What is generally known about recognizing and addressing suicidal ideation and behavior in individuals with a first episode of psychosis?

Research has shown there is an elevated risk of dying by suicide and of non-fatal attempts by people in the early phase of psychosis. In fact, during the first 6 months after the onset of psychotic symptoms regardless of age, individuals may be at greatest risk for dying by suicide. The risk of suicide during the first year is 12 times higher than that of the general population. Up to 26% of people with schizophrenia have attempted suicide by the time they are admitted to the psychiatric hospital for the first time.

Although there has not been much research on the differences in suicidal ideation and behavior between first episode and established psychosis, they are thought to be similar. Of the approximately 43,000 annual deaths by suicide in the general population, 15% of those individuals have psychosis. The risk for dying by suicide in people with schizophrenia is about 4-10%. Further, people with psychosis tend to make more lethal attempts and use odd methods of attempting suicide. In addition, 20-40% of individuals with psychosis attempt suicide and 50% or more of individuals who make an attempt make repeated attempts. Suicide attempts are serious in their own right because they can result in permanent physical injury and/or disability, or psychological trauma.

Although when a person dies by suicide the surviving members of the family or friends might have been unaware of his or her intentions, suicide does not come out of the blue. There usually are risk factors or warning signs. In a suicidal moment, people with psychotic disorders are likely to be experiencing active psychotic symptoms, feelings of depression, and stress. While most people who make attempts or complete suicide have previously discussed their suicidal thoughts, most do not tell anyone right before they act. However, if asked, they can talk about their suicidal intentions. Suicidal behavior in people with psychosis tends to be long-term and needs to be monitored regularly.

Some experts believe that suicidal behavior is preventable. The factors that can lead to reducing risk include: early identification of the onset of psychosis especially when access to care is available, identification of risk factors in individuals after the onset of psychosis, use of specific and targeted interventions, and continuity of care. In fact, medication and psychotherapy for depressed mood in individuals with psychosis are likely to reduce suicidal behavior. There are specialized therapy approaches that can be provided by a treatment team for suicide prevention such as Collaborative Assessment and Management of Suicidality (CAMS), Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy – Suicide Prevention (CBT-SP). However, many of these approaches often require specialized training. For additional information, see the Suicide Prevention Resource Center.

For a comprehensive review of this topic, see the SAMHSA webinar Recognizing Suicidal Ideation and Behavior in Individuals with First Episode Psychosis.

For help with managing suicidal individuals see ZeroSuicide.

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