Association of Psychotic Experiences With Subsequent Risk of Suicidal Ideation, Suicide Attempts, and Suicide Deaths

Importance: Recent research has highlighted that psychotic experiences are far more prevalent than psychotic disorders and that they are associated with the full range of mental disorders. A particularly strong relationship between psychotic experiences and suicidal behavior has recently been noted.

Objective: To provide the first quantitative synthesis of the literature examining the longitudinal relationship between psychotic experiences and subsequent suicidal ideation, attempts and deaths in the general population.

Data Sources: We searched PubMed, EMBASE, CINAHL, and PsycINFO from their inception until September 2017 for longitudinal population studies on psychotic experiences and subsequent suicidal ideation, attempts and deaths.

Study Selection: Two authors searched for original articles that reported a prospective assessment of psychotic experiences and suicidal ideation, attempts or death in general population samples, with at least one follow-up time point. Out of a total of 2,540 studies, ten met inclusion criteria.

Data Extraction and Synthesis: Two authors conducted independent data extraction. Authors of included studies were contacted for information where necessary. We assessed study quality using the Newcastle-Ottawa Quality Assessment Scale. We calculated pooled odds ratios using a random effects-model. A secondary analysis assessed the mediating role of co-occurring psychopathology.

Main Outcome(s) and Measure(s): Psychotic experiences and subsequent suicidal ideation, attempts and deaths.
Results: Ten studies reported on a total of 84,285 participants from 12 different samples and 23 countries. Follow-up periods ranged from one month to 27 years. Individuals who reported psychotic experiences had a 2-fold increased odds of future suicidal ideation (5 papers, N = 56,191; odds ratio, 2.39; 95%CI,1.62 to 3.51), 3-fold increased odds of future suicide attempt ( 8 papers, N = 66, 967; OR, 3.15; 95%CI, 2.23 to 4.45), and a 4-fold increased odds of future suicide death (1 paper, N = 15,049; OR, 4.39; 95%CI, 1.63 to 11.78). Risk was increased in excess of that explained by co-occurring psychopathology: suicidal ideation adjusted OR, 1.59 (95%CI=1.09 – 2.32) and suicide attempt adjusted OR, 2.68 (95%CI=1.71 – 4.21).

Conclusions and Relevance: Individuals with psychotic experiences are at increased risk of suicidal ideation, attempts and deaths. Psychotic experiences are important clinical markers of risk for future suicidal behavior.