Suicide attempt in first-episode psychosis: A 7.4year follow-up study
Received 15 June 2009; received in revised form 5 October 2009; accepted 10 October 2009. published online 28 October 2009.
Abstract
Background
Individuals with first-episode psychosis demonstrate high rates of suicide attempt (SA).
Aims
1) To examine the prevalence of, and risk factors for, SA in a first-episode psychosis (FEP) cohort over a 7.4year follow-up period. 2) To investigate differences between single versus multiple suicide attempters.
Methods
This study reports baseline and follow-up data from a naturalistic, prospective follow-up of 413 FEP patients treated at a specialist early psychosis centre. Assessments were conducted at treatment entry, initial symptom remission or stabilization, and long term follow-up. Binary logistic regression models were used to assess unadjusted and adjusted associations between early illness and sociodemographic characteristics and two outcome measures: any SA during follow-up; and multiple SAs.
Results
Follow-up data were available for 282 participants. Sixty-one (21.6%) made a suicide attempt over the follow-up period, including 12 successful suicides. The following baseline risk factors increased the risk of any SA: history of self-harm (OR=4.27; p<0.001), suicidal tendencies (OR=2.30; p=0.022), being depressed for >50% of the initial psychotic episode (OR=2.49; p=0.045), and hopelessness (OR=2.03; p=0.030). History of problem alcohol use increased the risk of multiple SAs (OR=4.43; 95% CI (1.05–18.7); p=0.043).
Discussion
The prevalence of suicide attempt in this study exceeds reports from short-term FEP studies but is comparable to longer term follow-up studies, indicating that risk remains elevated for at least 7years following commencement of treatment. The key predictor of future suicide attempt was previous self-harm, indicating that interventions for self-harm are required.
aOrygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre (EPPIC), 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
bThe University of Queensland, School of Population Health, Qld 4072, Australia
cSchool of Behavioural Science, The University of Melbourne, Grattan Street, Parkville Victoria 3052, Melbourne, Australia
ABSTRACT