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New research shows that by lessening the severity and impact of persecutory symptoms of psychosis, it may be possible to reduce the likelihood of someone with psychosis having thoughts of suicide or harming themselves.

Close-up of a devastated young man holding his head in his hands and friends supporting him during group therapy

Researchers from Oxford, Birmingham, London, and Naples have published a new study examining the results from several UK surveys to investigate how self-harm and different symptoms of psychosis may be related in adult populations. 

Using data from the three most recent rounds of UK APMS (Adult Psychiatric Morbidity Survey), the study’s authors compared how suicidal thoughts and attempts by individuals in the general population may be related to someone hearing voices and abnormal thoughts – both at a single point in time and then over a period of time, to investigate whether one might predict the other. For any relationships found, additional factors were taken into account, such as depression, having a very variable mood, or being impulsive.

Research shows that in virtually every case in each of the three datasets, current symptoms of psychosis were linked to previous and / or current suicidal attempts and thoughts. However, persecutory thoughts (false beliefs that people wish to harm you) were more likely to be related to self-harm than auditory hallucinations (hearing voices).

Further analysis examining the same group over time showed a clear relationship between earlier persecutory thoughts and later suicidal thoughts. When looking at possible factors that might mediate these relationships, features of depression and variable mood were more likely to be involved than being an impulsive person.

The first author of the study, Dr Angharad de Cates, Wellcome Trust Clinical Doctoral Fellow at the Department of Psychiatry, University of Oxford, said:


'As clinicians, we are understandably worried about the increased risk of self-harm and suicide in those with schizophrenia and other psychotic illnesses. Our study suggests that compared to hearing voices, current persecutory thoughts may be a bigger predictor of individuals at the greatest risk, presumably due to the distress and possible depressive symptoms that may result. It is possible that we can make a difference and reduce risk by actively screening for, and treating, persecutory and depressive thoughts.' 

The senior author of the study, Professor Matthew Broome said:


‘Those with psychosis are at greatly elevated risk of self-harm and suicide, both when they are becoming unwell, and also after recovery. This important study helps us scientifically to understand the processes which may connect certain symptoms of psychosis with self-harm and suicide, but also is clinically important in demonstrating that through addressing persecutory thoughts, depression, or mood instability, we may be able to impact on suicidal thinking and actions.’

To read the full paper, Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey.