Elsevier

Comprehensive Psychiatry

Volume 93, August 2019, Pages 41-47
Comprehensive Psychiatry

Suicidal ideation and behaviour in patients with persecutory delusions: Prevalence, symptom associations, and psychological correlates

https://doi.org/10.1016/j.comppsych.2019.07.001Get rights and content
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Highlights

  • Suicidal ideation is extremely common in patients with persecutory delusions.

  • Patients most typically had suicidal thoughts at least weekly, wanted to relieve pain, but reported deterrents to acting.

  • Severity of suicidal ideation was most associated with depression, negative self ideas, pessimism, worry, and low well-being.

  • The correlates found can inform future research that seeks to understand suicidal ideation in this patient group.

Abstract

Background

To determine the prevalence of suicidal ideation and behaviour - and their correlates - in patients with persecutory delusions.

Methods

110 patients with persecutory delusions in the context of non-affective psychosis were assessed for suicidal thoughts and behaviours over the past month. Symptom and psychological assessments were also completed.

Results

The severity of suicidal ideation was: no suicidal ideation (n = 26, 23.6%); wish to be dead (n = 21, 19.1%); nonspecific active suicidal thoughts (n = 14, 12.7%); suicidal thoughts with methods but no intent (n = 29, 26.4%); suicidal thoughts with intent but no specific plan (n = 13, 11.8%); and suicidal intent with plan (n = 7, 6.4%). In the past month, five patients (4.5%) had made an actual, interrupted, or aborted suicide attempt. The severity of suicidal ideation was associated with higher levels of depression, paranoia, hallucinations, anger, insomnia, negative beliefs about the self and others, pessimism, worry, and delusion safety-seeking behaviours and lower levels of psychological well-being and reward responsiveness. Severity of ideation was not associated with cannabis or alcohol use, working memory, pain, or meaningful activity levels.

Conclusions

Patients with persecutory delusions are typically in a severe state of psychological stress, and at risk of suicide, as indicated by very high levels of suicidal ideation. This exploratory study also identifies correlates of suicidal ideation that could be investigated in causal research designs.

Keywords

Suicide
Persecutory delusions
Schizophrenia
Depression

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