Psychotic symptoms increase suicidality risk in adolescents

By Mark Cowen, Senior medwireNews Reporter

The presence of psychotic symptoms is associated with a significantly increased risk for suicidal behavior in adolescents, research shows.

Ian Kelleher (Royal College of Surgeons in Ireland, Dublin) and colleagues found that psychotic symptoms were associated with more than a 10-fold increased risk for suicidal behavior in adolescents. This risk was even higher among those who had depression and psychotic symptoms.

"These findings highlight the importance of a thorough assessment for psychotic symptoms in [young] patients presenting with suicidal behavior," comment the researchers in the Archives of General Psychiatry.

The team studied data from two population-based studies on 212 adolescents aged 11-13 years and 211 adolescents aged 13-15 years.

All participants were assessed for psychotic symptoms, depression, and suicidal behavior (suicidal ideation, plans, and acts) using the Schedule for Affective Disorders and Schizophrenia for School-aged Children, Present and Lifetime versions (K-SADS).

Overall, 22% of adolescents aged 11-13 years and 7% of those aged 13-15 years reported psychotic symptoms, mainly auditory hallucinations. In addition, a respective 7% and 13% of adolescents reported suicidal behavior.

Analysis revealed that participants who reported psychotic symptoms had a significantly greater risk for suicidal behavior than those who did not, at odds ratios (ORs) of 10.2 in the early adolescent group and 10.5 in the older group.

Adolescents with depressive disorders who also experienced psychotic symptoms were at an even greater risk for suicidal behavior, particularly severe suicidal behavior (planning and acts), at an OR of 13.7 compared with those without psychotic symptoms and depression.

Furthermore, among participants who reported suicidal ideation, those with psychotic symptoms were 19.6 times more likely to also report suicide plans and acts compared with those without psychotic symptoms.

Kelleher et al conclude: "The results of two studies reported herein demonstrate that psychotic symptoms index greatly increased risk for suicidal behavior in adolescents in the general population and in adolescents with diagnosable psychiatric disorder.

"Furthermore, the presence of psychotic symptoms greatly increases the risk for more severe suicidal behavior among adolescents with suicidal ideation."

They add: Further epidemiologic and neuroscientific research is necessary to understand the mechanisms underlying the risk indexed by psychotic symptoms… knowledge of which may help to inform public health strategies and lead to a reduction in future attempted and completed suicides."

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