Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: Independent findings from two cohorts

Lisa R. Steenkamp, Nita G.M. de Neve-Enthoven, Amanda Moreira João, Diandra C. Bouter, Manon H.J. Hillegers, Witte J.G. Hoogendijk, Laura M.E. Blanken, Steven A. Kushner, Henning Tiemeier, Nina H. Grootendorst-van Mil, Koen Bolhuis*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Prior studies have shown that psychotic experiences are prospectively associated with an increased risk of suicidality. However, it is unclear whether this association is causal or arises from shared risk factors. Furthermore, little is known about the association between psychotic experiences and non-suicidal self-injury (NSSI). Methods: We used data from two independent samples of young adolescents, which we analyzed separately. In a population-based cohort, data on hallucinatory experiences and suicidality were collected at ages 10 and 14 years (N = 3435). In a cross-sectional study of a population oversampled for elevated psychopathology levels, psychotic experiences, suicidality, and NSSI were assessed at age 15 years (N = 910). Analyses were adjusted for sociodemographic covariates, maternal psychopathology, intelligence, childhood adversity, and mental health problems. Results: Psychotic experiences were prospectively associated with an increased risk of suicidality, even when considering self-harm ideation at baseline. Furthermore, persistent and incident, but not remittent, patterns of psychotic experiences were related to an increased burden of suicidality. Self-harm ideation was also prospectively associated with the risk for psychotic experiences, although of smaller magnitude and only by self-report. Among at-risk adolescents, psychotic experiences were cross-sectionally associated with a greater burden of suicidality and a higher frequency of NSSI events, with more extensive tissue damage. Conclusion: Psychotic experiences are longitudinally associated with suicidality beyond the effects of shared risk factors. We also found modest support for reverse temporality, which warrants further investigation. Overall, our findings highlight the importance of assessing psychotic experiences as an index of risk for suicidality and NSSI.

Original languageEnglish
Pages (from-to)50-57
Number of pages8
JournalSchizophrenia Research
Publication statusPublished - Jul 2023

Bibliographical note

Funding Information:
This work was supported by the Erasmus MC University Medical Center ( Mrace 2016 107569 ) to L. Steenkamp, H. Tiemeier, S. Kushner, M. Hillegers, L. Blanken, and K. Bolhuis; the Netherlands Organisation for Scientific Research (NWO-grant 016.VICI.170.200 ) to H. Tiemeier; Horizon2020 European Commission ( ERA-PerMed2018-127 , NEURON-JTC2018-024 ) to S. Kushner; and the Sophia Children's Hospital Research Foundation (research fellowship grant 921 ) to K. Bolhuis. The Generation R Study received financial support from the Erasmus MC ; Erasmus University Rotterdam ; The Netherlands Organisation for Health Research and Development (ZonMw). The iBerry Study is funded by the Erasmus MC University Medical Center and the following institutes of mental health care (GGz): Parnassia Psychiatric Institute Antes , GGz Breburg , GGz Delfland , GGz Westelijk Noord-Brabant and Yulius . All funding organizations participate in the Epidemiological and Social Psychiatric Research Institute (ESPRi), a consortium of academic and non-academic research groups. The study was also financially supported by a grant from the Janivo Foundation . The funding sources had no involvement in the analysis or interpretation of data, the writing of the report, and the decision to submit the article for publication.

Publisher Copyright:
© 2023 The Authors


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