Trajectories of positive symptoms and suicidality in individuals at clinical high risk for psychosis

J Affect Disord. 2025 May 5:S0165-0327(25)00779-7. doi: 10.1016/j.jad.2025.05.023. Online ahead of print.

ABSTRACT

Suicide is a major concern in individuals with psychotic disorders, with suicidality often emerging during the early stages of psychosis, when insight into psychosis-related changes in perception and thought is intact. Examining the association between suicidality and positive symptoms at an early phase of the illness can shed light on factors associated with the emergence of suicidality and inform prevention efforts. This study utilized data from the North American Prodrome Longitudinal Study Phase 3 to investigate whether positive symptoms and suicidality covaried over time in individuals at Clinical High Risk for Psychosis (CHR-P). Measures of suicidal ideation and positive symptoms, including hallucinations and delusions, were obtained at two-month intervals over an 8-month period among 464 CHR-P participants. Individuals who reported suicidal ideation at baseline and at later assessment timepoints (n = 92) in addition to those who reported suicidal ideation only at follow up assessment timepoints (n = 101) were found to exhibit sustained higher levels of positive symptom severity, specifically hallucinations and delusions, compared with individuals with remitted (n = 48) or absent (n = 223) suicidality, in whom positive symptoms declined significantly over the follow-up interval. This association remained significant after controlling for severity of depression symptoms (other than suicidality) at baseline and as a time-varying covariate. These findings highlight that hallucinations and delusions may be key factors in the emergence and persistence of suicidal ideation in CHR-P populations. This study underlines the potential to add targeted suicide prevention strategies in addressing specific positive symptoms (i.e., hallucinations and delusions) in early psychosis.

PMID:40334865 | DOI:10.1016/j.jad.2025.05.023