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Suicidal Ideation in People With Psychosis Not Taking Antipsychotic Medication: Do Negative Appraisals and Negative Metacognitive Beliefs Mediate the Effect of Symptoms?

Lookup NU author(s): Professor Douglas Turkington, Helen Spencer



This is the final published version of an article that has been published in its final definitive form by Oxford University Press, 2019.

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Between 5% and 10% of people with psychosis will die by suicide, a rate which is 20-75 times higher than the general population. This risk is even greater in those not taking antipsychotic medication. We examined whether negative appraisals of psychotic experiences and negative metacognitive beliefs about losing mental control mediated a relationship between psychotic symptoms and suicidal ideation in this group. Participants were diagnosed with schizophrenia spectrum disorders, antipsychotic-free for 6 months at baseline, and were participating in an 18-month randomized controlled trial of cognitive therapy vs treatment as usual. We conducted a series of mediation analyses with bootstrapping on baseline (N = 68), follow-up data (9-18 mo; n = 49), and longitudinal data (n = 47). Concurrent general symptoms were directly associated with suicidal ideation at baseline, and concurrent negative symptoms were directly associated with suicidal ideation at 9-18 months. Concurrent positive, negative, general, and overall symptoms were each indirectly associated with suicidal ideation via negative appraisals and/or negative metacognitive beliefs, at baseline and 9-18 months, except for negative symptoms at baseline. Controlling for baseline suicidal ideation and treatment allocation, baseline general symptoms were indirectly associated with later suicidal ideation, via baseline negative appraisals and negative metacognitive beliefs. Baseline negative metacognitive beliefs also had a direct association with later suicidal ideation. These findings suggest the clinical assessment of suicidal ideation in psychosis may be enhanced by considering metacognitive beliefs about the probability and consequences of losing mental control.

Publication metadata

Author(s): Hutton P, Di Rienzo F, Turkington D, Spencer H, Taylor P

Publication type: Article

Publication status: Published

Journal: Schizophrenia Bulletin

Year: 2019

Volume: 45

Issue: 1

Pages: 37-47

Print publication date: 01/01/2019

Online publication date: 02/11/2018

Acceptance date: 02/04/2018

Date deposited: 03/01/2019

ISSN (print): 0586-7614

ISSN (electronic): 1745-1701

Publisher: Oxford University Press


DOI: 10.1093/schbul/sby153

PubMed id: 30388270


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