Longitudinal Relationship between Attenuated Positive Symptoms and Suicidal Ideation among Individuals at Clinical High Risk for Psychosis

Individuals at clinical high-risk for psychosis (CHR-P) are at increased risk for suicide. However, the relationship between attenuated positive symptoms and suicidal ideation are not well understood in this population, particularly as they interact over time. The current study is the first longitudinal examination of the relationship between attenuated positive symptoms and suicidal ideation among individuals at CHR-P. Thirty-six participants were recruited from an early psychosis intervention center. Attenuated positive symptoms and the presence of suicidal ideation were assessed at each session. Logistic mixed effect models were used to examine the concurrent and time-lagged relationship between suicidal ideation and total attenuated symptoms as well as specific attenuated symptoms (unusual thought content, suspiciousness, grandiose ideas, perceptual abnormalities, and disorganized communication). Results indicated that greater total attenuated symptoms were associated with the presence of suicidal ideation. Further investigation into specific symptoms showed significant associations between suicidal ideation and suspiciousness in both the concurrent and the time-lagged models. Post hoc bidirectional models (i.e. suicidal ideation predicting time lagged attenuated symptoms) were also used to shed light on issues of causality and directionality. Results supported a bidirectional relationship between suspiciousness and suicidal ideation, raising questions about the causal nature of this relationship. Further research is needed to determine whether third variables can explain the relationship between attenuated symptoms and suicidal ideation

Impact of Treatment Initiation and Engagement on Deliberate Self-Harm Among Individuals With First-Episode Psychosis

OBJECTIVE: Individuals with psychosis are at increased risk for suicide, with the greatest risk being present during the first few months after diagnosis. The authors aimed to examine whether treatment initiation within 14 days of diagnosis and treatment engagement within 90 days of initiation reduce the risk for deliberate self-harm (DSH) among individuals with first-episode psychosis (FEP). METHODS: A retrospective longitudinal cohort design was adopted by using Ohio Medicaid claims for 6,349 adolescents and young adults ages 15-24 years with FEP. Logistic regression was used to examine factors associated with treatment initiation and engagement. Cox proportional hazard models were used to estimate the impact of treatment initiation and engagement on DSH. Propensity score weighting was used to control for sociodemographic and clinical covariates. RESULTS: Approximately 70% of the sample initiated treatment, 55% of whom engaged in treatment. Treatment initiation and engagement were associated with both demographic and clinical variables. Treatment initiation significantly reduced the hazard of DSH (average treatment effect in the entire population: hazard ratio [HR]=0.62, 95% CI=0.47-0.81; average treatment effect among those treated: HR=0.64, 95% CI=0.52-0.80). In contrast, treatment engagement was not significantly associated with DSH. CONCLUSIONS: These results suggest that the initial treatment contact is essential for reducing DSH among adolescents and young adults with FEP. Additionally, the finding that treatment engagement did not reduce DSH suggests that standard clinical care may not be sufficient for reducing DSH in this population. These findings highlight the need for suicide-specific interventions for individuals with FEP