Psychotic Experiences May Predict Future Suicidal Behaviors

Razor blade
Razor blade
Psychotic experiences may be a clinical marker of risk for future suicidal behaviors.

Individuals with psychotic experiences are at increased risk for suicidal ideation, suicide attempts, and suicide death, according to a study published in JAMA Psychiatry.1

Past studies in individuals with psychotic experiences (PEs) focused on increased risk for psychotic disorder,2 but investigators stated that “a striking finding in recent research on PEs has been the strong association with suicidal behavior.”

Investigators conducted a systematic review and meta-analysis of 10 longitudinal studies reporting PEs and subsequent suicidal ideation, suicide attempts, and suicide deaths in the general population. Data were analyzed from 84,285 individuals from 12 different samples and 23 countries, with follow-up periods ranging from 1 month to 27 years.

Analyses showed that psychotic experiences are important clinical markers of risk for future suicidal behavior. In the studies, PEs were associated with 2-fold increased odds of subsequent suicidal ideation (n=56,191; odds ratio [OR], 2.39; 95% CI, 1.62-3.51). In addition, individuals with PEs had more than 3-fold increased odds of suicide attempt (n=66,967; OR, 3.15; 95% CI, 2.23-4.45) and 4-fold increased odds of suicide death (n=15,049; OR, 4.39; 95% CI, 1.63-11.78). The increase in risk was in excess of that explained by co-occurring psychopathology for suicidal ideation and suicide attempt.

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The investigators concluded, “Our findings suggest that there is a psychosis-associated subtype of suicidal behavior that extends well beyond the previously established association between psychotic disorder and suicidal behavior.”


  1. Yates K, Lång U, Cederlöf M, et al. Association of psychotic experiences with subsequent risk of suicidal ideation, suicide attempts, and suicide deaths: a systematic review and meta-analysis of longitudinal population studies [published online November 28, 2018]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.3514
  2. Poulton R, Caspi A, Moffitt TE, Cannon M, Murray R, Harrington H. Children’s self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. JAMA Psychiatry. 2000;57(11):1053-1058.