Social and psychological contributions to the co-occurrence of sub-threshold psychotic experiences and suicidal behavior.
OBJECTIVE
Psychotic experiences and suicidal behavior commonly co-occur in the general population, which can have implications for suicide prevention approaches. However, little is known about the nature of this relation in non-clinical samples. This cross-sectional study aimed to address a research gap by testing whether the relation between psychotic experiences and suicide-related outcomes (ideation, intent, and attempts) is explained by common social and psychological factors.


METHODS
Young adult college students (N = 590) were assessed for psychotic experiences, suicidal behavior, and a comprehensive set of 24 potential shared risk factors selected through review of past epidemiological studies and meta-analyses. Nonparametric bootstrapped regression models were used to examine whether these factors attenuated or eliminated the associations between psychotic experiences and suicide-related outcomes.


RESULTS
Psychotic experiences were associated with greater risk for suicidal ideation and behaviors. Adjustment for psychosocial factors, particularly those contributing to cumulative stress, accounted for the associations between psychotic experiences and suicide-related outcomes, except broadly defined suicidal ideation.


CONCLUSIONS
These results suggest that the robust associations between psychotic experiences and suicidal behavior demonstrated in past studies may be primarily explained by shared risk factors, rather than by causal relations. In our sample, suicidal behavior and sub-threshold psychosis appear to be trans diagnostic clinical outcomes that share common causes, notably cumulative stress, but do not cause one another.
School of Social Work, University of Maryland, 525 W Redwood Street, Baltimore, MD, 21201, USA. jdevylder@ssw.umaryland.edu.
Jordan E
JE
DeVylder
VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA.|Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
Danielle R
DR
Jahn
School of Social Work, University of Maryland, 525 W Redwood Street, Baltimore, MD, 21201, USA.
Tracie
T
Doherty
Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA.
Camille S
CS
Wilson
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Holly C
HC
Wilcox
Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA.
Jason
J
Schiffman
Department of Psychology, The College of William and Mary, Williamsburg, VA, USA.
Matthew R
MR
Hilimire
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D059020:Suicidal Ideation; D014495:Universities; D055815:Young Adult
Attempts; Psychosis continuum; Risk factors; Suicide; Young adults