Skip to main content
×
×
Home

Are people at risk of psychosis also at risk of suicide and self-harm? A systematic review and meta-analysis

  • P. J. Taylor (a1), P. Hutton (a2) and L. Wood (a3)
Abstract
Background.

Suicide and self-harm are prevalent in individuals diagnosed with psychotic disorders. However, less is known about the level of self-injurious thinking and behaviour in those individuals deemed to be at ultra-high risk (UHR) of developing psychosis, despite growing clinical interest in this population. This review provides a synthesis of the extant literature concerning the prevalence of self-harm and suicidality in the UHR population, and the predictors and correlates associated with these events.

Method.

A search of electronic databases was undertaken by two independent reviewers. A meta-analysis of prevalence was undertaken for self-harm, suicidal ideation and behaviour. A narrative review was also undertaken of analyses examining predictors and correlates of self-harm and suicidality.

Results.

Twenty-one eligible studies were identified. The meta-analyses suggested a high prevalence of recent suicidal ideation (66%), lifetime self-harm (49%) and lifetime suicide attempts (18%). Co-morbid psychiatric problems, mood variability and a family history of psychiatric problems were among the factors associated with self-harm and suicide risk.

Conclusions.

Results suggest that self-harm and suicidality are highly prevalent in the UHR population, with rates similar to those observed in samples with diagnosed psychotic disorders. Appropriate monitoring and managing of suicide risk will be important for services working with the UHR population. Further research in this area is urgently needed considering the high rates identified.

