Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-27T22:57:37.313Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychosis as a risk factor for suicidal thoughts and behaviors: a meta-analysis of longitudinal studies

Published online by Cambridge University Press:  14 August 2017

X. Huang ,
K. R. Fox ,
J. D. Ribeiro  and
J. C. Franklin
X. Huang*
Affiliation:
Department of Psychology, Florida State University, Tallahassee, FL, USA
K. R. Fox
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA,USA
J. D. Ribeiro
Affiliation:
Department of Psychology, Florida State University, Tallahassee, FL, USA
J. C. Franklin
Affiliation:
Department of Psychology, Florida State University, Tallahassee, FL, USA
*
*Address for correspondence: X. Huang, Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, USA. (Email: huang@psy.fsu.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Research has long noted higher prevalence rates of suicidal thoughts and behaviors among individuals with psychotic symptoms. Major theories have proposed several explanations to account for this association. Given the differences in the literature regarding the operationalization of psychosis and sample characteristics, a quantitative review is needed to determine to what extent and how psychosis confers risk for suicidality.

Methods

We searched PsycInfo, PubMed, and GoogleScholar for studies published before 1 January 2016. To be included in the analysis, studies must have used at least one psychosis-related factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2541 studies. Fifty studies were retained for analysis, yielding 128 statistical tests.

Results

Suicide death was the most commonly studied outcome (43.0%), followed by attempt (39.1%) and ideation (18.0%). The median follow-up length was 7.5 years. Overall, psychosis significantly conferred risk across three outcomes, with weighted mean ORs of 1.70 (1.39–2.08) for ideation, 1.36 (1.25–1.48) for attempt, and 1.40 (1.14–1.72) for death. Detailed analyses indicated that positive symptoms consistently conferred risk across outcomes; negative symptoms were not significantly associated with ideation, and were protective against death. Some small moderator effects were detected for sample characteristics.

Conclusions

Psychosis is a significant risk factor for suicide ideation, attempt, and death. The finding that positive symptoms increased suicide risk and negative symptoms seemed to decrease risk sheds light on the potential mechanisms for the association between psychosis and suicidality. We note several limitations of the literature and offer suggestions for future directions.

