Suicide attempt in first-episode psychosis: a 7.4 year follow-up study.
BACKGROUND
Individuals with first-episode psychosis demonstrate high rates of suicide attempt (SA).


OBJECTIVE
1) To examine the prevalence of, and risk factors for, SA in a first-episode psychosis (FEP) cohort over a 7.4 year follow-up period. 2) To investigate differences between single versus multiple suicide attempters.


METHODS
This study reports baseline and follow-up data from a naturalistic, prospective follow-up of 413 FEP patients treated at a specialist early psychosis centre. Assessments were conducted at treatment entry, initial symptom remission or stabilization, and long term follow-up. Binary logistic regression models were used to assess unadjusted and adjusted associations between early illness and sociodemographic characteristics and two outcome measures: any SA during follow-up; and multiple SAs.


RESULTS
Follow-up data were available for 282 participants. Sixty-one (21.6%) made a suicide attempt over the follow-up period, including 12 successful suicides. The following baseline risk factors increased the risk of any SA: history of self-harm (OR=4.27; p<0.001), suicidal tendencies (OR=2.30; p=0.022), being depressed for >50% of the initial psychotic episode (OR=2.49; p=0.045), and hopelessness (OR=2.03; p=0.030). History of problem alcohol use increased the risk of multiple SAs (OR=4.43; 95% CI (1.05-18.7); p=0.043).


CONCLUSIONS
The prevalence of suicide attempt in this study exceeds reports from short-term FEP studies but is comparable to longer term follow-up studies, indicating that risk remains elevated for at least 7 years following commencement of treatment. The key predictor of future suicide attempt was previous self-harm, indicating that interventions for self-harm are required.
Orygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre (EPPIC), Parkville Victoria 3052, Melbourne, Australia. jo.robinson@mh.org.au
J
J
Robinson
M G
MG
Harris
S M
SM
Harrigan
L P
LP
Henry
S
S
Farrelly
A
A
Prosser
O
O
Schwartz
H
H
Jackson
P D
PD
McGorry
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000503:physiopathology; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult