Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study

Psychotic experiences are far more prevalent in the population than psychotic disorders and are associated with a wide range of depressive, anxiety and behavioral disorders, as well as increased risk for psychotic disorder. Recently, psychotic experiences have been highlighted as a potentially valuable clinical marker of risk for suicidal behavior. There have been few studies to date, however, to assess psychotic experiences as a predictor of suicidality over time. We wished to assess whether young persons with suicidal ideation at baseline assessment who reported psychotic experiences were at higher risk for persistence of suicidal ideation at follow-up than young persons who also reported suicidal ideation at baseline but who did not report co-occurring psychotic experiences. A total of 2,263 adolescents were assessed at age 13 to 14 years for psychotic experiences, suicidal ideation and internalizing and externalizing psychopathology. Participants were re-assessed at ages 16 to 17 years and 19 to 20 years. Among 13- to 14-year olds with suicidal ideation, co-occurring psychotic experiences did not predict an increased odds of persistence of suicidal ideation to age 16 to 17 years (OR=0.94, 95% CI: 0.19-4.78). Among 16- to 17-year olds with suicidal ideation, however, co-occurring psychotic experiences predicted a 6-fold increased odds of persistence of suicidal ideation to age 19 to 20 years (OR=5.53, 95% CI: 1.33-23.00). Psychotic experiences are an important but under-recognized marker of risk for persistence of suicidal ideation, in particular from mid-adolescence. An increased emphasis on the clinical assessment of psychotic experiences in mental health services should be a priority.