Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis

S. Honings, M. Drukker, R. Groen, J. van Os

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)

Abstract

Background. Recent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed. Method. A systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled. Results. The risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74% reduction in excess risk. Conclusions. PE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.
Original languageEnglish
Pages (from-to)237-251
Number of pages15
JournalPsychological Medicine
Volume46
Issue number2
DOIs
Publication statusPublished - 1 Jan 2016

Keywords

  • Meta-analyses
  • non-suicidal self-injury
  • psychotic experiences
  • self-injurious behaviour
  • suicide
  • BIPOLAR SPECTRUM FEATURES
  • SUICIDAL IDEATION
  • COMMUNITY SAMPLE
  • SYMPTOMS
  • ADOLESCENTS
  • ASSOCIATION
  • PREVALENCE
  • DEPRESSION
  • DISORDERS
  • CONTINUUM

Cite this

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title = "Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis",
abstract = "Background. Recent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed. Method. A systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled. Results. The risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74{\%} reduction in excess risk. Conclusions. PE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.",
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author = "S. Honings and M. Drukker and R. Groen and {van Os}, J.",
year = "2016",
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Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. / Honings, S.; Drukker, M.; Groen, R.; van Os, J.

In: Psychological Medicine, Vol. 46, No. 2, 01.01.2016, p. 237-251.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis

AU - Honings, S.

AU - Drukker, M.

AU - Groen, R.

AU - van Os, J.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background. Recent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed. Method. A systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled. Results. The risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74% reduction in excess risk. Conclusions. PE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.

AB - Background. Recent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed. Method. A systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled. Results. The risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74% reduction in excess risk. Conclusions. PE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.

KW - Meta-analyses

KW - non-suicidal self-injury

KW - psychotic experiences

KW - self-injurious behaviour

KW - suicide

KW - BIPOLAR SPECTRUM FEATURES

KW - SUICIDAL IDEATION

KW - COMMUNITY SAMPLE

KW - SYMPTOMS

KW - ADOLESCENTS

KW - ASSOCIATION

KW - PREVALENCE

KW - DEPRESSION

KW - DISORDERS

KW - CONTINUUM

U2 - 10.1017/s0033291715001841

DO - 10.1017/s0033291715001841

M3 - Article

VL - 46

SP - 237

EP - 251

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 2

ER -