Keywords

Predictionpsychosisrisk factorsuicide attemptsuicide deathsuicide ideation
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 5 , April 2018 , pp. 765 - 776
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramson, LY, Alloy, LB, Hogan, ME, Whitehouse, WG, Gibb, BE, Hankin, BL, Cornette, MM (2000). The hopelessness theory of suicidality. In Suicide Science: Expanding the Boundaries (ed. Joiner, T. E. and Rudd, M. D.), pp. 17–32. Kluwer Academic/Plenum Publishers: New York, NY.Google Scholar
Abramson, LY, Metalsky, GI, Alloy, LB (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review 96, 358–372.CrossRefGoogle Scholar
Aleman, A, Hijman, R, De Haan, F, Kahn, RS (1999). Memory impairment in schizophrenia: a meta-analysis. American Journal of Psychiatry 156, 1358–1366.Google Scholar
Awad, AG, Voruganti, LNP (2008). The burden of schizophrenia on caregivers: a review. PharmacoEconomics 26, 149–162.Google Scholar
Beck, AT (1986). Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences 487, 90–96.CrossRefGoogle ScholarPubMed
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, Le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2007). Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial. British Journal of Psychiatry 191, s140–s146.CrossRefGoogle Scholar
Black, DW, Winokur, G, Nasrallah, A (1988). Effect of psychosis on suicide risk in 1,593 patients with unipolar and bipolar affective disorders. American Journal of Psychiatry 145, 849–852.Google Scholar
Blanchard, JJ, Cohen, AS (2006). The structure of negative symptoms within schizophrenia: implications for assessment. Schizophrenia Bulletin 32, 238–245.Google Scholar
Buckley, PF, Miller, BJ, Lehrer, DS, Castle, DJ (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin 35, 383–402.CrossRefGoogle ScholarPubMed
Chang, WC, Chen, ESM, Hui, CLM, Chan, SKW, Lee, EHM, Chen, EYH (2014). The relationships of suicidal ideation with symptoms, neurocognitive function, and psychological factors in patients with first-episode psychosis. Schizophrenia Research 157, 12–18.Google Scholar
Crocq, MA, Naber, D, Lader, MH, Thibaut, F, Drici, M, Everitt, B, Hall, GC, Le Jeunne, C, Mittoux, A, Peuskens, J, Priori, S, Sturkenboom, M, Thomas, SHL, Tanghøj, P, Toumi, M, Mann, R, Moore, ND (2010). Suicide attempts in a prospective cohort of patients with schizophrenia treated with sertindole or risperidone. Elsevier B.V. European Neuropsychopharmacology 20, 829–838.CrossRefGoogle ScholarPubMed
DeVylder, JE, Lukens, EP, Link, BG, Lieberman, JA (2015). Suicidal ideation and suicide attempts among adults with psychotic experiences. JAMA Psychiatry 72, 219.CrossRefGoogle ScholarPubMed
Eisenberg, P, Lazarsfeld, PF (1938). The psychological effects of unemployment. Psychological Bulletin 35, 358–390.Google Scholar
Fenton, WS, McGlashan, TH, Victor, BJ, Blyler, CR (1997). Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. American Journal of Psychiatry 154, 199–204.Google Scholar
Fialko, L, Freeman, D, Bebbington, PE, Kuipers, E, Garety, PA, Dunn, G, Fowler, D (2006). Understanding suicidal ideation in psychosis: findings from the prevention of relapse in psychosis (PRP) trial. Acta Psychiatrica Scandinavica 114, 177–186.Google Scholar
Flensborg-Madsen, T, Knop, J, Mortensen, EL, Becker, U, Sher, L, Grønbæk, M (2009). Alcohol use disorders increase the risk of completed suicide – irrespective of other psychiatric disorders. A longitudinal cohort study. Elsevier Ireland Ltd Psychiatry Research 167, 123–130.Google Scholar
Folsom, D, Jeste, DV (2002). Schizophrenia in homeless persons: a systematic review of the literature 285. Acta Psychiatrica Scandinavica 105, 404–413.Google Scholar
Green, MF, Kern, RS, Heaton, RK (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research 72, 41–51.CrossRefGoogle ScholarPubMed
Grunebaum, MF, Oquendo, MA, Harkavy-Friedman, JM, Ellis, SP, Li, S, Haas, GL, Malone, KM, Mann, JJ (2001). Delusions and suicidality. American Journal of Psychiatry 158, 742–747.Google Scholar
Harkavy-Friedman, JM, Kimhy, D, Nelson, EA, Venarde, DF, Malaspina, D, Mann, JJ (2003). Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. Journal of Clinical Psychiatry 64, 871–874.Google Scholar
Havaki-Kontaxaki, BJ, Kontaxakis, VP, Protopappa, VA, Christodoulou, GN (1994). Suicides in a large psychiatric hospital: risk factors for schizophrenic patients. Bibliotheca Psychiatrica 165, 63–71.Google Scholar
Hawton, K, Sutton, L, Haw, C, Sinclair, J, Deeks, JJ (2005). Schizophrenia and suicide: systematic review. British Journal of Psychiatry 187, 9–20.Google Scholar
Hor, K, Taylor, M (2010). Suicide and schizophrenia: a systematic review of rates and risk factors. Journal of Psychopharmacology 24, 81–90.CrossRefGoogle ScholarPubMed
Jahn, DR, Bennett, ME, Park, SG, Gur, RE, Horan, WP, Kring, AM, Blanchard, JJ (2016). The interactive effects of negative symptoms and social role functioning on suicide ideation in individuals with schizophrenia. Schizophrenia Research 170, 271–277.CrossRefGoogle ScholarPubMed
Joiner, TE (2005). Why People Die by Suicide. Harvard University Press: Cambridge, MA.Google Scholar
Joiner, TE (2010). Myths about Suicide. Harvard University Press: Cambridge, MA.Google Scholar
Kasper, E, Rogers, R, Adams, PA (1996). Dangerousness and command hallucinations: an investigation of psychotic inpatients. Bulletin of the American Academy of Psychiatry and the Law 24, 219–224.Google Scholar
Keilp, JG, Gorlyn, M, Russell, M, Oquendo, MA, Burke, AK, Harkavy-Friedman, J, Mann, JJ (2013). Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt. Psychological Medicine 43, 539–551.Google Scholar
Kelleher, I, Connor, D, Clarke, MC, Devlin, N, Harley, M, Cannon, M (2012). Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine 42, 1857–1863.Google Scholar
Kessler, RC, Berglund, P, Nock, M, Wang, PS, Page, P (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. Journal of the American Medical Association 293, 1990–1992.Google Scholar
Kessler, RC, Warner, CH, Ivany, C, Petukhova, MV, Rose, S, Bromet, EJ, Brown, M, Cai, T, Colpe, LJ, Cox, KL, Fullerton, CS, Gilman, SE, Gruber, MJ, Heeringa, SG, Lewandowski-Romps, L, Li, J, Millikan-Bell, AM, Naifeh, JA, Nock, MK, Rosellini, AJ, Sampson, NA, Schoenbaum, M, Stein, MB, Wessely, S, Zaslavsky, AM, Ursano, RJ (2015). Predicting suicides after psychiatric hospitalization in US army soldiers: the army study to assess risk and resilience in servicemembers (Army STARRS). JAMA Psychiatry 72, 49–57.Google Scholar
Kim, CH, Jayathilake, K, Meltzer, HY (2003). Hopelessness, neurocognitive function, and insight in schizophrenia: relationship to suicidal behavior. Schizophrenia Research 60, 71–80.CrossRefGoogle ScholarPubMed
Kochanek, KD, Murphy, SL, Xu, J, Tejada-Vera, B (2016). Deaths: Final data for 2014. National Vital Statistics Reports 65, 1–122.Google Scholar
Koeda, A, Otsuka, K, Nakamura, H, Yambe, T, Fukumoto, K, Onuma, Y, Saga, Y, Yoshioka, Y, Mita, T, Mizugai, A, Sakai, A, Endo, S (2012). Characteristics of suicide attempts in patients diagnosed with schizophrenia in comparison with depression: a study of emergency room visit cases in Japan. Schizophrenia Research 142, 31–39.CrossRefGoogle ScholarPubMed
Kontaxakis, V, Havaki-Kontaxaki, B, Margariti, M, Stamouli, S, Kollias, C, Christodoulou, G (2004). Suicide ideation in inpatients with acute schiozphrenia. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie 49, 476–479.Google Scholar
Kraemer, HC, Kazdin, AE, Offord, DR, Kessler, RC, Jensen, PS, Kupfer, DJ (1997). Coming to terms with the terms of risk. Archives of General Psychiatry 54, 337–343.Google Scholar
Kuperberg, G, Heckers, S (2000). Schizophrenia and cognitive function. Current Opinion in Neurobiology 10, 205–210.Google Scholar
Large, M, Babidge, N, Andrews, D, Storey, P, Nielssen, O (2009). Major self-mutilation in the first episode of psychosis. Schizophrenia Bulletin 35, 1012–1021.Google Scholar
Leadholm, AKK, Rothschild, AJ, Nielsen, J, Bech, P, Ostergaard, SD (2014). Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression. Elsevier Journal of Affective Disorders 156, 119–125.Google Scholar
Lee, S, Lee, MTY, Chiu, MYL, Kleinman, A (2005). Experience of social stigma by people with schizophrenia in Hong Kong. British Journal of Psychiatry 186, 153–157.Google Scholar
