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Psychotic Symptoms Predict Suicidal Behavior Postdischarge in High Risk Psychiatric Inpatients

BARZILAY, SHIRA PhD; ASSOUNGA, KRYSTEL MA; KIM, HAE-JOON; RUDNER, ELVIRA MD; YASEEN, ZIMRI MD; GALYNKER, IGOR MD, PhD

Journal of Psychiatric Practice: November 2019 - Volume 25 - Issue 6 - p 418–426
doi: 10.1097/PRA.0000000000000421
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Background: Psychotic disorders, as well as psychotic symptoms, are associated with a greater lifetime risk of suicidal behavior (SB). It is not known, however, whether psychotic symptoms are independent predictors for short-term SB.

Methods: Data were collected from 201 psychiatric inpatients at Mount Sinai Beth Israel Hospital. Self-reported psychotic symptoms were assessed using the Brief Symptom Inventory (BSI). Postdischarge SB defined as an aborted, interrupted, or actual suicide attempt was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), during the 4 to 8 weeks following discharge from an inpatient psychiatric unit (n=127, 63% retention). Logistic regressions were performed to assess the relationships between psychotic symptoms and SB, controlling for primary psychiatric disorders.

Results: Self-reported psychotic symptoms were associated with subsequent postdischarge SB. There was no significant difference between the SB versus no SB groups on the basis of primary psychiatric disorder. Self-reported psychotic symptoms remained an independent and significant predictor of postdischarge SB when the analysis controlled for primary psychiatric disorder.

Conclusions: These results suggest that psychotic symptoms are a dimensional predictor of near-term postdischarge SB and are a necessary component of suicide risk assessment during inpatient hospitalization, independent of psychiatric diagnosis.

BARZILAY, YASEEN, GALYNKER: Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel, New York, NY and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY

ASSOUNGA, KIM, RUDNER: Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel, New York, NY

Supported by the focus grant #RFA-1-015-14 from the American Foundation for Suicide Prevention. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Foundation for Suicide Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors declare no conflicts of interest.

Please send correspondence to: Shira Barzilay, PhD, Icahn School of Medicine at Mount Sinai, 317 E 17th St., New York, NY 10003 (e-mail: shirabarzilay@gmail.com).

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