gajwani,Frauke Schultze‐Lutter

doi:10.1111/eip.13075

Abstract

AimSuicidal thoughts and behaviours are prevalent in individuals with schizophrenia. However, research examining the prevalence and predictors of suicidality and self‐harm in participants at clinical high‐risk for psychosis (CHR‐P) is limited and mostly focuses on help‐seeking participants recruited through clinical pathways. The current study sought to assess the prevalence of suicidality and self‐harm and identify predictors of current suicidal ideation in community‐recruited CHR‐P participants.MethodsData were available for 130 CHR‐P participants, 15 participants with first‐episode psychosis (FEP), 47 participants not fulfilling CHR‐P criteria (CHR‐Ns) and 53 healthy controls. Current and lifetime suicidality and self‐harm were assessed using the Mini‐International Neuropsychiatric Interview and the Comprehensive Assessment of At‐Risk Mental States (CAARMS). Multivariable logistic regression analysis was used to determine predictors of current suicidal ideation in the CHR‐P group.ResultsA considerable proportion of CHR‐P participants disclosed current suicidal ideation (34.6%). Overall, FEP individuals were at greatest risk, with considerably high prevalence rates for current suicidal ideation (73.3%), lifetime self‐harm behaviour (60.0%) and lifetime suicide attempt (60.0%). In the CHR‐P sample, current suicidal ideation was predicted by lifetime suicide attempts, lower CAARMS severity, impaired social functioning and greater comorbidity.ConclusionsOur findings suggest that suicidality and self‐harm are highly prevalent in community‐recruited CHR‐P and FEP individuals. Accordingly, these results highlight the importance of further research into the determinants of suicidality and self‐harm during at‐risk and early stages of psychosis, and the implementation of intervention strategies to reduce adverse outcomes in these populations.

Highlights

Psychotic disorders, such as schizophrenia, are strongly linked to high levels of suicidality
We examined the prevalence of suicidality and self-harm in clinical high-risk for psychosis (CHR-P) and first-episode psychosis (FEP) samples as well as predictors of current suicidal ideation in CHR-P individuals
In contrast to previous studies, our results suggest that suicidality and self-harm are more prevalent in FEP as compared to CHR-P participants, especially with regard to current suicidal ideation

Summary

Introduction

Psychotic disorders, such as schizophrenia, are strongly linked to high levels of suicidality. Compared to the general population, individuals with schizophrenia have a 13-fold greater risk of suicide (Too et al, 2019) and approximately 4.9% die by suicide (Palmer et al, 2005). Research examining the prevalence of suicidality and self-harm in individuals at clinical high-risk for psychosis (CHR-P) is more limited albeit emerging CHR-P participants are characterised using ultra-high risk (UHR) criteria, which include attenuated psychotic symptoms, brief frank psychosis and functional decline with genetic risk (Yung et al, 2005), as well as basic symptom criteria relying on perceptual and cognitive disturbances self-experienced with full and immediate insight Over a 2-year period, around 20% of individuals meeting UHR criteria transition to psychosis In a UHR sample, approximately 45% of nonconverters experienced either poor social or role outcome (Carrión et al, 2013); impairments previously related to persistence of CHR-P symptoms (Michel et al, 2018)

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