title: A comparison of correlates of suicidal ideation prior to initial hospitalization for first-episode psychosis with prior research on correlates of suicide attempts prior to initial treatment seeking.
abstract: OBJECTIVE
  Individuals with first-episode psychosis, like those with chronic psychotic disorders, are at elevated risk for suicidal ideation and suicide attempts. However, relatively little is known about suicidality among first-episode patients prior to their initial presentation for treatment. This analysis was designed as a US-based examination of recent findings on prior suicide attempts from Dublin, Ireland, here focusing on prevalence and correlates of suicidal ideation during the weeks prior to initial treatment-seeking.
  
  
  METHODS
  Participants included 109 first-episode inpatients with primary psychotic disorders in public-sector settings that serve an urban, low-income, socially disadvantaged, predominantly African American population. Eligible patients had received <3 months of prior antipsychotic treatment and had not been hospitalized for psychosis >3 months prior to the index admission, though most were completely treatment naïve. Assessments included the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Birchwood Insight Scale, and a rigorous method for determining age at onset of first psychotic symptoms and duration of untreated psychosis.
  
  
  RESULTS
  Disconcertingly, nearly one quarter of patients (23%) endorsed a history of suicidal ideation in the 2 weeks prior to first admission. In the model designed to replicate the prior study in Ireland, Calgary Depression score (calculated omitting hopelessness and suicidal ideation as these were separate variables in the analysis) was a predictor of suicidal ideation (P < 0.01). In separate bivariate analyses analogous to the original study, two domains of insight were associated with suicidal ideation.
  
  
  CONCLUSIONS
  Findings suggest that depression, insight, and suicidality should be carefully monitored among first-episode patients initiating treatment and during the early course of illness. As insight improves, coping strategies should be enhanced with a goal of minimizing depression and preventing suicidality.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Peggy
authors.initials: P
authors.lastname: Flanagan
authors.forename: Michael T
authors.initials: MT
authors.lastname: Compton
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology