Suicidal Behaviour in Early Psychosis
: The Role of Insight

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Early psychosis is a high-risk period for suicide. Of concern, suicide rates in psychosis have increased over recent years. Several risk factors have been established, including being male, white, recent loss, previous suicide attempts, depression, illegal drug use and agitation/restlessness.

    Although insight has been consistently associated with positive outcomes in psychosis, concerns have been voiced regarding the potential link between insight and increased suicidality. Thus, this thesis commences with a literature review on this topic, which reported mixed results and methodological limitations in previous studies, which were addressed in this investigation.

    Real-world data on suicides by patients with schizophrenia from the South London and Maudsley NHS Foundation Trust are also presented, which supports further the necessity for this work.

    Data from three large cohorts of first-episode psychosis (FEP) patients from the UK (n=112-181) and Spain (n=397) were analysed to ascertain the role of multiple insight dimensions (illness recognition, symptoms relabelling, awareness of the social consequences and awareness of the need for treatment) in risk for suicidal behaviour. Although bivariate analyses showed significant relationships between insight levels and risk of suicidal behaviour, only previous suicide attempts and depression, both of which were linked with insight, survived the multivariate analyses, hence emerging as the main predictors of suicidal behaviour. In other words, suicidal history and depression appear to explain the apparent association of insight with suicide risk in psychosis.

    Hence, no evidence was found supporting a direct relationship between insight and suicidal behaviour in early psychosis despite common assertions to the contrary, which has implications on clinical practice and future research. Insight, which is linked with better outcomes, does not increase suicidality. Guidelines should therefore prioritise improving insight interventions (e.g. talking therapies or antipsychotics) from first presentation with psychosis and future studies may examine whether this reduces suicide rates.
    Date of Award2017
    Original languageEnglish
    Awarding Institution
    • King's College London
    SupervisorRina Dutta (Supervisor) & Anthony David (Supervisor)

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