Suicidality in schizophrenia spectrum disorders: the relationship to hallucinations and persecutory delusions

E Kjelby; I Sinkeviciute; R Gjestad; R A Kroken; E-M Løberg; H A Jørgensen; K Hugdahl; E Johnsen

doi:10.1016/j.eurpsy.2015.07.003

Suicidality in schizophrenia spectrum disorders: the relationship to hallucinations and persecutory delusions

Eur Psychiatry. 2015 Oct;30(7):830-6. doi: 10.1016/j.eurpsy.2015.07.003. Epub 2015 Sep 25.

Authors

E Kjelby¹, I Sinkeviciute², R Gjestad², R A Kroken³, E-M Løberg⁴, H A Jørgensen⁵, K Hugdahl⁶, E Johnsen³

Affiliations

¹ Division of Psychiatry, Haukeland University Hospital, Bergen, Norway. Electronic address: eirik.kjelby@helse-bergen.no.
² Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
³ Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
⁴ Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway.
⁵ Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
⁶ Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway; NORMENT Centre of Excellence, University of Oslo, Norway.

PMID: 26443050
DOI: 10.1016/j.eurpsy.2015.07.003

Abstract

Background: Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia spectrum disorders.

Methods: One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at the time of admission were examined with multinominal logistic regression and structural equation modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation.

Results: Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety, Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight with Suicidal ideation and Suicide plans.

Conclusions: The study contributes to an increasing evidence base supporting an association between hallucinations and suicide risk. We want to emphasise the importance of treating depression and hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing drug abuse in order to lower suicide risk.

Trial registration: ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529.

Keywords: Psychiatry in Europe; Schizophrenia and psychosis; Suicide.

Publication types

Pragmatic Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Delusions / diagnosis
Delusions / etiology
Delusions / therapy*
Depression / diagnosis
Depression / etiology
Depression / therapy*
Female
Hallucinations / diagnosis
Hallucinations / etiology
Hallucinations / therapy*
Humans
Male
Middle Aged
Psychiatric Department, Hospital
Psychotic Disorders / complications*
Psychotic Disorders / diagnosis
Psychotic Disorders / therapy*
Risk Factors
Schizophrenia / diagnosis
Substance-Related Disorders / complications
Suicidal Ideation
Suicide / psychology*
Suicide Prevention

Associated data

ClinicalTrials.gov/NCT00932529