Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study.
| Autor: | Sicotte R; Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada., Iyer SN; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Verdun, Québec, Canada., Lacourse É; Department of Sociology, Faculty of Arts and Sciences, Université de Montréal, Montréal, Québec, Canada., Séguin JR; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.; Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Montréal, Québec, Canada., Abdel-Baki A; Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada. |
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| Jazyk: | angličtina |
| Zdroj: | Canadian journal of psychiatry. Revue canadienne de psychiatrie [Can J Psychiatry] 2023 Nov; Vol. 68 (11), pp. 850-859. Date of Electronic Publication: 2023 Apr 18. |
| DOI: | 10.1177/07067437231167387 |
| Abstrakt: | Objectives: Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation to suicide attempts. Therefore, we aimed to identify 5-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories. Method: This 5-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroners' reports in 382 FEP patients [mean age = 23.53 ( SD = 3.61)] admitted to 2 5-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression. Results: Three suicidal ideation trajectories were identified: low and decreasing ( n = 325, 85.08%); early decline, then increasing ( n = 30, 7.85%), and persistent suicidal ideation ( n = 27, 7.07%). Suicidal ideation prior to admission (OR = 2.85, 95% CI, 1.23 to 6.63, P < 0.05) and cocaine use disorder (OR = 6.78, 95% CI, 1.08 to 42.75, P < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33, 95% CI, 1.66 to 11.29, P < 0.05) and attempts (OR = 8.18, 95% CI, 2.39 to 27.97, P < 0.001) and alcohol use disorder (OR = 3.63, 95% CI, 1.4 to 9.42, P < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up. Conclusions: Our study highlights heterogeneity in the course of suicidal ideation over 5 years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly for patients who persistently report suicidal ideation, as they are likelier to engage in suicide attempts. Patients with factors associated with increasing or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions from the early phase of follow-up. Given the small number of persons in these trajectories and the wide CIs for some factors, larger studies are however needed to further characterize who belongs in each group. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Databáze: | MEDLINE |
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