Understanding suicidal ideation in psychosis: findings from the Psychological Prevention of Relapse in Psychosis (PRP) trial.
OBJECTIVE
To examine the clinically important phenomenon of suicidal ideation in psychosis in relation to affective processes and the multidimensional nature of hallucinations and delusions.


METHODS
In a cross-sectional study of 290 individuals with psychosis, the associations between level of suicidal ideation, affective processes, positive symptoms, clinical and demographic variables were examined.


RESULTS
Forty-one per cent of participants expressed current suicidal ideation. Suicidal ideation was associated with depressed mood, anxiety, low self-esteem, negative illness perceptions, negative evaluative beliefs about the self and others and daily alcohol consumption. Frequency of auditory hallucinations and preoccupation with delusions were not associated with suicidal ideation; however, positive symptom distress did relate to suicidal thoughts.


CONCLUSIONS
Affective dysfunction, including distress in response to hallucinations and delusions, was a key factor associated with suicidal ideation in individuals with psychotic relapse. Suicidal ideation in psychosis appears to be an understandable, mood-driven process, rather than being of irrational or 'psychotic' origin.
Fialko
L
L
Department of Psychology, Institute of Psychiatry, King's College London, University of London, London, UK. l.fialko@iop.kcl.ac.uk
Freeman
D
D
Bebbington
P E
PE
Kuipers
E
E
Garety
P A
PA
Dunn
G
G
Fowler
D
D
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003469:Culture; D003702:Delusions / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004739:England; D005196:Family Therapy; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018187:Personal Construct Theory; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D055502:Secondary Prevention; D012649:Self Concept; D012803:Sick Role; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention