Unraveling Suicidal Ideation and Behaviors in a Global Cohort of Individuals at Clinical High‐Risk for Psychosis: Multivariable Correlates and Subthreshold Psychotic Symptoms

ABSTRACT Introduction Suicidal ideation and behaviors (SIB) are common among individuals at clinical high risk for psychosis (CHR‐P), but their relationship with the overall clinical profile remains unclear. This study aimed to identify sociodemographic/clinical factors associated with SIB in CHR‐P individuals and to examine whether subthreshold psychotic symptom severity increases with suicidal risk. Methods Data from the AMP SCZ initiative included 1443 CHR‐P participants aged 12–30 years. SIB were assessed using the Columbia Suicide Severity Rating Scale (C‐SSRS). Three Elastic Net regression models examined associations between suicidal ideation severity, intensity, and behaviors using 54 variables spanning sociodemographics, general psychopathology, subthreshold psychotic symptoms, and socio‐occupational functioning. Moreover, ANCOVA compared overall psychotic symptom severity across five groups defined by increasing severity on the C‐SSRS. Results Sixty‐eight percent of participants reported lifetime suicidal ideation, and 26% reported previous suicidal behaviors. Model performance was modest but significant (cross‐validated ideation severity: R 2 = 0.161, RMSE = 0.916; ideation intensity: R 2 = 0.193, RMSE = 0.898; suicidal behavior: accuracy = 0.685; AUC = 0.675; p < 0.001). Across all models, concurrent depressive symptoms, present/past diagnosis of depression, female sex at birth, cannabis use, visual/gustatory abnormalities, guilt, and lower role functioning were the most consistent correlates of SIB. Ideation was associated with lower disorganized communication expression and lower negative symptoms, whereas behaviors were associated with schizotypal personality disorder. Other core CHR‐P symptoms, including Unusual Thoughts and Experiences, did not contribute to any model. ANCOVA ( p < 0.001, partial η 2 = 0.041) indicated increasing overall subthreshold psychotic symptoms across the SIB spectrum. Conclusion SIB in CHR‐P individuals reflects a multidimensional clinical profile primarily outside of core psychosis‐risk symptoms. Trial Registration: ClinicalTrials.gov identifier: NCT05905003

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Journal
Acta Psychiatrica Scandinavica
Published
2026-09-11
DOI
https://doi.org/10.1111/acps.70138
Primary Topic
Suicide and Self-Harm Studies
Type
article
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0.00

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article

Unraveling Suicidal Ideation and Behaviors in a Global Cohort of Individuals at Clinical High‐Risk for Psychosis: Multivariable Correlates and Subthreshold Psychotic Symptoms

Matcheri S. Keshavan, Heather M. Wastler, Sylvain Bouix, Celso Arango et al.
Acta Psychiatrica Scandinavica
Suicide and Self-Harm Studies
article

Unraveling Suicidal Ideation and Behaviors in a Global Cohort of Individuals at Clinical High‐Risk for Psychosis: Multivariable Correlates and Subthreshold Psychotic Symptoms

Matcheri S. Keshavan, Heather M. Wastler, Sylvain Bouix, Celso Arango, Barbara A. Cornblatt, John M. Kane, Diana O. Perkins, Nora Penzel, Jai L. Shah, Albert R. Powers, Godfrey D. Pearlson, Carrie E. Bearden, Kerstin Langbein, Nicholas J. K. Breitborde, Jason Eric Schiffman, Gregory P. Strauss, Jijun Wang, Philippe Conus, Daniel H. Mathalon, Swapna Verma, Lana Kambeitz‐Ilankovic, Jun Soo Kwon, Matthew R. Broome, Covadonga M. Díaz‐Caneja, Merete Nordentoft, Minah Kim, Steven M. Silverstein, Carla Gerber, Ricardo E. Carrión, Orlandi Marika, Christy Lai Ming Hui, Barnaby Nelson, Pablo A. Gaspar, Judy L. Thompson, Jean Addington, Elisa Bortolin, Zsüliet Kristóf, Umberto Provenzani, Rachel Upthegrove, Patrick D. McGorry, Paolo Fusar‐Poli, Stefano Damiani, Josh Nguyen, Monica E. Calkins, Rolando I Castillo-Passi, Scott W. Woods, Stefan Smesny, Kristin S. Cadenhead, Cassandra M. J. Wannan, Daniel H. Wolf, Joseph Kambeitz, Louise Birkedal Glenthøj, Leslie E. Horton, Nikolaos Koutsouleris, Margherita Rovida, Sung‐Wan Kim, Tianhong Zhang, Eric Yu Hai Chen, Jimmy Choi, Lauren M. Ellman, Riccardo Stefanelli, Jesus Perez, Abigayle Fogarty, Daniel Mamah, Jack C. Rogers, Ofer Pasternak, Rene S. Kahn, Vijay A. Mittal, Fred W. Sabb, Martha E. Shenton, Luis Alameda, William S. Stone, Tina Kapur, Cheryl M. Corcoran
article en

