Psychotic experiences and suicidal behavior: testing the influence of psycho-socioenvironmental factors
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ORIGINAL PAPER
Psychotic experiences and suicidal behavior: testing the influence of psycho‑socioenvironmental factors Jordan DeVylder1 · Kyle Waldman2 · Emily Hielscher3,4,5 · James Scott3,4,5,6 · Hans Oh7 Received: 17 June 2019 / Accepted: 3 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Research has produced inconsistent results with respect to whether the association between psychotic experiences and suicidal behavior is independent of co-occurring clinical and socioenvironmental factors, despite substantial evidence linking the two phenomena. This study tests whether a comprehensive set of demographic, socioenvironmental, and clinical variables account for the statistical association between psychotic experiences and suicidal behaviors. Methods We utilized blocked multivariable logistic regression models to analyze the association between 12-month psychotic experiences and 12-month suicide behaviors (ideation, plan, and attempt) on a subsample (N = 2307) of the National Comorbidity Survey Replication. The models adjusted for socio-demographic characteristics, environmental factors in the form of childhood adversity, mental health service utilization, and psychiatric and substance abuse disorders. Results Psychotic experiences were significantly associated with suicidal ideation, even after adjusting for socio-demographics, childhood adversity. However, the significant association between psychotic experiences and suicidal ideation was not robust to the inclusion of mental health service utilization and psychiatric disorders. There was no significant association between psychotic experiences and suicide plan. Psychotic experiences were associated with a significantly increased risk of reporting suicide attempts (OR 6.52; 95% CI 1.36–31.11), even after adjusting for the full set of variables. Conclusions Although psychotic experiences were not associated with suicidal ideation after statistical adjustments, psychotic experiences were associated with a significantly increased risk of suicide attempts after the inclusion of common risk factors and co-morbidities. Thus, psychotic experiences should be included in routine psychiatric assessments to identify the individuals most at risk for attempting suicide. Keywords Psychosis · Suicide · Attempts · Epidemiology · NCS-R
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01841-9) contains supplementary material, which is available to authorized users. * Jordan DeVylder [email protected] 1
Graduate School of Social Service, Fordham University, New York, NY 10009, USA
2
Department of Sociology, Harvard University, Cambridge, MA, USA
3
Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
There is now substantial evidence linking psychotic experiences to suicidal ideation and behavior, showing that the well-established elevated risk for suicide associated with schizophrenia
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