The Long-Term Relationship between Psychological Resilience, Psychosis, Distress, and Suicidal Thoughts and Behaviors

Abstract

Suicide deaths in people with non-Affective psychosis represent a major health care concern. Previous research has shown that psychosis and the associated distress increase suicidal experiences, whereas psychological resilience weakens the impact of suicide precursors, such as defeat, entrapment, and hopelessness on suicidal experiences. The moderating roles of psychosis, distress, and psychological resilience in the relationships between defeat, entrapment, hopelessness, and suicidal thoughts and behaviors have not been tested longitudinally. This 3-month longitudinal study used moderated mediation analysis to investigate: (1) the impact of defeat/entrapment and hopelessness on suicidal thoughts and behaviors and (2) the moderating effects of psychosis, distress, and psychological resilience in the relationships between defeat/entrapment, hopelessness, and suicidal thoughts and behaviors. Individuals with non-Affective psychosis-related diagnosis (including schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorders not otherwise specified) and lifetime experiences of suicidal thoughts, plans, and/or acts were recruited from the North-West of England, UK. Of the 100 participants at baseline, 90 took part in the follow-up assessment. At baseline, most of the participants had experienced one or more lifetime suicide attempts. Suicidal thoughts and behaviors scores were significantly lower at follow-up, compared with baseline. Over time, defeat/entrapment predicted suicidal thoughts and behaviors when the severity of psychosis and the associated distress were moderate and high, and resilience was lowest. The impact of defeat/entrapment, psychosis, distress due to psychosis, and resilience needs to be incorporated into interventions aiming to reduce suicidal experiences. These findings impact psychosis and resilience-focused suicide prevention interventions for people with non-Affective psychosis.