Suicide and Self-Harm Risk in Young People at Clinical High Risk of Psychosis: Exploring Comorbid Risk Factors and Potential Points for Intervention

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BACKGROUND: Suicide is a leading cause of death among young people, and those at clinical high risk (CHR) of psychosis face increased suicide risk. Despite recommendations for routine suicide monitoring in CHR individuals, identifying effective intervention points remains challenging. This study investigates clinical correlates of suicidality in CHR youth, with particular focus on depression severity and DSM-5 diagnoses. HYPOTHESES: We expected suicidality to be positively associated with depressive symptoms, psychiatric symptoms, and common comorbid DSM-5 diagnoses, particularly depression and substance use disorders, and negatively associated with social and occupational functioning. STUDY DESIGN: Cross-sectional data were drawn from the baseline assessment in the Staged Treatment in Early Psychosis (STEP) trial. Participants were 342 CHR young people (age M = 17.7, SD = 3.1, 57.9% female and 42.1% male). Measures included psychosis risk, suicidal ideation, and self-harm, psychiatric symptoms, functioning, depression, and DSM-5 disorders (SCID). STUDY RESULTS: Seventy-seven percent of participants reported lifetime thoughts of suicide or engaging in self-harm. While there were positive relationships between suicidality and severity of attenuated psychiatric symptoms, multivariable analyses showed that only depression, particularly moderate to severe depression, was associated with suicidality when controlling for other clinical factors and diagnoses. This pattern remained consistent across sensitivity analyses. CONCLUSIONS: Suicidality is highly prevalent among CHR young people. This study shows that depression severity, particularly severe and ongoing depression, should be a key consideration in monitoring and treating suicide risk within CHR services.

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