Characteristics of self-harm in patients with first episode psychosis

Suicide is a leading cause of premature death in schizophrenia spectrum disorders (SSD). Self-harm (SH)-including suicide attempts (SA) and non-suicidal self-harm (NSSH)-is highly prevalent, especially in first-episode psychosis (FEP). Detailed knowledge of SH characteristics before and at treatment start is limited.

In a FEP SSD sample, we aimed to: (I) estimate SH prevalence, distinguishing NSSH and SA; (II) describe characteristics of the most recent SH at first treatment, including planning and motives; (III) examine the most recent SA, including violent versus non-violent methods; and (IV) investigate associations between clinical characteristics and current suicidal behavior (SB) at treatment start.

We included 252 patients aged 18-65 years with DSM-IV SSD from the Thematically Organized Psychosis study, all within their first year of adequate treatment. Assessments included SCID, PANSS, GFS, BIS, PAS, AUDIT/DUDIT, detailed SH interviews, the Scale for Suicidal Ideation, and CGI-SS. Analyses comprised bivariate tests and logistic regressions.

Of 251 participants with SH data, 85 (34%) reported lifetime SH and 32 (13%) at least one SA. Multiple SH episodes were associated with younger age, poorer premorbid social adjustment, longer duration of untreated psychosis, fewer negative symptoms, and higher alcohol use. NSSH typically occurred closer to treatment start, with planning under one day and rarely leading to hospitalization. Among SA, 57% used violent methods, more common in men and those with schizophrenia. At baseline, 33% showed current SB, associated with depressive symptoms and higher self-reported insight.

SH and SB are common and often severe in early SSD, with frequent violent SA and short planning times.