Recent negative events and recent nonsuicidal self-injurious behavior are the strongest predictors of suicide-related behaviors among patients undergoing treatment for first-episode psychosis, an Australian study of 72 patients and 108 matched controls has shown.
The findings have important implications for the management of first-episode psychosis patients, and suggest a need for psychosocial interventions that could help reduce the high rates of suicide attempts and suicides in this population, Izabela E. Fedyszyn, a doctoral candidate at La Trobe University, Victoria, Australia, and her colleagues reported in the September issue of Schizophrenia Research.
About 12% of patients attempt suicide within 2 years of treatment for first-episode psychosis, and about 25% of those make multiple suicide attempts; about 1.5% of first-episode patients die from suicide within 18 months of presenting to psychiatric services. However, little is known about recent risk factors for these behaviors or about the relative importance of baseline, past, and recent variables to the prediction of suicide-related acts, the investigators said.
To determine the predictive power of these variables and to identify the most influential recent factors that could be targeted for intervention, the investigators performed a case-control study of 180 patients, aged 15-24 years, and found that having experienced negative events in the prior 3 months increased the likelihood of suicide-related behaviors nearly twofold, and having engaged in nonsuicidal self-injurious behaviors in the prior 3 months increased the likelihood by 73 times (Schizophr. Res. 2012;140:17-24).
The investigators noted, however, that the confidence interval for the latter finding is quite wide because of a small number of controls displaying nonsuicidal self-harm.
Other factors initially found to be associated with suicide-related behaviors included baseline depressive symptoms, baseline suicidal ideation/intent, past negative events, past nonsuicidal self-injurious behaviors, and recent depressive symptoms. However, in a hierarchical logistic regression model, only recent negative events and recent self-injurious behavior remained significant predictors of suicidal behavior (adjusted odds ratios, 1.90 and 72.96).
The association between nonsuicidal self-injurious behaviors and suicide-related behaviors within 3 months remained significant after the investigators controlled for the 10.6% of the study population with comorbid bipolar disorder, a subset of the study population that was significantly more likely than those without bipolar disorder to engage in suicide-related behaviors during treatment.
The final model, which took into account baseline, past, and recent characteristics of patients, correctly classified 75.5% of cases and 89.2% of controls with respect to suicide attempt status, the investigators said, noting that the findings suggest steps could be taken to prevent suicidal behaviors in these patients.
Targeting nonsuicidal self-injurious behavior could help reduce the incidence of suicidal behaviors, as could placing greater emphasis on psychosocial interventions to improve coping mechanisms among those with recent negative life events.
"A previous investigation of the characteristics of suicide attempts in first-episode patients indicated that interpersonal issues were the most common antecedents. Extending individuals’ range of coping skills, such as interpersonal effectiveness, affect regulation, stress management, and problem solving, could strengthen protective processes and reduce the rates of suicide-related acts," the investigators wrote.
Data for this study were obtained from an audit of medical records for patients treated between December 2002 and November 2005 at the Early Psychosis Prevention and Intervention Center in Melbourne. Cases were patients who had made at least one suicide attempt; controls were randomly selected patients who had not made a suicide attempt.
Though limited by factors such as the retrospective design and missing data in some cases, this study involved a multidiagnostic sample selected from an epidemiologically representative cohort of first-episode psychosis patients and a retrospective field audit methodology that avoided potential response biases. Another strength was the use of staged data analysis, enabling a range of variables to be examined without diminishing the power of the final model, the investigators noted.
"Given the role of recent negative events and nonsuicidal self-injurious behavior in increasing the likelihood of suicide-related behaviors, incorporating psychosocial interventions addressing affect regulation, interpersonal effectiveness, stress management and problem-solving skills, alongside case management and pharmacotherapy, may help to reduce the prevalence of suicide attempts and suicide in this population," they wrote.
The investigators reported having no relevant financial conflicts.