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Predictors of Suicide Attempt in Early-Onset, First-Episode Psychoses: A Longitudinal 24-Month Follow-Up Study

Vanessa Sanchez-Gistau, MD; Inmaculada Baeza, MD, PhD; Celso Arango, MD, PhD; Ana González-Pinto, MD, PhD; Elena de la Serna, PhD; Mara Parellada, MD, PhD; Motserrat Graell, MD; Beatriz Paya, MD; Cloe Llorente, MD; and Josefina Castro-Fornieles, MD, PhD

Published: November 13, 2012

Article Abstract

Objective: To study the prevalence of suicide attempts and factors associated with risk for suicide during the first episode of psychosis, and to identify early predictors of suicide attempts over a 24-month follow-up period in an early-onset, first-episode psychosis cohort.

Method: 110 subjects in their first episode of psychosis aged between 9 and 17 years were assessed by using the DSM-IV diagnostic interview Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and a battery of clinical instruments at baseline and at 12 and 24 months. Patients were enrolled in the study from March 2003 through November 2005. Suicide attempts and level of suicidality at each assessment were evaluated by using the Clinical Global Impression for Severity of Suicidality and the Hamilton Depression Rating Scale. Subjects were classified as being at high, low, or no risk of suicide, depending on their scores on certain items of these scales. Clinical associations between the outcome measures high risk for suicide during acute episode and suicide attempts during follow-up were investigated by 2 sets of logistic regression analyses.

Results: The 24-month prevalence of suicide attempters was 12.4%. History of suicide attempts prior to psychotic episode (OR=20.13; 95% CI, 1.83-220.55; P=.01), severe depressive symptoms (OR=8.78; 95% CI, 1.15-67.11; P=.003), and antidepressant treatment (OR=15.56; 95% CI, 2.66-90.86; P=.002) were associated with being classified as high suicide risk at baseline. The categorization of high suicide risk at baseline predicted suicide attempts during follow-up (OR=81.66; 95% CI, 11.61-574.35; P=.000).

Conclusions: Suicide is a major concern in early-onset first-episode psychosis. Suicidal behavior and depressive symptoms at psychosis onset are important signs to be aware of to prevent suicide attempts during the early period after first-episode psychosis.

J Clin Psychiatry

Submitted: January 5, 2012; accepted August 1, 2012.

Online ahead of print: November 13, 2012 (doi:10.4088/JCP.12m07632).

Corresponding author: Vanessa Sanchez-Gistau, MD, Department of Child and Adolescent Psychiatry and Psychology, Institut Clí­nic of Neurosciences, Hospital Clí­nic Universitari, Barcelona Villarroel, 170, Barcelona 08036, Spain (

Volume: 73

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