Examining Clinical and Social Predictors of Suicidal Ideation and Attempts in Individuals at Clinical High Risk for Psychosis (CHR-p)

Julia Pfluger, B.S. (1,2,3), James Green, B.A (1,2,3), Wenhui Qi (1,2,3), Claire Goods B.S. (1,2,3), Joey Rodriguez (1,2,3), Michelle West, Ph.D (2), Michelle Friedman-Yakoobian Ph.D (1,2,3)

1. Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston MA
2. CEDAR Clinic/Brookline Center for Community Mental Health, Boston MA
3. Harvard Medical School Department of Psychiatry, Boston MA

Abstract

Background: Research demonstrates that individuals who experience psychotic symptoms are at higher risk for suicidal ideation (SI) or suicide attempt (SA). However, the relationship between suicide risk and clinical high risk for psychosis (CHR-p) has yet to be clarified. Previous literature suggests that psychosis and suicidality may be associated through hopelessness, minority stress associated with minority identity status, interpersonal connections, and direct effects. Our study aims to examine the prevalence and risk factors of suicidality in youth at CHR-p.
Methods: Participants (n = 140) included CHR-p clients at the Center for Early Detection, Assessment, and Response to Risk (CEDAR), who participated in a baseline clinical assessment between 2017 and 2022. Instruments used measured psychosis symptoms, suicidality, clinical covariates, social and role functioning, and demographics. Frequency analyses assessed the prevalence of lifetime SI and SA. T-test and Chi-square examined variables associated with SI and SA. Logistic regression was implemented to examine the predictive accuracy, sensitivity, and specificity of variables flagged with a significant association with SI and SA.
Results: Results suggested that 65% of participants at CHR-p endorsed lifetime suicidal ideation, while 22.2% had at least 1 lifetime suicide attempt. In addition, participants who endorsed lifetime suicidal ideation also had significantly more hallucinations (t(130) = 2.46), hopelessness (t(109) = 2.09), depression (t(109) = 3.87), and trauma severity (t(62) = 2.03). The only significant predictor in the logistic regression predicting lifetime suicide attempts was a trauma diagnosis (b = 1.4).
Conclusion: Our results suggest that clients who meet diagnostic criteria for CHR-p have high rates of SI and SA. In addition, our findings suggest that in our sample, a trauma diagnosis was the strongest predictor of a suicide attempt. Longitudinal research is needed to explore changes in suicidality over time.