Suicidal Behaviour In Young People Research Articles

Study protocol for the Multimodal Approach to Preventing Suicide in Schools (MAPSS) project: A regionally based feasibility trial of an integrated response to suicide risk among UK secondary school pupils.

Suicide is the leading cause of death of children and young people under 35 in the UK, and suicide rates are rising in this age group. Schools are considered an appropriate and logical setting for youth suicide prevention activities, with universal, selective, and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programmes combine these approaches, and that to date this has not been done in school settings in the UK, this study aims to evaluate the feasibility of delivering a suicide prevention programme incorporating universal, selective, and indicated components in UK schools. This study is a feasibility cluster-randomised controlled trial (RCT) of an adapted version of the Multimodal Approach to Preventing Suicide in Schools (MAPSS) programme. The programme, initially developed in Australia, involves delivering universal psychoeducation to all pupils, screening them for suicide risk, and delivering Internet-based Cognitive Behavioural Therapy (Reframe IT-UK) to those students identified as being at high-risk for suicide. The programme will be trialled in six secondary schools in Northwest England and will target Year 10 students (14- and 15-year-olds). The primary aims are to assess: 1) the acceptability and safety of delivering MAPSS in a school setting in the UK; 2) the social validity of the MAPSS programme; and 3) the feasibility of delivering a large-scale, appropriately powered, cluster-RCT and economic evaluation of this intervention in the future. Secondary aims are to assess changes over time in mental health and wellbeing outcomes. This study is the first to evaluate a suicide prevention programme comprising universal, selective, and indicated components in UK schools. If the programme is found to be feasible, it could be more widely tested in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in young people.

Acceptability and Potential Impact of the #chatsafe Suicide Postvention Response Among Young People Who Have Been Exposed to Suicide: Pilot Study.

Young people are more likely to be affected by suicide contagion, and there are concerns about the role social media plays in the development and maintenance of suicide clusters or in facilitating imitative suicidal behavior. However, social media also presents an opportunity to provide real-time and age-appropriate suicide prevention information, which could be an important component of suicide postvention activities. This study aimed to test an intervention designed to equip young people to communicate safely online about suicide (#chatsafe) with a sample of young people who had recently been exposed to a suicide or suicide attempt, with a view to determining the role social media can play as part of a postvention response. A sample of 266 young people from Australia, aged 16 to 25 years, were recruited to participate in the study. They were eligible if they had been exposed to a suicide or knew of a suicide attempt in the past 2 years. All participants received the #chatsafe intervention, which comprised 6 pieces of social media content that were sent to them weekly via direct message through Instagram, Facebook, or Snapchat. Participants were assessed on a range of outcome measures (social media use, willingness to intervene against suicide, internet self-efficacy, confidence, and safety when communicating about suicide on social media platforms) at baseline, immediately after the intervention, and at 4-week follow-up. After the 6-week #chatsafe intervention, participants reported substantial improvements in their willingness to intervene against suicide online, their internet self-efficacy, and their perceived confidence and safety when communicating about suicide online. Overall, the participants reported that it was appropriate to receive the #chatsafe intervention via social media, and no iatrogenic effects were recorded. The findings suggest that it is safe and acceptable to disseminate suicide prevention information entirely via social media among young people who have recently been exposed to a suicide or suicide attempt. Interventions such as #chatsafe could potentially mitigate the risk of distress and future suicidal behavior in young people by improving the quality and safety of online communication about suicide and, as such, can be an important component of delivering a postvention response to young people.

Suicidal Behavior and Problematic Internet Use in College Students.

Suicidal behavior, especially in young populations such as university students, is currently one of the most concerning health problems worldwide, suicide being the second leading cause of death among students. Although literature is still scarce, one of the risk factors that correlates the most with suicidal behavior in young people appears to be problematic internet use (PIU). The aim of this study was to investigate the relationship between PIU and suicidal behavior in a Spanish university population. An ex post facto prospective design was used with a sample of 1,386 Spanish university students (68.7% women and 31.3% men). PIU was assessed by means of the Internet Addiction Test (IAT) and psychological problems by means of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). The results confirm the relationship between PIU and suicidal behavior, principally alongside those of social isolation and depression, this risk being 3.78 times higher among women with PIU and 5.58 times higher in men. PIU appears as a risk factor for suicidal behavior that must be taken into account together with social isolation, subjective distress and depression.

