Auditory verbal hallucination and suicide: a systematic review

Auditory verbal hallucination (AVH), hearing one or more voices in the absence of a speaker, is among the most prevalent psychotic symptoms across clinical populations. While AVH is generally reported to be associated with poor clinical outcomes, the association between AVH-specific variables and distinct suicidality dimensions is not clear. This systematic review addresses these gaps by synthesising evidence on the association between AVH and distinct suicidality dimensions that extends beyond diagnostic boundaries. A literature search was performed in the databases PubMed, PsycINFO, and Embase to identify the relevant journal articles until the final search on December 16, 2024. Among the 1981 screened articles, 29 met the inclusion criteria for this systematic review. The majority of studies consistently indicated significant associations between AVH and suicidal ideation, attempt, non-suicidal self-injury, and others. However, the role of AVH in the transition from suicide ideation to suicide attempt remains inconclusive. Moreover, the factor that was consistently associated with suicidality appears to be the individual's appraisal of the voices, rather than the voices themselves. These findings suggest that evaluating cognitive appraisals and emotional element associated with AVH may be relevant in clinical setting when assessing suicide risk. Also, innovative interventions that directly target voice-related appraisals and distress could be explored. Future research may look into the characteristics and dimensions of AVH, as well as other particular psychotic symptoms, in relation to the ideation-to-action transition across different populations. This could help further inform the interventions to reduce the risk of suicidal behaviors and suicide.