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Why are psychotic experiences associated with self-injurious thoughts and behaviours? A systematic review and critical appraisal of potential confounding and mediating factors

Published online by Cambridge University Press:  20 September 2017

E. Hielscher ,
J. E. DeVylder ,
S. Saha ,
M. Connell  and
J. G. Scott
E. Hielscher*
Affiliation:
Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia School of Public Health, The University of Queensland, Brisbane, QLD, Australia
J. E. DeVylder
Affiliation:
Graduate School of Social Service, Fordham University, New York, NY, USA
S. Saha
Affiliation:
Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia Department of Psychiatry, and Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
M. Connell
Affiliation:
Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
J. G. Scott
Affiliation:
Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
*
Author for correspondence: E. Hielscher, E-mail: e.hielscher@uq.edu.au
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Abstract

Psychotic experiences (PEs), including hallucination- and delusion-like experiences, are robustly associated with self-injurious thoughts and behaviours (SITB) in the general population. However, it remains unclear as to why there is an association. The purpose of this systematic review was to elucidate the role of other factors that influence the association between PEs and SITB and, in doing so, highlight potential mechanisms underlying the relationship. A search of electronic international databases was undertaken, including PubMed, PsycINFO and EMBASE, and eligible studies were grouped according to seven confounder categories: sociodemographics, mental disorders, alcohol and substance use, environmental, psychological, intervention and family history/genetic factors. The systematic search strategy identified 41 publications reporting on 1 39 427 participants from 16 different countries. In the majority of studies, where adjustment for other variables occurred, the association between PEs and SITB persisted, suggesting PEs have an independent role. Common mental disorders, psychological distress and negative environmental exposures explained a substantial amount of the variance and therefore need to be considered as potential underlying mechanisms. There was high variability in the variables adjusted for in these studies, and so the question still remains as to whether the association between PEs and self-harm/suicidality can be attributed (fully or in part) to confounding and mediating factors or directly causal mechanisms. Regardless of causality, the now extensive literature reporting an association between these two clinical phenomena supports the broad usefulness of PEs as an indicator of risk for SITB.

Keywords

Confounderspsychotic experiencesself-harmself-injurious behavioursuicide
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 9 , July 2018 , pp. 1410 - 1426
Copyright
Copyright © Cambridge University Press 2017 

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