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Psychotic Experiences a Marker for Future Suicidal Behavior

December 06, 2018

As many as one-quarter of suicide attempts are associated with psychotic experiences, according to a systematic review and meta-analysis published online in JAMA Psychiatry.

“These findings show the need both for clinicians to pay particular attention to patients reporting experience of psychotic experience, and for greater funding for research into recognizing a psychosis subtype of suicide,” said lead author Ian Kelleher, MD, PhD, a psychiatry research lecturer at the Royal College of Surgeons in Ireland,  Dublin.

Dr. Kelleher and colleagues analyzed 10 general population cohort studies spanning 84,285 people across 23 countries to examine the link between psychotic experiences and subsequent suicidal ideation, attempts, and deaths. Psychotic experiences such as hearing voices are far more prevalent than psychotic disorders, researchers pointed out, with up to 7% of the general population reporting occasionally hearing voices or other perceptual abnormalities.

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The analysis revealed increased odds of suicidal thoughts as well as suicide attempts and deaths in people who reported psychotic experiences. In fact, the increased risk was higher than could be explained by co-occurring psychopathy, researchers reported.

Psychotic experiences, they concluded, are an important clinical marker of future suicide risk.

“Our research shows that if we can understand and treat the factors associated with these perceptual abnormalities, we could prevent at least a quarter of suicide attempts and deaths,” Dr. Kelleher said. “Given that about 1 million people die by suicide every year, that’s a very encouraging prospect for suicide prevention.”

“If we are to understand suicide, we need to understand a lot more about perceptual abnormalities – what causes people to hear voices? How do these experiences relate to the biological and social factors involved in suicide risk?” added study coauthor Kathryn Yates, MSc, Royal College of Surgeons in Ireland. “There are still a lot of unanswered questions, but this research points to new avenues to improve prediction of suicidal behavior.”

—Jolynn Tumolo


Yates K, Lång U, Cederlöf M, et al. Association of psychotic experiences with subsequent risk of suicidal ideation, suicide attempts, and suicide deaths: a systematic review and meta-analysis of longitudinal population studies. JAMA Psychiatry. 2018 November 28;[Epub ahead of print].

RCSI research reveals that one in four suicide attempts are associated with perceptual difficulties such as ‘hearing voices’ [press release]. Dublin, Ireland: Royal College of Surgeons in Ireland; November 29, 2018.

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