Psychotic Experiences Increase Risk of Suicidal Thoughts, Behaviors

Regardless of age, psychotic experiences can increase the likelihood that a person will think about, plan, and/or attempt suicide, according to a study published today in JAMA Psychiatry. The report also suggests that the association between psychotic episodes and suicidal thoughts and behaviors was most prominent in children aged 12 years and younger and remained statistically significant after adjusting for antecedent mental disorders and demographic factors.

“This is an important finding from a clinical point of view because it suggests that PEs [psychotic experiences] may be a predictor of subsequent STBs [suicidal thoughts and behaviors] even in individuals who do not meet criteria for mental disorders,” wrote Evelyn J. Bromet, Ph.D., of the Department of Psychiatry at Stony Brook University School of Medicine and colleagues. 

The findings were based on data derived from World Health Organization World Mental Health Surveys. Survey participants were specifically asked about hallucinatory and delusional experiences, their age when the experiences began, and the number of psychotic episodes per year. Survey participants were also asked about lifetime occurrence of suicidal ideation, suicide plans, and suicide attempts, and their age when these thoughts and/or actions first occurred. The researchers controlled for demographic factors, including the respondent’s age at time of interview, sex, and country.

Of the 33,370 adults from 19 countries surveyed, 2,488 reported psychotic experiences. Respondents with one or more psychotic episodes had twofold increased odds of subsequent suicidal thoughts and behaviors after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio [OR], 2.2; suicide plans: OR, 2.1; and suicide attempts: OR, 1.9). There was also a threefold to fourfold increased odds of various suicidal thoughts and behaviors in those with more frequent annualized psychotic episodes (more than 0.3 episodes per year) compared with those with less frequent annualized psychotic episodes (0.3 episodes or less per year), with ORs ranging from 3.0 for attempts to 3.8 for plans.

“From a public health perspective, we speculate that the inclusion of PE items in routine screening tools could improve the prediction of suicide risk. Our study lends additional weight to the call for the routine inclusion of PE items when assessing STBs in both research and clinical settings,” the authors concluded.

For related information, see the Psychiatric News article “Hallucinations Can Be Marker for Variety of Psychiatric Disorders in Youth.”

(Image: iStock/Gawrav Sinha)