Early risk factors for suicide in an epidemiological first episode psychosis cohort

Background: Much remains unknown about whether there are early risk factors for suicide in psychosis. Aim: The aim of the study was to determine whether there are any identifiable early symptom clusters, aetiological factors or illness course markers for suicide in first episode psychosis. Method: A total of 2132 patients with first episode psychosis presenting to secondary care services in London (1965-2004; n = 1474), Nottingham (1997-1999; n = 195) and Dumfries and Galloway (1979-1998; n = 463) were traced after up to 40 years (mean 13 years) following first presentation. Risk factors were identified from the Operational Checklist for Psychotic Disorders rated for the first year following presentation. Results: Overall, there were 51 suicides and 373 deaths from other causes. Male gender (RR 2.84, 95% Cl 1.20-6.69, p = 0.02) and a cumulative threshold effect of symptoms early in the illness (RR 6.81,95% Cl 2.33-19.85, p <0.001) were associated with a higher propensity for later completed suicide. There was also a suggestion that early manic symptoms might increase the risk of later suicide irrespective of initial diagnosis. Conclusion: Suicide risk was associated with a cumulative threshold effect of symptoms and manic symptoms. As suicide is a relatively rare event in psychotic disorders, general population-based prevention strategies may have more impact in this vulnerable group as well as the wider population.