Arch Suicide Res. 2024 Oct-Dec;28(4):1093-1106. doi: 10.1080/13811118.2023.2269209. Epub 2023 Oct 16.
Individuals at clinical high-risk for psychosis (CHR-P) are at increased risk for suicide. However, the relationship between attenuated positive symptoms and suicidal ideation are not well understood, particularly as they interact over time. The current study addressed this gap in the literature. We hypothesized that greater attenuated symptoms would be concurrently and prospectively associated with suicidal ideation. Further, we hypothesized that suspiciousness and perceptual abnormalities would have the strongest relationship with suicidal ideation. Within-person variation in symptoms and suicidal ideation were examined across 24 treatment sessions for individuals at CHR-P. Attenuated positive symptoms (unusual thought content, suspiciousness, grandiose ideas, perceptual abnormalities, and disorganized communication) and suicidal ideation were assessed at each session. Logistic mixed effect models examined concurrent and time-lagged relationships between symptoms and suicidal ideation among 36 individuals at CHR-P. Results indicated that suicidal ideation was more likely during weeks when participants reported more severe total attenuated positive symptoms. Further, suspiciousness was uniquely associated with suicidal ideation, both concurrently and at the following session. Post hoc models examined the reverse direction of this relationship, demonstrating that suicidal ideation also prospectively predicted suspiciousness at the following session. These results suggest that within-person attenuated symptoms, particularly suspiciousness, are associated with suicidal ideation among individuals at CHR-P. However, the bidirectional relationship between suspiciousness and suicidal ideation raises questions about causal nature of this relationship. Further research is needed to examine the dynamic interplay of suspiciousness and suicidal ideation.
处于精神病高危状态的个体（CHR-P）自杀风险增加。然而，目前尚不清楚轻度阳性症状与自杀意念之间的关系，特别是随着时间的推移，它们之间的相互作用。本研究旨在填补这一文献空白。我们假设，更严重的轻度症状将同时和前瞻性地与自杀意念相关。此外，我们假设怀疑和知觉异常与自杀意念的关系最强。对处于 CHR-P 的个体的 24 个治疗疗程中的症状和自杀意念进行了个体内变异性分析。在每个疗程中评估了轻度阳性症状（异常思维内容、怀疑、夸大观念、知觉异常和沟通紊乱）和自杀意念。逻辑混合效应模型检查了 36 名处于 CHR-P 的个体中症状和自杀意念之间的同时和时滞关系。结果表明，当参与者报告更严重的总轻度阳性症状时，自杀意念更有可能发生。此外，怀疑与自杀意念在同时和下一次疗程中都有独特的关联。事后模型检验了这种关系的反向方向，表明自杀意念也可以前瞻性地预测下一次疗程中的怀疑。这些结果表明，个体内的轻度症状，特别是怀疑，与处于 CHR-P 的个体的自杀意念有关。然而，怀疑和自杀意念之间的这种双向关系引发了对这种关系的因果性质的质疑。需要进一步研究来检验怀疑和自杀意念之间的动态相互作用。