Quelle est la part du tabagisme dans l’augmentation du risque suicidaire chez les jeunes fumeurs ? Revue systématique

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population. Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded. This review included 43studies: 23studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide. Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Assessing Suicidal Ideation in Young People With Depression: Factor Structure of the Suicidal Ideation Questionnaire.

Evaluating suicidal ideation in young people seeking mental health treatment is an important component of clinical assessment and treatment planning. To reduce the burden of youth suicide, we need to improve our understanding of suicidal ideation, its underlying constructs, and how ideation translates into suicidal behaviour. Using exploratory factor analysis, we investigated the dimensionality of the Suicidal Ideation Questionnaire (SIQ) among 273 participants aged 15-25 with Major Depressive Disorder. Area under the receiver operating characteristic curve (AUROC) analysis was used to explore associations between latent factors and actual suicidal behaviour. Findings suggested that the SIQ assesses multiple factors underlying suicidal ideation. AUROC analyses demonstrated that latent factors relating to both active and passive suicidal ideation predicted past-month suicidal behaviour and suicide attempt. These findings contribute to an improved understanding of the complexities of suicidal ideation and relationships with suicidal behaviour in young people with depression.

Association Between Perceived Academic Stress And Suicide Behavior Among College Students From Pernambuco

OBJECTIVES: To verify whether there is an association between perceived academic stress and suicidal behavior in young people in the university community. METHOD: Cross-sectional study approved by ethics committee (n°2,581,563), with a sample of 609 undergraduates from the Federal University of Pernambuco from: health, human sciences and exact sciences from 17 to 50 years. For the collection, we used: Mini International Neuropsychiatric Interview, Questionnaire of Academic Experiences reduced version, and a sociodemographic questionnaire. The data were tabulated in the SPSS program in version 21.0. Descriptive and inferential statistical techniques were used for analysis, considering a significance level of 5%. RESULTS: Of the sociodemographic data, 34.6% (n=211) were in the age group of 21 to 23 years, the majority were female, 64.5% (n=393). There was a significant difference in economic organization, the university students of human sciences presented lower per capita family income than health students (p<0.001). There was an association between perceived academic stress and suicidal behavior, specifically for ideation (p< 0.001) and suicide attempt (p< 0.001). Suicidal ideation was present in 44.2% of those who suffer academic stress, and only present in 24% who did not report academic stress. 15.5% of students with academic stress reported previous suicide attempt, while 4.2% of students without academic stress reported attempting at some point in their lives. CONCLUSION: There was an association between perceived academic stress and suicidal behavior. The data reveal the vulnerability of this group to risk behaviors where academic pressure can intensify such behaviors, and these should be investigated throughout the university segment.

Neurocognitive functioning predicts suicidal behaviour in young people with affective disorders

BackgroundNeurocognitive impairment is recognised as a risk factor for suicidal behaviour in adults. The current study aims to determine whether neurocognitive deficits also predict ongoing or emergent suicidal behaviour in young people with affective disorders. MethodsParticipants were aged 12-30 years and presented to early intervention youth mental health clinics between 2008 and 2018. In addition to clinical assessment a standardised neurocognitive assessment was conducted at baseline. Clinical data was extracted from subsequent visits using a standardised proforma. ResultsOf the 635 participants who met inclusion criteria (mean age 19.6 years, 59% female, average follow up 476 days) 104 (16%) reported suicidal behaviour during care. In 5 of the 10 neurocognitive domains tested (cognitive flexibility, processing speed, working memory, verbal memory and visuospatial memory) those with suicidal behaviour during care were superior to clinical controls. Better general neurocognitive function remained a significant predictor (OR=1.94, 95% CI 1.29- 2.94) of suicidal behaviour in care after controlling for other risk factors. LimitationsThe neurocognitive battery used was designed for use with affective and psychotic disorders and may not have detected some deficits more specific to suicidal behaviour. ConclusionContrary to expectations, better neurocognitive functioning predicts suicidal behaviour during care in young people with affective disorders. While other populations with suicidal behaviour, such as adults with affective disorders or young people with psychotic disorders, tend to experience neurocognitive deficits which may limit their capacity to engage in some interventions, this does not appear to be the case for young people with affective disorders.

