Psychotic "experiences" may up risk for suicide

NEW YORK - People who have psychotic experiences (sub-threshold psychosis) are at risk for suicidal thoughts and behaviors, a new study hints.

"This study suggests that it may be possible to screen for psychotic experiences among people who report suicidal thoughts in clinical settings, and use this information to predict who is more likely to act on those thoughts by making a suicide attempt," Dr. Jordan E. DeVylder, of the University of Maryland School of Social Work in Baltimore, told Reuters Health.

"Currently," he explained in email, "there is no routine assessment of psychotic experiences among people with suicidal ideation. People with psychotic disorders are often assessed for suicide risk, but this study suggests that even lower severity psychotic experiences (among people without disorders like schizophrenia) may be relevant for suicide prevention."

Using the Collaborative Psychiatric Epidemiology Surveys (CPES), the researchers examined the association between psychotic experiences over one year and concurrent suicidal ideation and suicide attempts in about 11,700 adults living in the United States.

The average prevalence of psychotic experiences over 12 months was 2.6%. Nearly two-thirds of people with psychotic experiences met criteria for a depressive, anxiety, or substance use disorder.

Psychotic experiences were associated with more than three-fold greater odds of suicide attempts during the concurrent 12-month period and a more than two-fold greater odds of suicidal ideation, even after controlling for potential demographic and clinical covariates, including co-occurring psychiatric disorders, according to the February 25 online report in JAMA Psychiatry.

In contrast, depressive, anxiety and substance use disorders did not reliably identify individuals at risk for suicide attempts among those with suicidal thoughts.

"More research will be needed to determine how these population-level findings translate to clinical practice," Dr. DeVylder told Reuters Health.

"Having established a cross-sectional association between suicidal behavior and sub-threshold psychosis, the next step would be to examine the clinical utility of screening for sub-threshold psychosis among help-seeking adults who report suicidal ideation to determine whether such screens would be practical tools for identifying individuals at high risk for subsequent suicide attempts," he and his colleagues write in their paper.

They add, "If the relationship is causal, then interventions can address psychotic experiences directly, thereby reducing distress associated with these symptoms and risk of suicidal behavior. If the relationship is not causal, then psychotic experiences are nonetheless useful indicators of severe suicidal behavior that can be screened clinically. Either approach, properly implemented, has great potential public health benefits in reducing risk of death or disability associated with severe suicide attempts and other suicidal behavior."

The authors have no relevant disclosures.


JAMA Psychiatry 2015.

References: Reuters Health
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