Psychosis: Externalising internally-generated and self-directed threat

Purpose: Suicidal ideation/behaviour (SIB) and psychosis are two highly associated phenomena. This paper proposes that psychotic experiences (PEs), for some, may be consequential to SIB. More specifically this paper... [ view full abstract ]

Purpose: Suicidal ideation/behaviour (SIB) and psychosis are two highly associated phenomena. This paper proposes that psychotic experiences (PEs), for some, may be consequential to SIB. More specifically this paper hypothesises that PEs among individuals experiencing SIB may constitute self-preservatory beliefs or experiences that serve to externalise internally generated and self-directed threat. Methods: To initiate empirical testing of this hypothesis the current study, using prospective data from a Danish population cohort, first sought to test the temporal occurrence of SIB and PE. Next, using cross-sectional data from two UK epidemiological surveys, the study sought to demonstrate that PEs were more commonly reported by those who experienced SIB and that the strength of the association between PEs and SIB varied according to (i) SIB recency (lifetime/last 12 months) and (ii) SIB severity (suicidal thought/attempt).Results: Chi-square comparison tests on the Danish data revealed that SIB was statistically more likely to precede (41.4%) rather than follow PE (20.7%). Multivariate logistic regression analyses of the UK data indicated that individuals who thought about suicide in their lifetime were up to 8 times more likely to experience specific PEs while those who both thought about and attempted suicide in both their lifetime and in the year of assessment were up to 48 times more likely to experience PEs compared to SIB free members of the population. Overall, the probability of PEs increased in relation to SIB recency and severity. Conclusions: The findings provide preliminary support for a novel SIB – PE co-occurrence hypothesis.