Copyright
Corresponding author
* Address for correspondence: Dr P. J. Taylor, Institute of Psychology, Health & Society, University of Liverpool, Room 2.12, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK. (Email: pjtay@liv.ac.uk)
References
Hide All
Adlard, S, Yung, A (1997). An analysis of health damaging behaviours in young people at high risk of psychosis. The Royal Australian and New Zealand College of Psychiatrists.
Baca-Garcia, E, Perez-Rodriguez, MM, Diaz Sastre, C, Saiz-Ruiz, J, de Leon, J (2005). Suicidal behavior in schizophrenia and depression: a comparison. Schizophrenia Research 75, 7781.
Barendregt, JJ, Doi, SA, Lee, YY, Norman, RE, Vos, T (2013). Meta-analysis of prevalence. Journal of Epidemiology and Community Health 67, 974978.
Barrett, EA, Sundet, K, Faerden, A, Agartz, I, Bratlien, U, Romm, KL, Mork, E, Rossberg, JI, Steen, NE, Andreassen, OA, Melle, I (2010 a). Suicidality in first episode psychosis is associated with insight and negative beliefs about psychosis. Schizophrenia Research 123, 257262.
Barrett, EA, Sundet, K, Faerden, A, Nesvag, R, Agartz, I, Fosse, R, Mork, E, Steen, NE, Andreassen, OA, Melle, I (2010 b). Suicidality before and in the early phases of first episode psychosis. Schizophrenia Research 119, 1117.
Beck, AT, Steer, RA (1991). Manual for the Beck Scale for Suicidal Ideation. Psychological Corporation: San Antonio, TX.
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory-II. Psychological Corporation: San Antonio, TX.
Ben-David, S, Birnbaum, M, Eilenberg, M, Schienles, J, DeVlyder, J, Gill, K, Corcoran, C (2013). A qualitative research study in the subjective experience of youths identified as at clinical high risk of developing psychosis. Paper presented at the Society for Social Work and Research 17th Annual Conference, San Diego, USA.
Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR (2009). Introduction to Meta-analysis. John Wiley & Sons, Ltd.: Chichester, UK.
Brown, GK (2000). A review of suicide assessment measures for intervention research with adults and older adults. University of Pennsylvania: Pennsylvania.
Byrne, R, Morrison, AP (2010). Young people at risk of psychosis: a user-led exploration of interpersonal relationships and communication of psychological difficulties. Early Intervention in Psychiatry 4, 162168.
Challis, S, Nielssen, O, Harris, A, Large, M (2013). Systematic meta-analysis of the risk factors for deliberate self-harm before and after treatment for first-episode psychosis. Acta Psychiatrica Scandinavica 127, 442454.
Correll, CU, Hauser, M, Auther, AM, Cornblatt, BA (2010). Research in people with psychosis risk syndrome: a review of the current evidence and future directions. Journal of Child Psychol Psychiatry 51, 390431.
Demjaha, A, Valmaggia, L, Stahl, D, Byrne, M, McGuire, P (2012). Disorganization/cognitive and negative symptom dimensions in the at-risk mental state predict subsequent transition to psychosis. Schizophrenia Bulletin 38, 351359.
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.
DeVylder, JE, Oh, AJ, Ben-David, S, Azimov, N, Harkavy-Friedman, JM, Corcoran, CM (2012). Obsessive compulsive symptoms in individuals at clinical risk for psychosis: association with depressive symptoms and suicidal ideation. Schizophrenia Research 140, 110113.
Dinos, S, Stevens, S, Serfaty, M, Weich, S, King, M (2004). Stigma: the feelings and experiences of 46 people with mental illness: qualitative study. The British Journal of Psychiatry 184, 176181.
Feigenbaum, J (2007). Dialectical behaviour therapy: an increasing evidence base. Journal of Mental Health 16, 5168.
Freedenthal, S (2007). Challenges in assessing intent to die: can suicide attempters be trusted? Omega 55, 5770.
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E, McGuire, P (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rossler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, De Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkotter, J, McGuire, P, Yung, A (2013a). The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107120.
Fusar-Poli, P, Byrne, M, Badger, S, Valmaggia, LR, McGuire, PK (2013 b). Outreach and support in south London (OASIS), 2001–2011: ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis. European Psychiatry 28, 315326.
Fusar-Poli, P, Nelson, B, Valmaggia, L, Yung, AR, McGuire, PK (2014). Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophrenia Bulletin 40, 120131.
Goldney, RD (2005). Suicide prevention: a pragmatic review of recent studies. Crisis: the Journal of Crisis Intervention and Suicide Prevention 26, 128140.
Grano, N, Karjalainen, M, Edlund, V, Saari, E, Itkonen, A, Anto, J, Roine, M (2013). Depression symptoms in help-seeking adolescents: a comparison between adolescents at-risk for psychosis and other help-seekers. Journal of Mental Health 22, 317324.
Grano, N, Karjalainen, M, Suominen, K, Roine, M (2011). Poor functioning ability is associated with high risk of developing psychosis in adolescents. Nordic Journal of Psychiatry 65, 1621.
Gratz, KL (2001). Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment 23, 253263.
Haw, C, Hawton, K, Sutton, L, Sinclair, J, Deeks, JJ (2005). Schizophrenia and deliberate self-harm: a systematic review of risk factors. Suicide and Life-Threatening Behavior 35, 5062.
Hawton, K, Sutton, L, Haw, C, Sinclair, J, Deeks, JJ (2005). Schizophrenia and suicide: systematic review of risk factors. British Journal of Psychiatry 187, 920.
Hui, C, Morcillo, C, Russo, DA, Stochl, J, Shelley, GF, Painter, M, Jones, PB, Perez, J (2013). Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis. Schizophrenia Research 148, 175180.
Hutton, P, Bowe, S, Parker, S, Ford, S (2011). Prevalence of suicide risk factors in people at ultra-high risk of developing psychosis: a service audit. Early Intervention Psychiatry 5, 375380.
Hutton, P, Taylor, PJ (2014). Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis. Psychological Medicine 44, 449468.
Jackson, C, Knott, C, Skeate, A, Birchwood, M (2004). The trauma of first episode psychosis: the role of cognitive mediation. Australian and New Zealand Journal of Psychiatry 38, 327333.
Kang, NI, Park, TW, Yang, JC, Oh, KY, Shim, SH, Chung, YC (2012). Prevalence and clinical features of Thought-Perception-Sensitivity Symptoms: results from a community survey of Korean high school students. Psychiatry Research 198, 501508.
Kaplan, ML, Asnis, GM, Sanderson, WC, Keswani, L, De Lecuona, JM, Joseph, S (1994). Suicide assessment: clinical interview v. self-report. Journal of Clinical Psychology 50, 294298.
Kay, S, Fiszbein, A, Opler, L (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Kelleher, I, Corcoran, P, Keeley, H, Wigman, JT, Devlin, N, Ramsay, H, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C, Wasserman, D, Cannon, M (2012). Psychotic symptoms and population risk for suicide attempt: a prospective cohort study. JAMA Psychiatry 70, 940948.
Kontaxakis, V, Havaki-Kontaxaki, B, Margariti, M, Stamouli, S, Kollias, C, Christodoulou, G (2004). Suicidal ideation in inpatients with acute schizophrenia. Canadian Journal of Psychiatry 49, 476479.
Laye-Gindhu, A, Schonert-Reichl, KA (2005). Nonsuicidal self-harm among community adolescents: understanding the ‘Whats’ and ‘Whys’ of self-harm. Journal of Youth and Adolescence 34, 447457.
Miller, TJ, McGlashan, TH, Rosen, JL, Cadenhead, K, Ventura, J, McFarlane, W, Perkins, DO, Pearlson, GD, Woods, SW (2003). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703715.
Mork, E, Walby, F, Harkavy-Friedman, J, Barrett, E, Steen, N, Lorentzen, S, Andreassen, O, Melle, I, Mehlum, L (2013). Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm: a cross-sectional study. BMC Psychiatry 13, 255.
Morrison, AP, French, P, Parker, S, Roberts, M, Stevens, H, Bentall, RP, Lewis, SW (2007). Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophrenia Bulletin 33, 682687.
Morrison, AP, French, P, Stewart, SLK, Birchwood, M, Fowler, D, Gumley, AI, Jones, PB, Bentall, RP, Lewis, SW, Murray, GK, Patterson, P, Brunet, K, Conroy, J, Parker, S, Reilly, T, Byrne, R, Davies, LM, Dunn, G (2012). Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. British Medical Journal 344, 22332233.
Morrison, AP, French, P, Walford, L, Lewis, SW, Kilcommons, A, Green, J, Parker, S, Bentall, RP (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. British Journal of Psychiatry 185, 291297.
Nelson, B, Yuen, HP, Wood, SJ, Lin, A, Spiliotacopoulos, D, Bruxner, A, Broussard, C, Simmons, M, Foley, DL, Brewer, WJ, Francey, SM, Amminger, GP, Thompson, A, McGorry, PD, Yung, AR (2013). Long-term follow-up of a group at ultra high risk (‘prodromal’) for psychosis: the PACE 400 study. JAMA Psychiatry 70, 793802.
Nielssen, OB, Large, MM (2009). Untreated psychotic illness in the survivors of violent suicide attempts. Early Intervention Psychiatry 3, 116122.
Niendama, TA, Berzaka, J, Cannona, TD, Beardena, CE (2008). Obsessive compulsive symptoms in the psychosis prodrome: correlates of clinical and functional outcome. Schizophrenia Research 108, 170175.
Nordentoft, M (2002). OPUS study: suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis: one-year follow-up of a randomised controlled trial. British Journal of Psychiatry 181, 98s106s.
Nordentoft, M, Mortensen, P, Pedersen, C (2011). Absolute risk of suicide after first hospital contact in mental disorder. Archives of General Psychiatry 68, 10581064.
Palmer, BA, Pankratz, S, Bostwick, JM (2005). The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry 62, 247253.
