Trajectories of suicidal behavior and their clinical correlates in the early phases of schizophrenia spectrum disorders

Abstract

Background

Many risk factors for suicidal behavior (SB) in schizophrenia spectrum disorders (SSD) are present before the onset of psychosis or are associated with specific phases of illness. We aim to investigate the trajectories of SB from before the onset of psychosis until the first start of treatment in patients with first-episode psychosis (FEP).

Method

A total of 252 patients with first-episode SSD were recruited, out of which 224 had complete SB data. They participated in clinical interviews and self-report questionnaires during their first treatment. We assessed SB in three time periods: Before the onset of psychosis, during untreated psychosis, and at treatment start (study baseline). We used K-mean cluster analyses to identify trajectories of SB over these periods.

Results

Four trajectories of SB were identified: persistent low/no SB (n = 114, 51 % of 224), increasing mild/moderate SB (n = 54, 24 %), severe SB during untreated psychosis (n = 25, 11 %), severe persistent SB (n = 31, 14 %). With “persistent low/no SB” as a reference group, all other groups had significantly more depressive symptoms at baseline. The duration of untreated psychosis was significantly longer in the group with “severe SB during untreated psychosis”. Clinical insight subscale scores differed between the trajectory groups. Also, the “severe persistent SB” group reported more emotional abuse and total childhood trauma than the “increasing mild/moderate SB” group.

Conclusion

Our findings suggest the presence of different pathways to SB in FEP. More knowledge about these pathways can support the development of tailored preventive strategies in this patient group.