Clinical insight and cognitive functioning as mediators in the relationships between symptoms of psychosis, depression, and suicide ideation in first-episode psychosis

Trajectories of suicidal behavior and their clinical correlates in the early phases of schizophrenia spectrum disorders

BACKGROUND

Many risk factors for suicidal behavior (SB) in schizophrenia spectrum disorders (SSD) are present before the onset of psychosis or are associated with specific phases of illness. We aim to investigate the trajectories of SB from before the onset of psychosis until the first start of treatment in patients with first-episode psychosis (FEP).

METHOD

A total of 252 patients with first-episode SSD were recruited, out of which 224 had complete SB data. They participated in clinical interviews and self-report questionnaires during their first treatment. We assessed SB in three time periods: Before the onset of psychosis, during untreated psychosis, and at treatment start (study baseline). We used K-mean cluster analyses to identify trajectories of SB over these periods.

RESULTS

Four trajectories of SB were identified: persistent low/no SB (n = 114, 51 % of 224), increasing mild/moderate SB (n = 54, 24 %), severe SB during untreated psychosis (n = 25, 11 %), severe persistent SB (n = 31, 14 %). With "persistent low/no SB" as a reference group, all other groups had significantly more depressive symptoms at baseline. The duration of untreated psychosis was significantly longer in the group with "severe SB during untreated psychosis". Clinical insight subscale scores differed between the trajectory groups. Also, the "severe persistent SB" group reported more emotional abuse and total childhood trauma than the "increasing mild/moderate SB" group.

CONCLUSION

Our findings suggest the presence of different pathways to SB in FEP. More knowledge about these pathways can support the development of tailored preventive strategies in this patient group.

A Latent Profile Analysis of Psychosis Symptoms to Examine Distress and Depression as Pathways to Suicide Ideation Among Individuals in an Early Phase of Psychosis Illness

BACKGROUND

Suicide rates are high among individuals in first episode psychosis and there is a critical need to better understand drivers of suicide risk to inform treatment efforts. This study identified profiles of psychosis symptoms and examined a mediation model of depression and distress as mechanisms in the relationships between psychosis symptoms and suicide ideation by latent profiles.

METHODS

Data were obtained from the Human Connectome Project for Early Psychosis (n = 166) of individuals between 16 and 35 years of age who had onset of affective or non-affective psychosis within 5 years of consent. Data were analysed using Latent Profile Analysis (LPA) and Structural Equation Modelling in MPlus.

RESULTS

LPA revealed the following groups: (1) relatively lower and more balanced levels of symptoms, (2) highest positive and general symptoms and (3) highest negative symptoms. Findings indicated the relationships in the model differed between by LPA groups. Distress and depression functioned as mediators between psychosis symptoms and suicide ideation for Groups 1 and 2.

CONCLUSIONS

A better understanding of the roles that distress and depression play in the relationships between psychosis symptoms and suicide ideation can help inform modifiable targets of early intervention and subsequently decrease risk for suicide.

Exploring the Relationship Between Suicidality and Persistent Negative Symptoms Following a First Episode of Psychosis

BACKGROUND AND HYPOTHESIS

Suicide is a leading cause of death in first-episode psychosis (FEP), with an elevated risk during the first year following illness onset. The association between negative symptoms and suicidality remains contentious. Some studies suggest that negative symptoms may be associated with lower suicidality, while others fail to find an association between the two. No previous studies have specifically investigated suicidality in Persistent Negative Symptoms (PNS) and its associated subgroups.

STUDY DESIGN

In a large cohort of FEP patients (n = 515) from an early intervention service, we investigated suicidality in those with PNS, secondary PNS (ie, sPNS; PNS with clinical-level positive, depressive, or extrapyramidal symptoms), and non-PNS (all other patients) over 24 months. Patients were categorized into PNS groups based on symptoms from month 6 to month 12, and suicidality was evaluated using the Brief Psychiatric Rating Scale (BPRS).

STUDY RESULTS

Covarying for age and sex, we found that sPNS had higher suicidality relative to PNS and non-PNS throughout the 24-month period, but PNS and non-PNS did not differ. These differences were maintained after adjusting for depressive symptoms.

CONCLUSION

We observed that PNS did not significantly differ from non-PNS. However, we identified sPNS as a group with elevated suicidality above and beyond depression, suggesting that sPNS would benefit from targeted intervention and that PNS categorization identifies a subgroup for whom negative symptoms are not associated with lower suicidality.

