Reasons for Thinking About Suicide Among Individuals With First-Episode Psychosis: An Ecological Momentary Assessment Study.

Aim: This study aimed to examine patient perceived reasons for thinking about suicide among individuals with first-episode psychosis (FEP).

Methods: Participants completed a baseline assessment followed by 28 days of ecological momentary assessment (EMA). Baseline measures assessed lifetime suicidal ideation and reasons for thinking about suicide. EMA items assessed real-time suicidal ideation and reasons for thinking about suicide.

Results: The average number of lifetime reasons for thinking about suicide was 11.47 ± 5.99, with the most commonly endorsed reasons being to get away or escape (81.6%), to stop bad feelings (71.1%), and to relieve feelings of aloneness, emptiness or isolation (57.9%). Only 31.6% of participants endorsed positive symptoms as a lifetime reason for thinking about suicide. EMA results were consistent with lifetime data. Participants typically endorsed multiple reasons (2.15 ± 0.71), with the desire to escape and to stop bad feelings being the most commonly endorsed items. Psychosis was endorsed as a reason for thinking about suicide during 16.3% of instances of ideation during EMA.

Conclusion: These findings highlight the multi-faceted nature of suicide risk in psychosis. Interestingly, positive symptoms were not frequently endorsed as reasons for thinking about suicide from the patient's perspective. Further research is needed to identify when and for whom positive symptoms contribute to suicide risk. Additionally, our results identify important risk factors for further study, namely the desire to escape and/or stop bad feelings.