Psychotic symptoms and suicidality: combined findings from a high-risk and a clinical cohort of adolescents

Suicidality is common across the psychosis spectrum. To better understand this relationship, studies across different settings, varying levels of severity, and in-depth examination of psychotic symptoms, are needed. Here, we examined the association between psychotic symptoms and suicidality in adolescents who are at high-risk for psychopathology or already engaged in mental health care. Data were combined from a high-risk cohort from the general population (n = 156, 49.4% female, mean age 18.7 years) and a clinical sample receiving mental health care (n = 95, 86.3% females, mean age 15.2 years). Adolescents were interviewed on unusual thought content, non-bizarre delusional ideas, or hallucinations and assessed on suicidal ideations (SI) and suicide attempts (SA). Co-occurring psychopathology was measured with a semi-structured DSM-5 interview. Among the 251 adolescents, 50 (19.9%) reported SI and 59 (23.5%) also reported SA. When examined separately, all types of psychotic symptoms were associated with SI, SA, and suicidality severity. Multinomial regression analysis showed that unusual thought content was associated with SI (age and sex adjusted OR = 8.05 [2.79;23.19]). Both non-bizarre delusional ideas and unusual thought content were associated with a higher likelihood of SA (OR = 3.89 [1.37;11.04] and OR 6.45 [2.30;18.08], respectively). Notably, hallucinations were not associated with suicidality when delusional ideas were simultaneously considered. Results were independent of co-occurring psychopathology and multimorbidity (i.e. the presence of multiple disorders). Psychotic symptoms, especially delusional ideas, were associated with suicidality in adolescents. Psychotic symptoms may serve as important markers for suicidality, underscoring the need for closer monitoring in at-risk youth.