Subclinical psychosis and suicidal behavior in England: Findings from the 2007 Adult Psychiatric Morbidity Survey

doi:10.1016/j.schres.2015.07.041

Schizophrenia Research

Volume 168, Issues 1–2, October 2015, Pages 62-67

https://doi.org/10.1016/j.schres.2015.07.041 Get rights and content

Abstract

Background

Psychotic disorders have been associated with suicidality but information on the association between subclinical psychosis and suicidality in the general adult population is scarce.

Methods

Data from the 2007 Adult Psychiatric Morbidity Survey (n = 7403) were analyzed. This was a nationally representative survey of the English adult household population (aged ≥ 16 years). Five types of psychotic symptoms (hypomania, thought control, paranoia, strange experience, auditory hallucination) occurring in the past 12 months were assessed with the Psychosis Screening Questionnaire. Participants with probable or definite psychosis were excluded. Logistic regression analysis was used to assess the association between psychotic symptoms and suicidal ideation and suicide attempt in the past 12 months.

Results

The prevalence of at least one psychotic symptom was 5.4%. After adjusting for potential confounders including mental disorders, each individual psychotic symptom was significantly associated with suicidal ideation with odds ratios (ORs) ranging from 3.22 to 4.20. With the exception of thought control, all symptoms were also associated with significantly higher odds for suicide attempt (ORs 3.95 to 10.23). Having at least one psychotic symptom was associated with ORs of 3.13 (95%CI 2.09–4.68) and 3.84 (95%CI 1.67–8.83) for suicidal ideation and suicide attempt respectively. In addition, a greater number of psychotic symptoms was associated with higher odds for suicidal ideation and suicide attempt.

Conclusions

Psychotic symptoms, regardless of the type, were independently associated with higher odds for suicidal ideation and suicide attempt. Assessment and management of suicide risk in individuals with psychotic symptoms may be important for suicide prevention.

Introduction

Evidence is increasing that psychotic symptoms which do not reach the clinical threshold or psychotic-like experiences may be common in the general population. Although prevalence figures for psychotic symptoms from previous studies are not totally comparable due to the different definitions of psychotic symptoms employed, a figure of 20% or above has been reported (Johns et al., 2004). This is much higher than the prevalence of psychotic disorders which has been reported to be 3% or less (Johns et al., 2004, Perala et al., 2007).

Although interest in understanding the negative health consequences of subclinical psychosis has recently grown, as yet, research on its association with suicidal behavior remains scarce especially in the adult population. This is an important research gap as suicide is the leading cause of preventable deaths, particularly among people with psychiatric disorders (Brown et al., 2000). For example, patients with schizophrenia are known to have an 8.5 times higher risk of suicide compared to the general population (Kasckow et al., 2011). Furthermore, it has been estimated that suicide attempts occur in 30% of patients with schizophrenia (Allebeck, 1989, Caldwell and Gottesman, 1992). The only two studies that have been undertaken to date on subthreshold psychotic symptoms, among Australian (Saha et al., 2011a) and US (DeVylder et al., 2015) adult populations, have reported 2–4 times higher odds for suicidal ideation or suicide attempt. However, both studies used a single category of any psychotic symptom despite the potential dimensional differences that may exist between symptoms (Peralta and Cuesta, 1999, Vazquez-Barquero et al., 1996, Wigman et al., 2011). Furthermore, the Australian study did not include information on hallucinations.

Since subclinical psychosis may be highly prevalent in the population, further information on its association with suicidality across different populations may help with the design and implementation of effective suicide prevention strategies. In connection with this, the present study will examine this association using data from England. This may be particularly instructive given the recent increase in suicide rates in the UK, especially among males, with more than 6000 individuals aged 15 and over committing suicide in 2013 (Office for National Statistics, 2015), and the scarcity of population-based studies on this topic from the UK. Thus, the aim of the current study was to assess the association between subclinical psychosis and suicidal ideation and suicide attempt using nationally representative data from the 2007 Adult Psychiatric Morbidity Survey (APMS) conducted in England.

