Suicidal thinking and behavior in young people at Clinical High Risk for Psychosis: Psychopathological considerations and treatment response across a 2-year follow-up study

Introduction: Suicidal ideation has high rates among individuals at Clinical High Risk for Psychosis (CHR-P). CHR-P mental states are currently defined as attenuated psychotic symptoms, brief intermittent psychotic symptoms, or genetic risk and functioning deterioration syndrome. However, the relationship between psychotic experiences and suicidality in CHR-P subjects is still not fully understood. Research emphasizes the need to address suicidality in CHR-P individuals due to its incidence and severe socio-economic impact. This study aimed to assess the baseline prevalence and 2-year incidence rates of suicidal thinking and behaviors in an Italian CHR-P sample, investigate the stability of suicidal ideation over 2 years, and examine its associations with treatment outcomes, sociodemographic characteristics, and clinical factors. Methods: CHR-P participants were treated in an “Early Intervention in Psychosis” program and completed the PANSS and the GAF scale at baseline and every 12months. Results: 180 CHR-P individuals were enrolled (92 with suicidal ideation [SI+]). SI+ subjects had a higher baseline prevalence of past suicide attempts. Over 2 years, a decrease in suicidal ideation severity was observed in the total group. Longitudinal improvement in disorganized symptoms was a key predictor of the decrease in suicidal ideation. Participants with a history of suicide attempts were more likely to attempt again. Conclusion: Addressing disorganization is crucial for suicide prevention in the CHR-P population. Continuous risk monitoring and preventive actions are needed for those with past suicide attempts.