Exploring the neurocognitive correlates of suicidal ideation in major depressive disorder: The role of frontoparietal and default mode networks

Suicidal ideation (SI) is a common symptom of major depressive disorder (MDD), often accompanied by cognitive alterations and emotional dysregulation. However, it is unclear whether cognitive dysfunction in patients with MDD is related to the presence or absence of SI and impaired connectivity within or between large-scale neurocognitive networks. Previous studies have shown that the frontoparietal network (FPN) and default mode network (DMN) are critical for cognitive control and emotional regulation. Participants were 51 MDD patients with suicidal ideation (MDDSI), 52 MDD patients without suicidal ideation (MDDNSI), and 55 healthy controls (HC). Using areas located within FPN and DMN networks as regions of interest (ROIs), we compared the cognitive performance of the three groups and the strength of the resting state functional connections (RSFC) within and between the FPN and DMN networks. Additionally, we examined the correlation between the strength of FC within the FPN and cognitive function in the SI group. Furthermore, network-based statistics (NBS) were used to correct for the strength of FPN and DMN functional connections. The study identified significant cognitive deficits in MDD patients. Reduced strength of FC was observed within the FPN and DMN networks in the SI group compared to the NSI group. In the SI group, the strength of FC within the FPN network was positively correlated with attention/vigilance. These insights underscore the critical roles of the FPN and DMN in the suicidal ideation, shedding light on the cognitively relevant neurobiological characteristics of MDDSI, providing new insights into the neural mechanisms of MDDSI. URL: https://www.chictr.org.cn/bin/project/edit?pid=131537. Registration number: ChiCTR2100049646.

Sociodemographic and clinical risk factors associated with suicidal ideation and attempt during a 2-year early intervention program for first-episode psychosis

BACKGROUND

Identifying risk factors for suicidal ideation and attempt among first-episode psychosis patients is essential to prevent suicide in this high-risk population. We investigated risk factors at admission for suicidal ideation and attempt during a 2-year early intervention program.

METHODS

Our sample included patients aged 18-35 years who were consecutively admitted to an early intervention program (2003-2017). Sociodemographic and clinical variables were obtained from a longitudinal study, while data on suicidal ideation and attempt were collected via systematic file review. Univariable and multivariable logistic regressions assessed the association of these variables with suicide ideation and attempt.

RESULTS

Of 446 participants, 35 (7.8 %) attempted suicide during the 2-year follow up, including two resulting in death (0.45 %), and 168 (37.7 %) reported solely suicidal ideation. Multivariable analyses indicated living alone (OR = 4.01, CI = 2.11-7.63), affective psychosis (OR = 1.95, CI = 1.22-3.14) and depressive symptomatology (OR = 1.45, CI = 1.13-1.86) were associated with increased risk for suicidal ideation. Attempting suicide close to admission (OR = 10.29, CI = 3.63-29.22), living alone (OR = 4.17, CI = 1.40-12.35), and depressive (OR = 1.67, CI = 1.06-2.63) and positive symptomatology (OR = 1.60, CI = 1.02-2.50) were associated with increased risk for suicide attempt. Attempting suicide close to admission (OR = 11.65, CI = 4.08-33.30), being part of an ethnic minority (OR = 3.71, CI = 1.59-8.63), and presenting lower anxiety (OR = 0.58, CI = 0.36-0.94) were the only factors specifically associated with suicide attempt compared to ideation.

CONCLUSION

Close monitoring of patients who recently attempted suicide, live alone, are part of an ethnic minority, and present with affective and positive symptomatology may help reduce the risk of suicide-related outcomes during early intervention programs.

Depression, suicide intent, and plan among adults presenting in an emergency department after making a suicide attempt: Exploratory differences by psychosis symptom experience

Rates of suicide are significantly higher for individuals with schizophrenia spectrum disorders (SSDs) than those in the general population. With limited understandings of factors contributing to engaging in a suicide attempt among the psychosis population in the literature, the current study sought to preliminarily explore depression, suicide intent, and suicide plan among adults with and without psychosis symptom experiences who presented to an emergency department (ED) after making a suicide attempt. Electronic health record data were collected from the ED of an academic healthcare system in the Midwestern United States between 2011 and 2022. Patients included 1178 adults who arrived after making a suicide attempt. Trained research assistants conducted chart reviews and data were explored in SPSS28. A significantly smaller proportion of patients with psychosis had depressive symptoms and endorsed having suicide intent prior to their attempt in comparison to patients without psychosis. A smaller trending (p < .10) proportion of patients with psychosis endorsed having a suicide plan prior to their attempt than those with psychosis. Exploratory findings highlight the importance of EDs assessing for suicide risk beyond traditional approaches among patients with psychosis symptom experiences, including considerations for the potential of individuals not experiencing depression, suicide intent, or a suicide plan. Future research is particularly needed to examine psychosis symptomatology and the experience of distress as potential contributing factors to suicide behavior and death among patients with psychosis symptoms to better inform suicide risk assessment and intervention efforts.