Patterns of suicidal thoughts and behaviors in depressed adolescents with and without psychotic features

We sought to assess the influence of psychotic symptoms on suicidal thoughts and behaviors in youth with depression; and we aimed to examine variations in established suicidal risk factors between youth with depression who experienced psychotic symptoms compared to those who had not.

Youth with depression were asked about past suicidal behavior and received a diagnostic interview to determine the presence of psychotic symptoms. Additionally, suicidal ideation, behaviors, socioemotional factors, impulsivity, and executive functioning were assessed.

The distribution of suicidal categories differed between youth presenting psychotic symptoms (PSY+) and those without (PSY-). Youth with a history of suicide attempts reported more intense and severe ideations than those with suicidal ideations but no attempts across psychosis groups. PSY+ youth had more feelings of perceived burdensomeness and thwarted belongingness and less social protective factors. PSY+ youth were also more impulsive, but only on behavioral, not self-report, measures. There were no differences between psychosis groups on measures of suicidal action and acceptability or executive functioning.

Youth with a history of both depression and psychotic features exhibit a significantly higher likelihood for suicidal behavior than those with depression alone. Social disruption significantly contributed to this behavior. Social connections and perceived social support were significant risk factors for youth with a history of depression and psychotic symptoms. Clinicians must be keenly aware of psychotic features in patients with depression, as these symptoms significantly elevate the risk of suicide attempt, highlighting the necessity for timely and focused intervention.