University of Michigan, School of Social Work, Ann Arbor, MI, United States of America; University of Michigan, Department of Psychiatry, Ann Arbor, MI, United States of America.
Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, OH, United States of America.
Schizophr Res. 2021 Feb;228:298-304. doi: 10.1016/j.schres.2020.12.025. Epub 2021 Jan 23.
Suicide is a leading cause of death for individuals with psychosis. Although factors influencing suicide risk have been studied in schizophrenia, far less is known about factors that protect against or trigger increased risk during early-stage and first episode of psychosis. This study examined whether depression, psychotic symptoms, clinical insight, and cognition were associated with suicide ideation among individuals with first-episode psychosis.
Data were obtained from the Recovery After an Initial Schizophrenia Episode (RAISE) project. Participants (n = 404) included adults between ages 15 and 40 in a first episode of psychosis. Measurement included the Positive and Negative Syndrome Scale, Brief Assessment of Cognition in Schizophrenia, and Calgary Depression Scale for Schizophrenia. A logistic regression model evaluated clinical and cognitive variables as predictors of suicidal ideation.
Greater positive symptoms (OR = 1.085, p < .01) and depression (OR = 1.258, p < .001) were associated with increased likelihood of experiencing suicidal ideation during the RAISE project. Meanwhile, stronger working memory (OR = 0.922, p < .05) and impaired clinical insight (OR = 0.734, p < .05) were associated with a decreased likelihood of experiencing suicidal ideation.
The likelihood of experiencing suicidal ideation was significantly increased when positive and depressive symptoms were present, and significantly decreased when clinical insight was poorer and working memory stronger. These findings have important implications for the role of cognition and insight in risk for suicide ideation in early-stage psychosis, which may aid in improving the prediction of suicide behaviors and inform clinical decision-making over the course of the illness.
自杀是精神病患者的主要死亡原因。尽管已经研究了影响自杀风险的因素，但对于在精神病早期和首次发作期间保护或引发风险增加的因素知之甚少。本研究调查了首发精神病患者的抑郁、精神病症状、临床洞察力和认知是否与自杀意念有关。
数据来自首次精神病发作后的康复（RAISE）项目。参与者（n=404）包括处于精神病首次发作的 15 至 40 岁之间的成年人。测量包括阳性和阴性综合征量表、简明精神分裂症认知评估量表和卡尔加里精神分裂症抑郁量表。逻辑回归模型评估了临床和认知变量作为自杀意念预测因子的作用。
阳性症状（OR=1.085，p<.01）和抑郁（OR=1.258，p<.001）增加与 RAISE 项目期间发生自杀意念的可能性增加有关。同时，更强的工作记忆（OR=0.922，p<.05）和受损的临床洞察力（OR=0.734，p<.05）与发生自杀意念的可能性降低有关。
当存在阳性和抑郁症状时，发生自杀意念的可能性显著增加，而当临床洞察力较差和工作记忆较强时，发生自杀意念的可能性显著降低。这些发现对认知和洞察力在早期精神病自杀意念风险中的作用具有重要意义，这可能有助于提高自杀行为的预测，并为疾病过程中的临床决策提供信息。
