TY  - JOUR
PY  - 2021//
TI  - Self-harm, suicidal ideation, and the positive symptoms of psychosis: cross-sectional and prospective data from a national household survey
JO  - Schizophrenia Research
A1  - de Cates, Angharad N.
A1  - Catone, Gennaro
A1  - Marwaha, Steven
A1  - Bebbington, Paul
A1  - Humpston, Clara S.
A1  - Broome, Matthew R.
SP  - 80
EP  - 88
VL  - 233
IS  - 
N2  - BACKGROUND: Schizophrenia is associated with premature mortality, partly through increased suicide rates. AIMS: To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability). <br><br>METHOD: We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset. <br><br>RESULTS: In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour. <br><br>CONCLUSIONS: Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.<p />  <p>Language: en</p>
LA  - en
SN  - 0920-9964
UR  - http://dx.doi.org/10.1016/j.schres.2021.06.021
ID  - ref1
ER  -