Suicidality Over the First 5 Years of Psychosis: Does Extending Early Intervention Have Benefits?. (May 2021)

• Record Type: Journal Article
• Authors: Iyer, Srividya N.; Mustafa, Sally S.; Moro, Laura; Jarvis, G. Eric; Joober, Ridha; Abadi, Sherezad; Casacalenda, Nicola; Margolese, Howard C.; Abdel-Baki, Amal; Lepage, Martin; Malla, Ashok
• Is Part Of: Canadian journal of psychiatry =. Volume 66:Number 5(2021)
• Page Start: 468
• Page End: 476
• Publication Date: 2021-05
• Subjects: suicidality -- first-episode psychosis -- early intervention -- depressive symptoms -- RCT -- longitudinal course; Psychiatry -- Periodicals; Psychiatry -- Canada -- Periodicals; 616.8900971
• DOI: 10.1177/0706743720961714
• Languages: English
• ISSNs: 0706-7437

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, F (7, 1038) = 1.84, P = 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.