Measures of frequency used in cohorts studies to evaluate the suicidal behaviour in young people (12–26 years): A systematic review

IntroductionA priority for the WHO by 2020 is to have reduced the rates of suicide; they indicate difficulties in giving precise estimations due to a wide variety of factors, which include aspects related to the statistical measurements themselves of suicidal behaviour. The proportion of deaths from suicide is 8.5% among young people between 15 and 29 years of age. ObjectiveTo review the methodology used to express the frequency of suicidal behaviour in young people and to describe the methodological characteristics of the studies reviewed. MethodA systematic review of longitudinal studies registered on PROSPERO. The extracted information included the following: year of publication, journal, population size, sample, country, design, age, percentage of men, follow-up time and losses, suicidal behaviour, risk factors, ethical aspects, fundamentally, evaluating the measures of frequency used. ResultsEighty-two articles were selected from 37,793 documents. None of the studies define the measure of frequency used for suicidal behaviour, there are currently up to 9 different ways of measuring it. The populations are students or the general population (66%), birth cohorts (16%) and specific groups. Follow-up was from 24 weeks to 30 years. Only 24.1% of the studies took ethical aspects into consideration. ConclusionsResearchers must make an effort to reach an agreement on the measures of frequency used in suicidal behaviour studies, as the methodological and terminological variability currently used impedes making any comparisons between different studies or understanding the real dimension of the problem.

Internalizing and externalizing symptoms and suicidal behaviour in young people: a systematic review and meta-analysis of longitudinal studies.

To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults. We conducted a systematic review of articles published until January 2017. We identified 26883 potential papers; 1701 full-text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta-analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables. Finally, 41 studies were included, involving participants aged 12-26years for a systematic review, and 24 articles were included for meta-analysis. The meta-analysis showed that youths with any internalizing (ES=0.93) or externalizing symptoms (ES=0.76 and OR=2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR=6.58 and ES=1.00), legal problems (OR=3.36), and anxiety (ES=0.65). Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group.

Correction: A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown.

[This corrects the article DOI: 10.1371/journal.pone.0181722.].

Measures of frequency used in cohorts studies to evaluate the suicidal behaviour in young people (12-26 years): A systematic review.

A priority for the WHO by 2020 is to have reduced the rates of suicide; they indicate difficulties in giving precise estimations due to a wide variety of factors, which include aspects related to the statistical measurements themselves of suicidal behaviour. The proportion of deaths from suicide is 8.5% among young people between 15-29 years of age. To review the methodology used to express the frequency of suicidal behaviour in young people and to describe the methodological characteristics of the studies reviewed. A systematic review of longitudinal studies registered on PROSPERO. The extracted information included the following: year of publication, journal, population size, sample, country, design, age, percentage of men, follow-up time and losses, suicidal behaviour, risk factors, ethical aspects, fundamentally, evaluating the measures of frequency used. Eighty-two articles were selected from 37,793 documents. None of the studies define the measure of frequency used for suicidal behaviour, there are currently up to 9 different ways of measuring it. The populations are students or the general population (66%), birth cohorts (16%) and specific groups. Follow-up was from 24 weeks to 30 years. Only 24.1% of the studies took ethical aspects into consideration. Researchers must make an effort to reach an agreement on the measures of frequency used in suicidal behaviour studies, as the methodological and terminological variability currently used impedes making any comparisons between different studies or understanding the real dimension of the problem.

A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown.

BackgroundResearch exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people.MethodsWe conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis.ResultsForty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified.ConclusionsThere is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach). Young people appear to be increasingly using social media to communicate distress, particularly to peers. The focus should now be on how specific mediums’ (social media, video/image sharing) might be used in therapy and recovery. Clinicians working with young people who self-harm or have mental health issues should engage in discussion about internet use. This should be a standard item during assessment.A protocol for this review was registered with the PROSPERO systematic review protocol registry: (http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42015019518).

