Frequency of Suicidal Ideation Predicts Suicide Attempts But Not Deaths

Persistent suicidal ideation was identified in up to 40% of participants with first-episode psychosis.

Patients with a schizoaffective disorder who experienced frequent thoughts of suicide had approximately 3- to 6-times greater odds of attempting suicide over 5 years, according to new research published in the Lancet Psychiatry. The frequency of suicidal ideation did not appear to predict odds of death by suicide, however.

Trine Madsen, PhD, of Copenhagen University Hospital in Denmark, and her associates analyzed 10 years of follow-up data on 521 young Danish patients with first-episode psychosis involved in a separate randomized controlled trial. The patients, ages 18 to 45, were diagnosed along the schizophrenia spectrum and joined the study between January 1998 and December 2000.

Just over a quarter of the patients had an alcohol misuse disorder, and the same proportion were diagnosed with depression. Nearly 1 in 5 of the participants had attempted suicide in the past year and 15% reported feeling hopelessness. Follow-up assessments of the patients at 1, 2, 5, and 10 years included reports on suicidal ideation. The researchers aimed to characterize the different trajectories that patients followed in terms of suicidal ideation.

The 61% of patients following the most common trajectory reported suicidal thoughts once or a few times within the past year, and this frequency decreased over time. One-third of the participants experienced suicidal ideation sometimes or frequently in a pattern that continued over the full decade. The final 6% of participants comprised the “frequent-increasing” trajectory group, whose frequent thoughts of suicide worsened over time.

This latter group had 6.6-times greater odds of attempting suicide after 5 years of followup, compared to the majority with less frequent suicidal ideation. The odds of a suicide attempt were 2.8 times greater for those with stable, frequent thoughts of suicide compared to the “low-decreasing” group. Yet actual suicide rates did not differ at 5 or 10 years among any of the 3 groups. Eight patients died by suicide during the decade of followup.

Those experiencing frequent thoughts of suicide, whether it remained stable or increased, had 4.5- to 4.7-times greater odds of persistent suicidal ideation than those with a low and decreasing trajectory at 5 years after the start of the study. These odds dropped only slightly, to 3.2 times greater among the frequent-increasing patients and 4.2 times greater among the frequent-stable patients, at 10 years followup compared to those with infrequent suicidal thoughts.


Madsen T, Karstoft K-I, Secher RG, Austin SF, Nordentoft M. Trajectories of suicidal ideation in patients with first-episode psychosis: secondary analysis of data from the OPUS trial. Lancet Psychiatry. 2016; Mar 2. [Epub ahead of print]