A study of patients with first-episode schizophrenia spectrum disorders identified four distinct patterns of suicidal behavior, each associated with clinical factors such as depression, insight into illness, and duration of untreated psychosis.
In the analysis, researchers included 224 individuals and tracked suicidal thoughts, plans, or attempts during three key periods: prior to symptom onset, during the untreated phase, and at the start of treatment.
The participants, aged 18 to 65 years, were grouped based on how their suicidal behavior evolved over time. More than half (51%) showed little to no suicidal behavior across all stages. This group, labeled “persistent low/no suicidal behavior,” served as the reference group.
Another 24% of the participants had minimal symptoms early but showed increased suicidal behavior at treatment onset. A third group (11%) experienced severe symptoms only during the untreated period. The remaining 14% had consistently high levels of suicidal behavior throughout all phases.
Depression was a common factor among all higher-risk groups. Those with persistent suicidal behavior had an average depression score of 3.3 compared with 2.4 in the low/no suicidal behavior group.
Clinical insight—specifically, awareness of the need for treatment—was also higher in individuals with increasing or persistent suicidal behavior. In contrast, those who experienced suicidal behavior only during the untreated phase tended to be younger and had longer durations without care. This group’s median untreated period was 130 weeks compared with 22 weeks in the reference group.
In a subsample of 97 patients, the researchers examined childhood trauma and found that those with persistent suicidal behavior reported more emotional abuse and higher overall trauma scores. The average emotional abuse score was 13.4 in the persistent group vs 9.6 in the group with increasing but less severe symptoms.
The researchers used structured interviews and validated scales to assess depression, insight, trauma, and other psychiatric symptoms. Suicidal behavior was categorized by thoughts, plans, or attempts.
No statistically significant link was found between the severity of hallucinations or delusions (positive symptoms) and suicide risk, indicating other factors may have played a more substantial role.
The researchers suggested that suicidal behavior in early schizophrenia could follow multiple trajectories, each influenced by distinct clinical profiles. They noted that understanding these pathways could inform targeted interventions. For instance, reducing the delay in treatment may help those at risk during the untreated phase, while trauma-informed care may be necessary among patients with persistent risk.
The authors reported no conflicts of interest.
Source: Psychiatry Research