Friendship, Depression, and Suicide Attempts in Adults: Exploratory Analysis of a Longitudinal Follow-Up Study.

Social support is thought to protect against the risk of suicidal behavior in young people and late life, but less is known about the role of friendship in adults. We explored the effect of friendship on suicide attempt risk during 1-year follow-up of 132 adults presenting with major depressive episode (MDE). Items from the Social Adjustment Scale-Self-Report were used as an index of frequency and quality of recent friendship contacts. Survival methods tested associations of friendship with risk of suicide attempt, recurrent MDE, and related outcomes during follow-up. Impaired friendship predicted greater risk of suicide attempt in an unadjusted Cox model. This association was stronger for quality (p=.009) than frequency (p=.081) of friendship contacts. In the adjusted model, the effect of friendship on suicide attempts was largely explained by self-reported depression severity. Friendship has a potentially bidirectional relationship with depression, and its effect on suicidal behavior appears to occur through its relationship with depression. Future research should examine the effect of antidepressant treatment on friendship and bedesigned to test mediation models of relationships between friendship, depression, and suicidal behavior.

A Preliminary Test of the Interpersonal Psychological Theory of Suicidal Behavior in Young People With a First Episode of Psychosis.

The interpersonal-psychological theory (IPT) of suicidal behavior suggests that an individual who does not feel they belong and believes they are a burden combined with the capability to attempt suicide is more likely to attempt suicide. The study aimed to investigate this hypothesis in the context of psychosis. Young people with a first episode of psychosis (N = 45) who considered suicide, attempted suicide, and had no history of suicide or attempt were compared on self-report measures of suicidal desire, capability for suicide, and substance use. No significant differences were found between groups in terms of suicidal desire or capability. All participants perceived they were a burden, did not feel they belonged, and had the capability for suicide. Poisoning (n = 22) was the most frequently reported method of a suicide attempt. Of those who had attempted suicide, 50% (n = 7) reported that it had been related to a psychotic episode. Of the participants, 30 reported previous suicidal ideation mainly to completely end or stop the distress they were experiencing. Levels of depression were significantly different between groups; moderate levels of depression were reported in the suicidal ideation and attempt groups. The concepts of IPT appear to resonate with the experience of psychosis, regardless of suicidality. Specific features of psychosis and their influence on suicidality are worth further exploration.

Life adversities and suicidal behavior in young individuals: a systematic review.

Suicidal behavior in young people is a significant public health problem. However, it is not yet clear whether adversities (adverse life events) may be related to suicidality in adolescence and early adulthood. This paper aimed to investigate systematically the association between the type/number of adverse life events and experiences and suicidal behavior in young people. We developed a detailed strategy to search relevant articles in Pubmed, Scopus, PsycInfo, and Science Direct (January 1980-January 2015) about adverse life events and suicidal behavior. Adverse life events and experiences included maltreatment and violence, loss events, intra-familial problems, school and interpersonal problems. Studies were restricted to suicidal behavior in young people aged 10-25 years. The search yielded 245 articles, of which 28 met our inclusion criteria. Most studies reported a strong association between adversities and suicidality (both suicidal ideation and attempts). Based on the main results, the number of adversities or negative life events experienced seemed to have a positive dose-response relationship with youth suicidal behavior. However, the type of event experienced also appeared to matter: one of the most consistent findings was the association between suicidal behavior and experience of sexual abuse. More prospective studies are needed to elucidate the relative importance of risk accumulation and risk specificity for youth suicide.

Prevalence and risk factors for suicidal behavior in young people presenting with first-episode psychosis in Hong Kong: a 3-year follow-up study.

