Investigating the Perceived Impact of Psychosis on Suicidal Thoughts and Behaviors

Abstract

There is evidence showing a link between experiencing psychosis and suicidal thoughts and behaviors. However, individual accounts of the impact of psychosis on suicidal experiences have not been examined in detail. This study aimed to investigate the perceived impact of psychosis on suicidal thoughts and behaviors from the perspectives of individuals with these experiences. Semi-structured interviews with 20 people with non-affective psychosis and lifetime experiences of suicidal thoughts and/or behaviors were conducted. Data were analyzed using inductive Thematic Analysis. Based on participants’ experiences of psychosis and suicidal thoughts and behaviors, 3 themes were identified, including (1) Psychosis experiences are immensely distressing, (2) Changes in behaviors and appraisals of self, and (3) Suicidality as a means of escaping distress. A practical heuristic was proposed, describing a vicious cycle between psychological distress and changes in behaviors and self-appraisals, whereby suicidality was perceived as the only way to escape immense psychological pain. Hallucinations and delusions were central to the development of suicidal experiences. However, certain types of delusions, such as grandiose delusions, were sometimes found to reduce the intensity of suicidal experiences and associated psychological distress. It is necessary to examine the impact of psychosis on individuals, in order to assess the possibility of suicide-related experiences, as certain aspects of psychosis can have an amplifying effect, whereas others can have a weakening effect on those experiences. Minimizing the immense psychological pain experienced by some people with psychosis and the inter-related suicidal thoughts and behaviors is of paramount importance for clinical practice.