Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: Independent findings from two cohorts

Lisa R Steenkamp; Nita G M de Neve-Enthoven; Amanda Moreira João; Diandra C Bouter; Manon H J Hillegers; Witte J G Hoogendijk; Laura M E Blanken; Steven A Kushner; Henning Tiemeier; Nina H Grootendorst-van Mil; Koen Bolhuis

doi:10.1016/j.schres.2023.05.006

Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: Independent findings from two cohorts

Schizophr Res. 2023 Jul:257:50-57. doi: 10.1016/j.schres.2023.05.006. Epub 2023 Jun 6.

Affiliations

¹ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
² Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
³ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
⁴ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁵ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, USA.
⁶ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands. Electronic address: k.bolhuis@erasmusmc.nl.

PMID: 37285715
DOI: 10.1016/j.schres.2023.05.006

Abstract

Background: Prior studies have shown that psychotic experiences are prospectively associated with an increased risk of suicidality. However, it is unclear whether this association is causal or arises from shared risk factors. Furthermore, little is known about the association between psychotic experiences and non-suicidal self-injury (NSSI).

Methods: We used data from two independent samples of young adolescents, which we analyzed separately. In a population-based cohort, data on hallucinatory experiences and suicidality were collected at ages 10 and 14 years (N = 3435). In a cross-sectional study of a population oversampled for elevated psychopathology levels, psychotic experiences, suicidality, and NSSI were assessed at age 15 years (N = 910). Analyses were adjusted for sociodemographic covariates, maternal psychopathology, intelligence, childhood adversity, and mental health problems.

Results: Psychotic experiences were prospectively associated with an increased risk of suicidality, even when considering self-harm ideation at baseline. Furthermore, persistent and incident, but not remittent, patterns of psychotic experiences were related to an increased burden of suicidality. Self-harm ideation was also prospectively associated with the risk for psychotic experiences, although of smaller magnitude and only by self-report. Among at-risk adolescents, psychotic experiences were cross-sectionally associated with a greater burden of suicidality and a higher frequency of NSSI events, with more extensive tissue damage.

Conclusion: Psychotic experiences are longitudinally associated with suicidality beyond the effects of shared risk factors. We also found modest support for reverse temporality, which warrants further investigation. Overall, our findings highlight the importance of assessing psychotic experiences as an index of risk for suicidality and NSSI.

Keywords: Adolescent; Hallucinations; Psychotic disorders; Psychotic-like experiences; Self-injurious behavior; Suicidal ideation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Cross-Sectional Studies
Humans
Mental Disorders* / complications
Psychotic Disorders* / psychology
Risk Factors
Self-Injurious Behavior* / epidemiology
Suicidal Ideation
Suicide*
Suicide, Attempted / psychology