Individuals with first-episode psychosis (FEP) have markedly elevated risk for suicide. Previous research investigating risk factors of suicidal behavior in FEP mainly focused on western populations. This study aimed to examine the prevalence, and pretreatment and early illness predictors of suicidal behavior in Chinese FEP patients. Seven hundred participants aged 15-25 years consecutively enrolled in a territory-wide treatment program for FEP in Hong Kong from July 2001 to August 2003 were studied. Baseline and 3-year follow-up variables were collected via systematic medical file review. Suicidal behavior evaluated in this study comprised suicide attempt and completed suicide. Seventy-four (10.6%) participants attempted suicide before treatment. Ten percent (n = 70) exhibited suicidal behavior and 1% (n = 7) committed suicide during 3-year follow-up. The majority of post-treatment suicidal behaviors (51.4%) occurred in the first year of follow-up. Jumping from a height was the most common method of committing suicide. Multivariate regression analysis indicated that previous suicide attempt, history of substance abuse and poorer baseline functioning were significantly associated with an increased risk for suicidal behavior after treatment initiation. In a large representative cohort of Chinese young FEP patients, the rates of suicidal behavior before and after treatment and risk factors for post-treatment suicidal behavior were comparable to the findings of previous research on early psychosis conducted in western populations. Close monitoring of high-risk patients with history of attempted suicide or substance abuse, and enhancement of psychosocial functioning may help reduce suicide risk in the early stage of psychotic illness.

Research round-up

Research round-up

Constructing the Suicide Risk Index (SRI): Does It Work in Predicting Suicidal Behavior in Young Adults Mediated by Proximal Factors?

Suicide is a key concern among young adults. The aim of the study was to (1) construct a suicide risk index (SRI) based on demographic, situational, and behavioral factors known to be linked to suicidal behavior and (2) investigate whether the association between the SRI and suicidal behavior was mediated by proximal processes (personal factors, coping strategies, and emotional states). Participants consisted of 7,558 individuals aged 17–25 years (M = 20.35, SD = 1.91). Nearly 22% (n = 1,542) reported self-harm and 7% (n = 499) had attempted suicide. Mediation analysis revealed both a direct effect (ß = .299, 95% CI = [.281, .317], p < .001), and a mediated effect (ß = .204, 95% CI = [.186, .222], p < .001), between the risk index and suicidal behavior. The strongest mediators were levels of self-esteem, depression, and avoidant coping. Interventions to increase self-esteem, reduce depression, and encourage adaptive coping strategies may prevent suicidal behavior in young people.

Harmful or helpful? The role of the internet in self-harming and suicidal behaviour in young people

Purpose– The internet plays an important role in the lives of self-harming and suicidal young people yet little is known about how internet use influences this behaviour. The purpose of this paper is to examine the evidence base with a view to determining directions for future research and practice.Design/methodology/approach– Literature relating to self-harming and suicidal behaviour, young people, and the internet is reviewed with a focus on content and methodology.Findings– The internet provides access to: “how-to” descriptions of suicide; unregulated/illegal online pharmacies; forums to spread this information; access to others seeking to end their own lives. Such sites are believed to elevate risk amongst vulnerable individuals. Conversely, the internet provides access to intervention and prevention activity, online support groups, advice, and personal chat. These can be a key resource in helping young people. There is a lack of consensus on what constitutes harmful and helpful online exchange, often evidenced in disparity between the perceptions of professionals and users.Research limitations/implications– Research is needed to map out a more accurate picture of suicide and self-harm resources on the internet and to establish a consensus about what constitutes harmful and helpful exchange. This needs to be based on: a comprehensive and informed range of search terms; a clear distinction between types of resource; a clear and consistent rationale for distinguishing and categorizing sites; a systematic replicable methodology for plotting the scope, content, accessibility, and popularity of web resources at a given point in time; the views of young people who use these sites, as well as practitioners and professionals.Practical implications– Practitioners need to: regularly assess the quantity, quality, and nature of self-harm/suicide focused internet use amongst service users; be aware of which sites are most appropriate for particular individuals; promote sites directed at young people that enhance effective coping. Professional mental health organizations need to find ways of ensuring that: they are consistently well represented amongst search results online; sites are readily accessible; more practitioners are trained in text-based communications.Originality/value– This paper offers a framework and rationale for future research and for those involved in service provision, policy, and practice.

Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning

Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour. The investigation was a clinical case-clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services. Psychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59-49.83], anxiety disorder (OR 15.4, 95% CI 1.85-127.94) or behavioural disorder (OR 3.13, 95% CI 1.11-8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences. Psychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.