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Study Linking Suicidal Behavior, Psychotic Experiences May Yield Strategies to Help Prevent Suicide Attempts

A study that could help to bolster suicide prevention efforts has examined the prevalence of suicidal ideation and suicide attempts among adults who reported psychotic experiences. These respondents, drawn from a large national sample, were found to be more likely to report concurrent ideation and attempts than were adults without psychotic experiences.

The study, "Suicidal Ideation and Suicide Attempts Among Adults with Psychotic Experiences, was published Feb. 25 in the journal JAMA Psychiatry. Such experiences were especially prevalent among individuals reporting severe attempts and may account for nearly one-third of attempts with intent to die in the United States annually, states lead author Jordan DeVylder, PhD, Assistant Professor at the University of Maryland School of Social Work.

Suicide is a leading cause of preventable death, especially among individuals with psychotic disorders, and may also be common among nonclinical populations of adults whose psychotic experiences cause less impairment. Psychotic experiences resemble the hallucinations and delusions of psychotic disorders such as schizophrenia but are of lower persistence and intensity.

"People with suicidal thoughts will often report this to their health care providers. A current difficulty in suicide prevention is identifying who, among this group with suicidal ideation, will go on to make an attempt. This study suggests that assessing for psychotic experiences may provide valuable information in predicting attempts," DeVylder says.

DeVylder and colleagues concluded that such assessment among individuals with suicidal ideation has potential clinical and public health utility in reducing the prevalence of attempts, particularly attempts with intent to die.

"Suicide is a complication of multiple mental disorders including mood and psychotic disorders. This study supports the clinical concern that patients with psychotic experiences are at increased risk for suicidal behavior and provides additional data on risk factors for clinicians to monitor," adds co-author Jeffrey A. Lieberman, MD, Lawrence C. Kolb Professor and Chairman of Psychiatry, Columbia University College of Physicians and Surgeons.

Other co-authors are Ellen P. Lukens, PhD, MSW, Firestone Centennial Professor of Professional Practice at Columbia University School of Social Work; and Bruce Link, PhD, Professor of Epidemiology and Professor of Sociomedical Sciences (in Psychiatry) at Columbia University Mailman School of Public Health.

"Psychotic experiences were more strongly associated with suicide attempts than were common mental health conditions in our study. However, suicide attempts were especially common among respondents who reported psychotic experiences and had a diagnosable disorder," says DeVylder. "Suicide attempts were approximately 25 times more likely to occur among this group relative to those who did not report psychotic experiences or a disorder, compared to five times more likely among those with a disorder alone, without psychotic experiences."

DeVylder and colleagues found that depressive, anxiety, and substance abuse disorders did not readily identify those at risk for attempts among respondents with suicidal ideation.

The study examined the association between 12-month suicidality and 12-month psychotic experiences, using cross-sectional survey data drawn from a large, general population-based sample of U.S. households identified through the Collaborative Psychiatric Epidemiology Surveys (2001-2003). The study of 11,716 adults, who were 18 years or older, used an oversampling design of racial/ethnic minority groups intended to make the findings applicable to a broad demographic.

--Source: University of Maryland, Baltimore