Abstract

ABSTRACT Introduction Suicidal ideation and behaviors (SIB) are common among individuals at clinical high risk for psychosis (CHR‐P), but their relationship with the overall clinical profile remains unclear. This study aimed to identify sociodemographic/clinical factors associated with SIB in CHR‐P individuals and to examine whether subthreshold psychotic symptom severity increases with suicidal risk. Methods Data from the AMP SCZ initiative included 1443 CHR‐P participants aged 12–30 years. SIB were assessed using the Columbia Suicide Severity Rating Scale (C‐SSRS). Three Elastic Net regression models examined associations between suicidal ideation severity, intensity, and behaviors using 54 variables spanning sociodemographics, general psychopathology, subthreshold psychotic symptoms, and socio‐occupational functioning. Moreover, ANCOVA compared overall psychotic symptom severity across five groups defined by increasing severity on the C‐SSRS. Results Sixty‐eight percent of participants reported lifetime suicidal ideation, and 26% reported previous suicidal behaviors. Model performance was modest but significant (cross‐validated ideation severity: R 2 = 0.161, RMSE = 0.916; ideation intensity: R 2 = 0.193, RMSE = 0.898; suicidal behavior: accuracy = 0.685; AUC = 0.675; p < 0.001). Across all models, concurrent depressive symptoms, present/past diagnosis of depression, female sex at birth, cannabis use, visual/gustatory abnormalities, guilt, and lower role functioning were the most consistent correlates of SIB. Ideation was associated with lower disorganized communication expression and lower negative symptoms, whereas behaviors were associated with schizotypal personality disorder. Other core CHR‐P symptoms, including Unusual Thoughts and Experiences, did not contribute to any model. ANCOVA ( p < 0.001, partial η 2 = 0.041) indicated increasing overall subthreshold psychotic symptoms across the SIB spectrum. Conclusion SIB in CHR‐P individuals reflects a multidimensional clinical profile primarily outside of core psychosis‐risk symptoms. Trial Registration: ClinicalTrials.gov identifier: NCT05905003

Acta Psychiatrica Scandinavica
Rutgers, The State University of New Jersey (US), Universidad de Santiago de Chile (CL), Northwestern University (US), University of North Carolina at Chapel Hill (US), University of Southern California (US), University of Copenhagen (DK), Brigham and Women's Hospital (US), Hartford Hospital (US), Beth Israel Deaconess Medical Center (US), Feinstein Institute for Medical Research (US), Universidad del Desarrollo (CL), Harvard University (US), Seoul National University (KR), Vita-Salute San Raffaele University (IT), University of California, Los Angeles (US), University of Georgia (US), The University of Melbourne (AU), University of Calgary (CA), University of Pittsburgh (US), Douglas College (CA), University of California, San Francisco (US), University of Cologne (DE), University of Oregon (US), King's College London (GB), Universidad de Salamanca (ES), South London and Maudsley NHS Foundation Trust (GB), University of California, Irvine (US), Washington University in St. Louis (US), Gwangju Health University (KR), University of Pavia (IT), Douglas Mental Health University Institute (CA), PeaceHealth St. John Medical Center (US), Hospital Universitario La Paz (ES), Mental Health Services (DK), Clínica Alemana (CL), Birmingham and Solihull Mental Health NHS Foundation Trust (GB), Foundation Center (US), Shanghai Mental Health Center (CN), Seoul National University Hospital (KR), The Ohio State University Wexner Medical Center (US), University of Rochester Medical Center (US), Hospital General Universitario Gregorio Marañón (ES), Yale University (US), University of California San Diego (US), Massachusetts General Hospital (US), Chonnam National University Hospital (KR), Orygen Youth Health (AU), Urology Foundation (GB), Donald & Barbara Zucker School of Medicine at Hofstra/Northwell (US), California Institute of Behavioral Neurosciences and Psychology (United States) (US), Hospital Clínico de la Universidad de Chile (CL), Institute of Behavioral Sciences (JP), Instituto de Biomedicina de Sevilla (ES), Instituto de Investigación Biomédica de Salamanca (ES), Jena University Hospital (DE), Washington University Medical Center (US), Institute for Behavioral Medicine (US), North Shore Diabetes and Endocrine Associates (US), Institute of Mental Health (SG), Hanyang University Seoul Hospital (KR), San Francisco VA Health Care System (US), Cambridgeshire and Peterborough NHS Foundation Trust (GB), Hospital Universitario Virgen del Rocío (ES), University Hospital Cologne (DE), Birmingham Women’s and Children’s NHS Foundation Trust (GB), Connecticut Mental Health Center (US), Hanyang University (KR), McGill University (CA), The University of Adelaide (AU), University of Chile (CL), University of Pennsylvania (US), University of Birmingham (GB), Ludwig-Maximilians-Universität München (DE), IT University of Copenhagen (DK), Temple University (US), University of Hong Kong (HK), École de Technologie Supérieure (CA), University of Lausanne (CH), Icahn School of Medicine at Mount Sinai (US)
Wellcome Trust, National Institute of Mental Health
Openalex Percentile: Top 7%
Suicide and Self-Harm Studies
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