Palmier-Claus, J, Taylor, P, Gooding, P, Dunn, G, Lewis, S (2012). Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: an experience sampling study. British Journal of Clinical Psychology 51, 7283.
Phillips, LJ, Nelson, B, Yuen, HP, Francey, SM, Simmons, M, Stanford, C, Ross, M, Kelly, D, Baker, K, Conus, P, Amminger, P, Trumpler, F, Yun, Y, Lim, M, McNab, C, Yung, AR, McGorry, PD (2009). Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics. Australian & New Zealand Journal of Psychiatry 43, 818829.
Preti, A, Meneghelli, A, Pisano, A, Cocchi, A, Programma, T (2009). Risk of suicide and suicidal ideation in psychosis: results from an Italian multi-modal pilot program on early intervention in psychosis. Schizophrenia Research 113, 145150.
Pyle, M, Stewart, SLK, French, P, Byrne, R, Patterson, P, Gumley, A, Birchwood, M, Morrison, AP (2013). Internalized stigma, emotional dysfunction and unusual experiences in young people at risk of psychosis. Early Intervention in Psychiatry. Published online: 3 December 2013. doi: 10.1111/eip.12098
Raballo, A, Nelson, B, Thompson, A, Yung, A (2011). The comprehensive assessment of at-risk mental states: from mapping the onset to mapping the structure. Schizophrenia Research 127, 107114.
Radomsky, ED, Haas, GL, Mann, JJ, Sweeney, JA (1999). Suicidal behavior in patients with schizophrenia. American Journal of Psychiatry 156, 15901595.
Rausch, F, Eifler, S, Esser, A, Esslinger, C, Schirmbeck, F, Meyer-Lindenberg, A, Zink, M (2013). The Early Recognition Inventory ERIraos detects at risk mental states of psychosis with high sensitivity. Comprehensive Psychiatry 54, 10681076.
Royal College of Psychiatrists (2010). Self-harm, Suicide and Risk: Helping People who Self-harm. Royal College of Psychiatrists: London.
Ruhrmann, S, Klosterkotter, J, Bodatsch, M, Nikolaides, A, Julkowski, D, Hilboll, D, Schultze-Lutter, F (2012). Chances and risks of predicting psychosis. European Archive of Psychiatry & Clinical Neuroscience 262(Suppl. 2), S85S90.
Schultze-Lutter, F (2009). Subjective symptoms of schizophrenia in research and the clinic: The basic symptoms concept. Schizophrenia Bulletin 35, 58.
Silverman, MM, Berman, AL, Sanddal, ND, O'Carroll, PW, Joiner, TE (2010). Rebuilding the tower of babel: a revised nomenclature for the study of suicide and suicidal behaviors, part 2: suicide-related ideations, communications, and behaviors. Suicide and Life-Threatening Behavior 37, 264276.
Stafford, MR, Jackson, H, Mayo-Wilson, E, Morrison, AP, Kendall, T (2013). Early interventions to prevent psychosis: systematic review and meta-analysis. British Medical Journal 346, f185.
StataCorp (2005). Stata Statistical Software: Release 9. College Station, TX: StataCorp LP.
Tarrier, N, Khan, S, Cater, J, Picken, A (2007). The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour. Social Psychiatry & Psychiatric Epidemiology 42, 2935.
Upthegrove, R, Birchwood, M, Ross, K, Brunett, K, McCollum, R, Jones, L (2010). The evolution of depression and suicidality in first episode psychosis. Acta Psychiatrica Scandinavica 122, 211218.
Velthorst, E, Nieman, DH, Linszen, D, Becker, H, de Haan, L, Dingemans, PM, Birchwood, M, Patterson, P, Salokangas, RK, Heinimaa, M, Heinz, A, Juckel, G, von Reventlow, HG, French, P, Stevens, H, Schultze-Lutter, F, Klosterkotter, J, Ruhrmann, S (2010). Disability in people clinically at high risk of psychosis. British Journal of Psychiatry 197, 278284.
Welsh, P, Tiffin, PA (2013). The ‘at-risk mental state’ for psychosis in adolescents: clinical presentation, transition and remission. Child Psychiatry and Human Development 45, 9098.
Williams, JW, Plassman, BL, Burke, J, Holsinger, T, Benjamin, S (2010). Preventing Alzheimer's Disease and Cognitive Decline. Evidence Report/Technology Assessment No. 193. (Prepared by the Duke evidence-based practice center under contract No. HHSA 290-2007-10066-I). Agency for Healthcare Research and Quality: Rockville, MD.
Wing, JK, Beevor, AS, Curtis, RH, Park, SB, Hadden, S, Burns, A (1998). Health of the Nation Outcome Scales (HoNOS): research and development. British Journal of Psychiatry 172, 1118.
Young, AS, Nuechterlein, KH, Mints, J, Ventura, J, Qitlin, M, Liberman, RP (1998). Suicidal ideation and suicide attempts in recent-onset schizophrenia. Schizophrenia Bulletin 24, 629634.
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Austalian an New Zealand Journal of Psychiatry 39, 964971.
Zimbron, J, Ruiz de Azua, S, Khandaker, GM, Gandamaneni, PK, Crane, CM, Gonzalez-Pinto, A, Stochl, J, Jones, PB, Perez, J (2013). Clinical and sociodemographic comparison of people at high-risk for psychosis and with first-episode psychosis. Acta Psychiatrica Scandinavica 127, 210216.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Taylor Supplementary Material
Appendix

 Word (19 KB)
19 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed