Predictors of suicide in Asian patients with first episode psychosis

High rates of suicide have been reported in psychotic disorders, particularly in the early phases. Studies examining suicide risk during the first episode of psychosis (FEP) are lacking, especially in the Asian context. The present study aims to investigate the prevalence of completed suicides and associated risk factors in a multi-ethnic Asian society.

Data from 1397 patients accepted into a local Early Psychosis Intervention Programme (EPIP) was collected. This included sociodemographic and clinical data. Cox proportional-hazards regression models were performed in order to explore factors associated with time to completed suicide.

The sample comprised of 1397 FEP patients, with 687 females and 710 males. The mean age was 28.2 years. The prevalence of suicide in this sample was 1.9%. Of the 26 FEP patients who committed suicide, data on time to suicide was available for 23 of them. 56.5% committed suicide during the first year of follow-up. A higher risk of suicide was associated with an older age (Hazard Ratio (HR)=1.31, 95% CI, 1.05-1.63), longer DUP (HR=1.05, 95% CI, 1.02-1.11), higher PANSS positive (HR=1.91, 95% CI, 1.37-2.67), higher GAF symptomatology (HR=1.16, 95% CI, 1.04-1.30) and GAF disability scores (HR=1.12, 95% CI, 1.02-1.22).

Older patients with longer DUPs, higher PANSS positive and negative scores and better functioning appear to be at higher risk of suicide in this sample. Early intervention services should focus on a thorough risk assessment in order to reduce the risk of suicide during FEP.