Suicidality Over the First 5 Years of Psychosis: Does Extending Early Intervention Have Benefits? Suicidabilité dans les cinq premières années d'une psychose: Prolonger une intervention précoce a-t-il des avantages?

TitleSuicidality Over the First 5 Years of Psychosis: Does Extending Early Intervention Have Benefits? Suicidabilité dans les cinq premières années d'une psychose: Prolonger une intervention précoce a-t-il des avantages?
Publication TypeJournal Article
Year of Publication2020
AuthorsIyer SN, Mustafa SS, Moro L, G Jarvis E, Joober R, Abadi S, Casacalenda N, Margolese HC, Abdel-Baki A, Lepage M, Malla A
JournalCan J Psychiatry
Pagination706743720961714
Date Published2020 Sep 28
ISSN1497-0015
Abstract

OBJECTIVE: We aimed to investigate whether individuals with first-episode psychosis (FEP) receiving extended early intervention (EI) were less likely to experience suicidal ideation and behaviors than those transferred to regular care after 2 years of EI. Another objective was to examine the 5-year course of suicidality in FEP.METHODS: We conducted a secondary analysis of a randomized controlled trial where 220 patients were randomized after 2 years of EI to receive extended EI or regular care for the subsequent 3 years. Suicidality was rated using the Brief Psychiatric Rating Scale. Linear mixed model analysis was used to study time and group effects on suicidality.RESULTS: Extended EI and regular care groups did not differ on suicidality. There was a small decrease in suicidality over time, (7, 1038) = 1.84, = 0.077, with an immediate sharp decline within a month of treatment, followed by stability over the remaining 5 years. Patients who endorsed suicidality at entry (46.6%) had higher baseline positive, negative, and depressive symptoms. The 5-year course fell in 3 groups: never endorsed suicidality (33.9%), endorsed suicidality at low-risk levels (43.1%), and endorsed high-risk levels (23.0%). The high-risk group had a higher proportion of affective versus nonaffective psychosis diagnosis; higher baseline positive and depressive symptoms; higher 5-year mean depression scores, and fewer weeks of positive symptom remission over the 5-year course.CONCLUSIONS: The first month of treatment is a critical period for suicide risk in FEP. Although early reductions in suicidality are often maintained, our findings make the case for sustained monitoring for suicide risk management.

DOI10.1177/0706743720961714
Alternate JournalCan J Psychiatry
PubMed ID32986470