Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

SCHIZOPHRENIA RESEARCH

卷:233

Article

de Cates, Angharad N.^1,2  Catone, Gennaro³  Marwaha, Steven⁴  Bebbington, Paul^4,5  Humpston, Clara S.⁴  Broome, Matthew R.^4,6 

[1] Univ Oxford, Dept Psychiat, Oxford, England

[2] Oxford Hlth NHS Fdn Trust, Oxford, England

[3] Suor Orsola Benincasa Univ, Dept Educ Psychol & Commun Sci, Naples, Italy

[4] Univ Birmingham, Inst Mental Hlth, Sch Psychol, Coll Life & Environm Sci, Birmingham, W Midlands, England

[5] UCL, Div Psychiat, London, England

[6] Birmingham Womens & Childrens NHS Fdn Trust, Birmingham, W Midlands, England

关键词: Schizophrenia;    Psychosis;    Epidemiology;    Self-harm;    Suicide;   

DOI  :  10.1016/j.schres.2021.06.021

来源: Elsevier

【 摘 要 】

Background: Schizophrenia is associated with premature mortality, partly through increased suicide rates. Aims: To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability). Method: We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset. Results: In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour. Conclusions: Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.

【 授权许可】

Free