Unraveling Suicidal Ideation and Behaviors in a Global Cohort of Individuals at Clinical High-Risk for Psychosis: Multivariable Correlates and Subthreshold Psychotic Symptoms.
Stefano Damiani, Marika Orlandi, Umberto Provenzani, Elisa Bortolin, Margherita Rovida, Riccardo Stefanelli, Jean Addington, Luis Alameda, Celso Arango, Nicholas J K Breitborde, Matthew R Broome, Kristin S Cadenhead, Monica E Calkins, Ricardo E Carrion, Rolando I Castillo-Passi, Eric Yu Hai Chen, Jimmy Choi, Philippe Conus, Barbara A Cornblatt, Covadonga M Diaz-Caneja, Lauren M Ellman, Abigayle Fogarty, Pablo A Gaspar, Carla Gerber, Louise Birkedal Glenthøj, Leslie E Horton, Christy Lai Ming Hui, Joseph Kambeitz, Lana Kambeitz-Ilankovic, Matcheri S Keshavan, Minah Kim, Sung-Wan Kim, Nikolaos Koutsouleris, Zsuliet Kristof, Jun Soo Kwon, Kerstin Langbein, Daniel Mamah, Daniel H Mathalon, Vijay A Mittal, Josh Nguyen, Merete Nordentoft, Godfrey D Pearlson, Nora Penzel, Jesus Perez, Diana O Perkins, Albert R Powers, Jack Rogers, Fred W Sabb, Jason Schiffman, Jai L Shah, Steven M Silverstein, Stefan Smesny, William S Stone, Gregory P Strauss, Judy L Thompson, Rachel Upthegrove, Swapna Verma, Cassandra Wannan, Jijun Wang, Heather Wastler, Daniel H Wolf, Tianhong Zhang, Sylvain Bouix, Cheryl M Corcoran, Tina Kapur, Ofer Pasternak, Carrie E Bearden, Rene S Kahn, John M Kane, Patrick D McGorry, Barnaby Nelson, Martha E Shenton, Scott W Woods, Paolo Fusar-Poli
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引用次数: 0
Abstract
Introduction: Suicidal ideation and behaviors (SIB) are common among individuals at clinical high risk for psychosis (CHR-P), but their relationship with the overall clinical profile remains unclear. This study aimed to identify sociodemographic/clinical factors associated with SIB in CHR-P individuals and to examine whether subthreshold psychotic symptom severity increases with suicidal risk.
Methods: Data from the AMP SCZ initiative included 1443 CHR-P participants aged 12-30 years. SIB were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). Three Elastic Net regression models examined associations between suicidal ideation severity, intensity, and behaviors using 54 variables spanning sociodemographics, general psychopathology, subthreshold psychotic symptoms, and socio-occupational functioning. Moreover, ANCOVA compared overall psychotic symptom severity across five groups defined by increasing severity on the C-SSRS.
Results: Sixty-eight percent of participants reported lifetime suicidal ideation, and 26% reported previous suicidal behaviors. Model performance was modest but significant (cross-validated ideation severity: R2 = 0.161, RMSE = 0.916; ideation intensity: R2 = 0.193, RMSE = 0.898; suicidal behavior: accuracy = 0.685; AUC = 0.675; p < 0.001). Across all models, concurrent depressive symptoms, present/past diagnosis of depression, female sex at birth, cannabis use, visual/gustatory abnormalities, guilt, and lower role functioning were the most consistent correlates of SIB. Ideation was associated with lower disorganized communication expression and lower negative symptoms, whereas behaviors were associated with schizotypal personality disorder. Other core CHR-P symptoms, including Unusual Thoughts and Experiences, did not contribute to any model. ANCOVA (p < 0.001, partial η2 = 0.041) indicated increasing overall subthreshold psychotic symptoms across the SIB spectrum.
Conclusion: SIB in CHR-P individuals reflects a multidimensional clinical profile primarily outside of core psychosis-risk symptoms.
期刊介绍：
Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers.
Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.
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