Heterogeneity in the course of suicidal ideation and its relation to suicide attempts in first-episode psychosis: a five-year prospective study

Abstract Background Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation with suicide attempts. Aims To identify five-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories. Method This five-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroner's reports in 382 FEP patients [mean age = 23.53(SD = 3.61)] admitted to two five-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression. Results Three suicidal ideation trajectories were identified : low and decreasing (85.08%); early decline, then increasing (7.85%), and persistent suicidal ideation (7.07%). Suicidal ideation prior to admission (OR = 2.85,p < 0.05) and cocaine use disorder (OR = 6.78,p < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33,p < 0.05) and attempts (OR = 8.18,p < 0.001) and alcohol use disorder (OR = 3.63, p < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up. Conclusions Our study highlights heterogeneity in the course of suicidal ideation over five years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly during periods of transition to other services and for patients who persistently report suicidal ideation, as they are more likely to engage in suicide attempts. Patients with factors associated with increased or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions.