Suicidal Ideation to Attempt Pathways and Experiences Among Adults with Schizophrenia Spectrum Disorders

There is an absence of investigations and knowledge of the pathways from suicidal ideation to attempt among individuals with schizophrenia spectrum disorders (SSDs). This study explored suicide attempt experiences and identified pathway steps and timeframes among adults with SSDs.

Quantitative and qualitative data were collected from adults with SSDs in a community mental health setting of the United States who had a history of suicide attempt and 6-month history of suicidal ideation (n = 19). The Pathway to Suicidal Action Interview (PSAI) was administered and data from qualitative questions were analyzed using a hybrid analytic approach with inductive and deductive coding.

Transition toward suicide attempt occurred often within minutes or seconds of the decision point (mode of 30 minutes) and first step of attempt action (mode of 30 seconds). Most participants did not engage in preparatory behavior (68%) or mull in contemplation (53%) prior to their attempt. Symptoms of depression (89%) and psychosis symptoms (63%) were endorsed by most participants at the time of attempt, with 47% reporting hearing auditory hallucinations to kill themselves or die. Suicide attempt experience themes pertained to impulsivity, access to means, psychosis symptoms, survival ambivalence, attempt antecedents, attempt location, travel, and role of others.

Findings underscore the heterogeneity of suicide attempt pathways and reveal opportunities for prevention efforts related to lethal means safety, management of acute emotional distress, and targeting psychosis symptoms that can impact suicide risk for those with SSDs. Future research is needed among larger and more diverse samples.