Near-Term Risk for Psychosis and Non-Psychosis-Related Suicide: A Retrospective Examination of the Last 30 Days of...

Suicide is a major public health problem in the United States. This retrospective exploratory study examined clinician-identified state-related risk factors observed within 30 days prior to death by suicide, comparing 24 decedents with psychosis-related suicide and 133 non-psychosis-related suicide. A secondary descriptive analysis was conducted for 47 patients who were evaluated and denied suicidal ideation within 48 h of death by suicide.

Demographic factors being single and unemployed increased risk across both cohorts. While reporting similar SI histories, decedents with psychosis had higher rates of suicide attempts (67% vs. 38%), anxiety and agitation (83% vs. 77%), substance abuse (79% vs. 40%), comorbid diagnosis (71% vs. 54%), social isolation (71% vs. 54%), and treatment non-adherence (58% vs. 4%). In contrast, decedents without psychosis reported sleep problems (80% vs. 54%), and acquired capability for suicide (96% vs. 46%). Among psychotic patients who denied having SI, 83% died by suicide within two days of evaluation.

Suicide risk assessment that places strong reliance on verbalized SI as a gateway to determine risk is insufficient in practice. For optimal clinical management and suicide prevention clinicians need a better understanding of near-term risk for suicide and to focus assessment and clinical care accordingly.