High rates of suicidality and parasuicidal behavior in individuals at clinical high-risk for psychosis: Implications for suicide risk assessment and suicide prevention

IF 3.6 2区医学 Q1 PSYCHIATRY

Schizophrenia Research Pub Date : 2025-04-29 DOI:10.1016/j.schres.2025.04.030

Tara Trujillo , Heline Mirzakhanian , Jean Addington , Carrie E. Bearden , Tyrone D. Cannon , Barbara A. Cornblatt , Matcheri Keshavan , Daniel H. Mathalon , Diana O. Perkins , William Stone , Elaine F. Walker , Scott W. Woods , Kristin S. Cadenhead

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引用次数: 0

Abstract

Background

Prior early psychosis studies have reported higher rates of suicidal ideation (SI) and parasuicidal behavior compared to healthy controls, but there is limited research examining rates and predictors of SI or protective factors in clinical high risk (CHR) youth. We investigated suicidality in CHR participants in the third sample of the North American Prodrome Longitudinal Study (NAPLS-3) and investigated associated demographic, life event, symptom, functional, treatment and outcome information.

Methods

The sample included 710 CHR (mean age 18.2, 45.8 % female) and 96 healthy control (HC) participants (mean age 18.6, 50.0 % female). Past SI, plans, self-harm and attempts were assessed via the clinician-administered Structured Assessment of Violence Risk in Youth (SAVRY) scale and the Calgary Depression Scale for Schizophrenia (CDSS).

Results

A significantly greater proportion of CHR participants compared to HC participants endorsed a history of SI or plan (30.7 % vs 0 %), a history of self-harm with no intent (25.6 % vs 4.2 %), serious suicide attempts (12 % vs 0 %) and suicide attempts designed to end in death (1 % vs 0 %). Within the CHR group, increasing levels of suicidality were significantly associated with worse symptoms; comorbid DSM diagnoses; decreased global and premorbid functioning; and stressful life events at baseline. Although parasuicidal behavior predicted future general symptoms including dysphoria and stress intolerance, it did not predict psychotic conversion at future timepoints.

Conclusion

Suicidality is prominent in CHR youth and an indicator of greater acuity, highlighting the importance of suicide risk assessments and suicide prevention interventions specifically targeted to CHR youth.

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精神病临床高危人群的高自杀率和准自杀行为：自杀风险评估和自杀预防的意义

背景先前的早期精神病研究报告了自杀意念（SI）和准自杀行为的发生率高于健康对照组，但对临床高危青少年（CHR）中自杀意念和保护因素的发生率和预测因素的研究有限。我们在北美前驱期纵向研究（NAPLS-3）的第三个样本中调查了CHR参与者的自杀行为，并调查了相关的人口统计学、生活事件、症状、功能、治疗和结果信息。方法纳入CHR 710例（平均年龄18.2岁，女性45.8%）和健康对照96例（平均年龄18.6岁，女性50.0%）。通过临床医生管理的青少年暴力风险结构化评估（SAVRY）量表和精神分裂症卡尔加里抑郁量表（CDSS）对过去的SI、计划、自残和企图进行评估。结果与HC参与者相比，CHR参与者承认有自杀史或自杀计划（30.7%比0%）、有非故意自残史（25.6%比4.2%）、有严重自杀企图（12%比0%）和以死亡告终的自杀企图（1%比0%）的比例显著高于HC参与者。在CHR组中，自杀水平升高与症状加重显著相关；共病DSM诊断；整体功能和病前功能下降；压力生活事件的基线。虽然准自杀行为预测了未来的一般症状，包括烦躁不安和压力不耐受，但它并不能预测未来时间点的精神病转化。结论自杀倾向在CHR青少年中较为突出，是一项较为敏感的指标，因此有必要开展针对CHR青少年的自杀风险评估和自杀预防干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Schizophrenia Research 医学-精神病学

CiteScore

7.50

自引率

8.90%

发文量

429

审稿时长

10.2 weeks

期刊介绍： As official journal of the Schizophrenia International Research Society (SIRS) Schizophrenia Research is THE journal of choice for international researchers and clinicians to share their work with the global schizophrenia research community. More than 6000 institutes have online or print (or both) access to this journal - the largest specialist journal in the field, with the largest readership! Schizophrenia Research''s time to first decision is as fast as 6 weeks and its publishing speed is as fast as 4 weeks until online publication (corrected proof/Article in Press) after acceptance and 14 weeks from acceptance until publication in a printed issue. The journal publishes novel papers that really contribute to understanding the biology and treatment of schizophrenic disorders; Schizophrenia Research brings together biological, clinical and psychological research in order to stimulate the synthesis of findings from all disciplines involved in improving patient outcomes in schizophrenia.