Psychotic Experiences Associated With Subsequent Suicidal Thoughts

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The inclusion of psychotic experience items in routine screening tools could improve the prediction of suicide risk.
The inclusion of psychotic experience items in routine screening tools could improve the prediction of suicide risk.

Psychotic experiences were shown to be associated with subsequent suicidal thoughts and behaviors, particularly in children younger than 12, according to a recent study published in JAMA Psychiatry.

Researchers assessed 33,370 adults who responded to World Health Organization (WHO) World Mental Health Surveys, in which participants were assessed for psychotic experiences, suicidality (ideation, plans, and attempts), and 21 DSM-IV mental disorders. Associations between psychotic experiences and subsequent suicidal thoughts or behaviors were evaluated.  Age at first occurrence of suicidal thoughts and behaviors was obtained retrospectively.

In participants who had psychotic experiences (n=2488, 7.45%), 28.5% had at least 1 incidence of suicidal ideation, 10.8% had suicide plans, and 10.2% attempted suicide.

After adjusting for antecedent or intervening mental disorders, participants with at least 1 psychotic experience were significantly more likely to experience suicidal ideation (odds ratio [OR] 2.2), make a suicide plan (OR 2.1), or attempt suicide (OR 1.9). Moreover, an increased number of psychotic experiences was associated with increased subsequent suicidal thoughts and behaviors.

The researchers noted that psychotic experiences were associated with subsequent suicidal thoughts and behaviors at all life stages, with the strongest correlation found in individuals younger than 12. The overall population-attributable risk percentages for suicidal thoughts and behavior associated with prior psychotic experiences ranged from 4.8% to 5.3% after adjustment for antecedent mental disorders.

The study investigators concluded that "[psychotic experiences] were independently associated with subsequent [suicidal thoughts and behaviors] regardless of antecedent mental disorders… From a public health perspective, we speculate that the inclusion of [psychotic experience] items in routine screening tools could improve the prediction of suicide risk."

Reference

Bromet EJ, Nock MK, Saha S, et al. Association between psychotic experiences and subsequent suicidal thoughts and behaviors: a cross-national analysis from the World Health Organization World Mental Health Surveys [published online August 30, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.2647

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