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A systematic review of longitudinal studies of suicidal thoughts and behaviors in first-episode psychosis: course and associated factors

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Abstract

Purposes

To better assess and reduce suicidal risk in first-episode psychosis (FEP), we aimed to investigate the evolution of suicidal thoughts and behaviors (STBs) and associated factors in FEP.

Method

This systematic review (PROSPERO-CRD42020168050) meets PRISMA guidelines. PubMed, Medline, PsycINFO, Embase, EBM Reviews and references lists of relevant articles were searched (February 2020) to identify longitudinal studies, published in English or in French, that assessed the prevalence of STBs at entry to services and over follow-up, and examined factors associated with STBs among all persons with affective and non-affective FEP from a defined catchment area. Screening, data extraction and quality assessment using the adapted Newcastle Ottawa Scale were done independently by two reviewers. Results on prevalence and associated factors are presented by type of STB.

Results

Of 3,177 references, 17 studies of 11 non-overlapping samples (n = 14,907) with varying lengths of follow-up (1–41.7 years) were included. The prevalence of STBs decreased over follow-up. Up to 21.6% made at least one suicide attempt, 27% had suicidal ideation, and 1–4.3% died by suicide during follow-up. Of 53 factors assessed across studies, only male sex, depressive symptoms, and STBs occurring early during follow-up were associated with subsequent STBs. Early intervention for psychosis decreased STBs in the first three years. Other factors were assessed in a single study, yielded conflicting results, or were not associated with STBs.

Conclusions

The high prevalence of STBs following onset of psychosis highlights the need for early detection and intervention and ongoing assessment of suicidal risk throughout follow-up, with attention to identified risk factors. The heterogeneity of the studies precluded a meta-analysis and several factors were each assessed by a single study. Additional well-designed longitudinal studies of STBs and associated factors are warranted.

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Availability of data and material

All relevant data are within the manuscript and its Supporting Information files.

Code availability

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Acknowledgements

We thank the three librarians who supported us for this systematic review: Cynthia Gagné and Monique Clar, Université de Montréal, and Caroline Sauvé, Centre hospitalier de l’Université de Montréal.

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Author notes

  1. Srividya N. Iyer and Amal Abdel-Baki are co-senior authors and contributed equally to this work.

Authors and Affiliations

  1. Research Center Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada

    Roxanne Sicotte, Barnabé Kiepura & Amal Abdel-Baki

  2. Department of Psychiatry and Addiction, Faculty of Medicine, Montréal, Québec, Canada

    Roxanne Sicotte & Amal Abdel-Baki

  3. Department of Psychiatry, McGill University, Montréal, Québec, Canada

    Srividya N. Iyer

  4. Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec, Canada

    Srividya N. Iyer

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  1. Roxanne Sicotte
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Contributions

RS: Conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing—original draft, writing—review and editing, SNI: Conceptualization, methodology, validation, visualization, writing—review and editing, BK: Data curation, formal analysis, investigation, methodology, AA-B: conceptualization, methodology, validation, visualization, writing—review and editing.

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Correspondence to Amal Abdel-Baki.

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Sicotte, R., Iyer, S.N., Kiepura, B. et al. A systematic review of longitudinal studies of suicidal thoughts and behaviors in first-episode psychosis: course and associated factors. Soc Psychiatry Psychiatr Epidemiol 56, 2117–2154 (2021). https://doi.org/10.1007/s00127-021-02153-2

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  • DOI: https://doi.org/10.1007/s00127-021-02153-2

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