Lewine, RRJ (2005). Social class of origin, lost potential, and hopelessness in schizophrenia. Schizophrenia Research 76, 329–335.Google Scholar
Liddle, PF (2000). Cognitive impairment in schizophrenia: its impact on social functioning. Acta Psychiatrica Scandinavica 101, 11–16.Google Scholar
Lykouras, E, Gournellis, R, Fortos, A, Oulis, P, Christodoulou, GN (2000). Psychotic major depression in the elderly and suicide behavior. Psychiatriki 11, 177–183.Google Scholar
Marwaha, S, Johnson, S (2004). Schizophrenia and employment: a review. Social Psychiatry and Psychiatric Epidemiology 39, 337–349.Google Scholar
Nock, MK (2010). Self-injury. Annual Review of Clinical Psychology 6, 339–363.CrossRefGoogle ScholarPubMed
Nordentoft, M, Jeppesen, P, Abel, M, Kassow, P, Petersen, L, Thorup, A, Krarup, G, Hemmingsen, R, Jorgensen, P (2002). OPUS study: suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis: one-year follow-up of a randomised controlled trial. Special Issue: The European First-Episode Schizophrenia Network 181, s98–s106.Google Scholar
Paerregaard, G (1975). Suicide among attempted suicides. Suicide and Life-Threatening Behavior 5, 140–144.Google Scholar
Palmer, BA, Pankratz, VS, Bostwick, JM (2005). The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry 62, 247–253.Google Scholar
Papastavrou, E, Charalambous, A, Tsangari, H, Karayiannis, G (2012). The burdensome and depressive experience of caring. Cancer Nursing 35, 187–194.Google Scholar
Paul, KI, Moser, K (2009). Unemployment impairs mental health: meta-analyses. Elsevier Inc. Journal of Vocational Behavior 74, 264–282.Google Scholar
Pillmann, F, Balzuweit, S, Haring, A, Blöink, R, Marneros, A (2003). Suicidal behavior in acute and transient psychotic disorders. Psychiatry Research 117, 199–209.Google Scholar
Radomsky, ED, Haas, GL, Keshavan, MS, Sweeney, JA (1995). Suicidal behavior in schizophrenia and other psychotic disorders. American Journal of Psychiatry 156, 1590–1595.Google Scholar
Reichenberg, A, Harvey, PD, Bowie, CR, Mojtabai, R, Rabinowitz, J, Heaton, RK, Bromet, E (2009). Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. Schizophrenia Bulletin 35, 1022–1029.CrossRefGoogle ScholarPubMed
Ribeiro, JD, Franklin, JC, Fox, KR, Bentley, KH, Kleiman, EM, Chang, BP, Nock, MK (2016). Letter to the editor: suicide as a complex classification problem: machine learning and related techniques can advance suicide prediction – a reply to Roaldset (2016). Psychological Medicine 46, 1–2.Google Scholar
Robinson, J, Harris, MG, Harrigan, SM, Henry, LP, Farrelly, S, Prosser, A, Schwartz, O, Jackson, H, McGorry, PD (2010). Suicide attempt in first-episode psychosis: a 7.4 year follow-up study. Elsevier B.V. Schizophrenia Research 116, 1–8.Google Scholar
Shawyer, F, Mackinnon, A, Farhall, J, Sims, E, Blaney, S, Yardley, P, Daly, M, Mullen, P, Copolov, D (2008). Acting on harmful command hallucinations in psychotic disorders: an integrative approach. Journal of Nervous and Mental Disease 196, 390–398.Google Scholar
Steblaj, A, Tavcar, R, Dernovsek, MZ (2007). Predictors of suicide in psychiatric hospital. Acta Psychiatrica Scandinavica 100, 383–388.Google Scholar
Van Orden, KA, Witte, TK, Cukrowicz, KC, Braithwaite, SR, Selby, EA, Joiner, TE (2010). The interpersonal theory of suicide. Psychological Review 117, 575–600.Google Scholar
Walsh, CG, Ribeiro, JD, Franklin, JC (2017). Predicting risk of suicide attempts over time through machine learning. Clinical Psychological Science 5, 457–469.Google Scholar
Wong, Z, Öngür, D, Cohen, B, Ravichandran, C, Noam, G, Murphy, B (2013). Command hallucinations and clinical characteristics of suicidality in patients with psychotic spectrum disorders. Comprehensive Psychiatry 54, 611–617.Google Scholar
Supplementary material: File

Huang supplementary material

Huang supplementary material 1

Download Huang supplementary material(File)
File 30.5 KB
Supplementary material: File

Huang supplementary material

Huang supplementary material 2

Download Huang supplementary material(File)
File 19.6 KB
Supplementary material: File

Huang supplementary material

Huang supplementary material 3

Download Huang supplementary material(File)
File 26.1 KB