Psychopathological Characteristics and Subjective Dimensions of Suicidality in Adolescents at Ultra High Risk (UHR) for Psychosis

Background and hypothesis: Suicide and suicidal behaviour are among the most frequent and serious complications in severe mental disorders, especially in the developmental years. From the early stages of psychosis, i.e., in ultra high risk (UHR) and first psychotic episode (FEP) subjects, the suicide risk (SR) is higher than in the general population. Therefore, assessing suicidal thoughts during the high psychotic risk period is extremely important. This study aims to assess SR in a group of UHR adolescents compared to FEP and clinical help-seeking controls (CHSC) peers.

Study design: 95 adolescents (13-18 years) were evaluated through psychopathological interviews and self-report questionnaires to assess UHR, FEP or CHSC condition, clinical suicidal behaviour and suicide thoughts, global functioning, self-disorders, and other psychiatric comorbidities.

Study results: We identified 17 FEP, 33 UHR, and 45 CHSC. 54.7% of the total sample is at SR, identified in 70.6% of FEP subjects, 81.8% of UHR subjects and 28.9% of CHSC patients. Furthermore, SR correlated with positive symptoms (p = 0.013), negative symptoms (p = 0.032), general symptoms (p = 0.009), and global functioning (p < 0.001) as well as with the total EASE score (p < 0.001). An increasing rate of self-disorders was associated with an increased likelihood of SR.

Conclusions: Monitoring UHR adolescents not only for psychotic onset but also for SR is crucial due to their higher suicidality and worse prognosis. Rigorous management and monitoring can enable more targeted interventions and suicide prevention strategies.