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Further evidence of a link between psychotic experiences and suicidality

By Nicole MacKee
Mental health assessments should include questions about occasional hallucinations or delusions, says an Australian expert after a meta-analysis provided further evidence of a link between psychotic experiences and suicidality.

Associate Professor James Scott, Child and Adolescent Psychiatrist and Conjoint Associate Professor at the University of Queensland’s School of Public Health, Brisbane, said subthreshold psychotic experiences were a clear risk factor for suicidal ideation, suicide attempts and death by suicide.

‘We need to be asking people about these experiences as part of mental health risk assessments to help us with safety planning and provision of support for people who are distressed or experiencing mental ill health,’ he said.

Associate Professor Scott’s comments came as international researchers reported the findings of a systematic review and meta-analysis in JAMA Psychiatry.

The researchers evaluated 10 studies, three of which were coauthored by Associate Professor Scott, including almost 85,000 participants from 23 countries.

They found that people who reported psychotic experiences had an increased risk of future suicidal ideation (five articles; odds ratio [OR], 2.39), future suicide attempt (eight articles; OR, 3.15) and future suicide death (one article; OR, 4.39).

Psychotic experiences were defined as hallucinatory experiences and delusional beliefs that occurred with some degree of intact reality testing. The researchers said 5 to 8% of the general adult population had reported such experiences.

Associate Professor Scott said his group’s research had found about one in 12 Australian adolescents experienced hallucinations, which was much more common than previously thought.

‘There are a lot of people in the community who have psychotic experiences or psychotic symptoms. They might hear voices, see things that aren’t there or have feelings of paranoia, but it comes and goes and may cause some anxiety, but it is not psychosis,’ he said.

Associate Professor Scott said there were several theories about the mechanism underlying the link, including a possible shared genetic predisposition, and the content of the hallucinations influencing suicidality.

There was also growing evidence that psychotic experiences emerged as part of experiencing severe distress, he added.
JAMA Psych 2018; doi:10.1001/jamapsychiatry.2018.3514.