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

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.