The role of anxiety in the relationships between psychotic experiences and suicidal ideation severity

The effects of anxiety on psychological pathways underpinning psychosis and suicidal thoughts are poorly understood. The overall goal of the present study was to rectify this by examining pathways linking emotional distress from psychotic symptoms, specifically, auditory hallucinations and delusions with suicide ideation severity, via anxiety, defeat, entrapment, and hopelessness.

Participants had psychosis and recent suicidal experiences and were under the care of mental health services. The design was cross-sectional. Two key mediated models were examined. In the first, the extent to which anxiety mediated the association between distress from psychosis and suicidal ideation severity was tested. In the second, the extent to which distress mediated the association between anxiety and ideation was tested. In both models, defeat, entrapment and hopelessness were parallel, proximal, mediators of suicidal ideation severity. General psychiatric symptoms were statistically controlled, as were severity levels of hallucinations and delusional symptoms.

There was an indirect, mediated, association linking emotional distress from auditory hallucinations and delusions with ideation severity via anxiety and entrapment. There was also a second mediated effect in which anxiety was associated with suicidal ideation severity via emotional distress from auditory hallucinations and delusions and entrapment. These mediation effects were not significant when symptom severity, rather than distress arising from symptoms, was tested.

Our findings underscore the importance of incorporating into contemporary suicide theories the complex dynamics underpinning the emotional impact of auditory hallucinations and delusions on suicidal thoughts especially when linked with anxiety and entrapment, whilst simultaneously developing suicide-focused therapies.