Section snippets

The survey

Data came from the 2007 APMS which included information on 7403 people. Details of this survey have been provided elsewhere (Jenkins et al., 2009, McManus et al., 2009). In brief, this survey was designed to be representative of the English adult population (aged ≥ 16 years) living in private households. Homeless or institutionalized people were not included. Fieldwork was carried out between October 2006 and December 2007 by the National Center for Social Research, in collaboration with the

Results

The prevalence of past 12-month suicidal ideation and suicide attempt was 4.1% (n = 319) and 0.6% (n = 42) respectively, while the prevalence of each psychotic symptom was: hypomania 0.7% (n = 41); thought control 0.8% (n = 65); paranoia 1.7% (n = 113); strange experiences 3.0% (n = 223); and auditory hallucinations 0.7% (n = 53). At least one psychotic symptom was present in 5.4% (n = 391) of the respondents. Of those with at least one psychotic symptom, 21.6% and 4.5% had suicidal ideation or attempted

Discussion

This study showed that various types of psychotic symptom are associated with suicidal ideation and suicide attempt among English adults without definite or probable psychosis. All psychotic symptoms were significantly associated with suicidality with the exception of thought control and hypomania in some analyses. However, the high ORs suggest that this non-significance may have been due to a lack of statistical power. Having any psychotic symptom was associated with 2–3 times higher odds for

Role of funding source

Ai Koyanagi's work was supported by the Miguel Servet contract financed by the CP13/00150 project, integrated into the National R + D + I and funded by the ISCIII – General Branch Evaluation and Promotion of Health Research – and the European Regional Development Fund (ERDF-FEDER). These organizations had no role in the study design, collection, analysis and interpretation; in the writing of the manuscript; and in the decision to submit the paper for publication.

Contributors

AK designed the study, conducted the analysis, and wrote the first draft of the manuscript. AS and JMH participated in the interpretation of the results and critically revised the paper. All authors contributed to and have approved the final manuscript.

Conflict of interest

The authors have no conflicts of interest to declare.

Acknowledgment

We would like to thank the National Center for Social Research and the University of Leicester who were the Principal Investigators of this survey. In addition, we would also like to thank the UK Data Archive and the National Center for Social Research as the data collectors and for making these data publically available. They bear no responsibility for this analysis or interpretation of this publically available dataset.

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Subclinical psychosis and suicidal behavior in England: Findings from the 2007 Adult Psychiatric Morbidity Survey

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

The survey

Results

Discussion

Role of funding source

Contributors

Conflict of interest

Acknowledgment

Psychiatry Res.

Lancet Psychiatr.

Schizophr. Res.

Schizophr. Res.

Schizophr. Res.

Schizophr. Res.

Sleep Med. Rev.

Schizophrenia: a life-shortening disease

Schizophr. Bull.

The psychosis screening questionnaire

Int. J. Methods Psychiatr. Res.

Risk factors for suicide in psychiatric outpatients: a 20-year prospective study

J. Consult. Clin. Psychol.

Schizophrenia—a high-risk factor for suicide: clues to risk reduction

Suicide Life Threat. Behav.

Screening for psychotic experiences: social desirability biases in a non-clinical sample

Early Interv. Psychiatry

Suicidal ideation and suicide attempts among adults with psychotic experiences: data from the collaborative psychiatric epidemiology surveys

JAMA Psychiatr.

Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking

Soc. Psychiatry Psychiatr. Epidemiol.

Factors influencing the development and amelioration of suicidal thoughts in the general population. Cohort study

Br. J. Psychiatry

The British Mental Health Survey Programme: achievements and latest findings

Soc. Psychiatry Psychiatr. Epidemiol.

Prevalence and correlates of self-reported psychotic symptoms in the British population

Br. J. Psychiatry