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Original Investigation
November 28, 2018

Association of Psychotic Experiences With Subsequent Risk of Suicidal Ideation, Suicide Attempts, and Suicide Deaths: A Systematic Review and Meta-analysis of Longitudinal Population Studies

Author Affiliations
  • 1Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
  • 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  • 3Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  • 4Data Science Centre and Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland
  • 5Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
  • 6School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland
  • 7Lucena Clinic St. John of God, Dublin, Ireland
  • 8Department of Child Psychiatry, Our Lady’s Hospital for Sick Children, Dublin, Ireland
  • 9Graduate School of Social Service, Fordham University, New York, New York
JAMA Psychiatry. Published online November 28, 2018. doi:10.1001/jamapsychiatry.2018.3514
Key Points

Question  Are psychotic experiences associated with an increased risk of later suicidal ideation, suicide attempt, and/or suicide death?

Findings  In this systematic review and meta-analysis of 10 general population cohort studies on 84 285 individuals, psychotic experiences were associated with significantly increased odds of subsequent suicidal ideation, suicide attempts, and suicide death. The increase in risk was in excess of that explained by co-occurring psychopathology.

Meaning  Psychotic experiences are clinical markers of risk for future suicidal behavior in excess of the risk associated with co-occurring psychopathology.

Abstract

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

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

Data Sources  We searched PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO from their inception until September 2017 for longitudinal population studies on psychotic experiences and subsequent suicidal ideation, suicide attempts, and suicide death.

Study Selection  Two authors searched for original articles that reported a prospective assessment of psychotic experiences and suicidal ideation, suicide attempts, or suicide death in general population samples, with at least 1 follow-up point.

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 Outcomes and Measures  Psychotic experiences and subsequent suicidal ideation, suicide attempts, and suicide death.

Results  Of a total of 2540 studies retrieved, 10 met inclusion criteria. These 10 studies reported on 84 285 participants from 12 different samples and 23 countries. Follow-up periods ranged from 1 month to 27 years. Individuals who reported psychotic experiences had an increase in the odds of future suicidal ideation (5 articles; n = 56 191; odds ratio [OR], 2.39 [95% CI,1.62-3.51]), future suicide attempt (8 articles; n = 66 967; OR, 3.15 [95% CI, 2.23-4.45]), and future suicide death (1 article; n = 15 049; OR, 4.39 [95% CI, 1.63-11.78]). 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, suicide attempts, and suicide death. Psychotic experiences are important clinical markers of risk for future suicidal behavior.

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