Suicide Ideation, Plan, and Attempt Among a Sample of Adults with Psychosis in a Psychiatric Emergency Care Setting

Background and Purpose: Suicide is among the leading causes of death for individuals with schizophrenia spectrum disorders (SSPD). Depression and hopelessness are consistently shown to be risk factors for non-fatal and fatal suicide behaviors, and there is growing evidence for the role that positive symptoms play in heightening risk. With fatal and non-fatal suicide rates are rising over time, it is essential for service settings to increase preparedness for assessment of risk and intervention; particularly among individuals with SSPDs given an elevated risk compared to the general population. The current study examined psychosis symptomatology, depression, suicide ideation, suicide plan, and suicide attempt among a sample of adults in psychiatric emergency care.

Methods: Data were obtained from Psychiatric Emergency Services (PES) of Michigan Medicine at the University of Michigan from 2013 until 2020 using an Electronic Medical Record Search Engine (EMERSE). Participants included 980 adults between the ages of 18 to 65 who presented in PES with symptoms of psychosis and either suicide ideation or a recent suicide attempt. Data from electronic medical records include investigations of assessments and encounter notes by psychiatrists and social workers of PES treatment teams. Data were examined in SPSS26.

Results: Participants were on average 35.3 years of age (SD=13.31) and most often identified as male (57%), white (66.2%), single/unmarried (78%), and unemployed (75%). Medical chart data indicated participants most often either had been to PES once (37%) or 2-3 times (41%) in a lifetime, and the majority either stayed for less than one day in PES (41%) or only one day (22%). Of the 980 participants, 99% reported the experience of positive symptoms at the time of assessment during their PES visit, with 80% endorsing hallucinations and 67% delusions, and almost half experienced symptoms of depression (n=46%). As for suicide-related outcomes, 78% reported suicide ideation, 35% reported having a suicide plan, and 8% made a suicide attempt prior to their visit. The most common methods identified for suicide plans and recent attempts with intent to die were use of pills to overdose and cutting.

Conclusions and Implications: Consistent with literature, there is a high prevalence of suicide ideation, plan, and attempt among adults with psychosis. These findings have important clinical implications for the need to identify and address characteristics which may put an individual at heightened risk for suicide ideation, plan, and attempt. Our future research will go beyond prevalence to examine the relationships between these variables in a risk-factor model. With social workers providing the majority of mental health services in the US and frequently providing care within a multidisciplinary treatment team, such as in hospital settings like PES, it is essential for social workers to increase understandings of risk factors for ideation, plan, and attempt among individuals with psychosis; a population in which risk is elevated as compared to the general population.