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Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial

Bispebjerg Hospital, Department of Psychiatry, Copenhagen, Denmark

JOHAN ØHLENSCHLÆGER, MD, PhD

Sct Hans Hospital, Roskilde, Denmark

PHUONG LE QUACH, MD, TORBEN ØSTERGAARD CHRISTENSEN, MSc, GERTRUD KRARUP, MD, PER JØRGENSEN, MD and MERETE NORDENTOFT, MD, PhD, MPH

Bispebjerg Hospital, Department of Psychiatry, Copenhagen, Denmark

Correspondence: Merete Nordentoft, Bispebjerg Hospital, Department of Psychiatry, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. Tel: +4535316239, fax +4535313953, email merete.nordentoft{at}dadlnet.dk

Declaration of interest None.

Background Those with first-episode psychosis are at high-risk of suicide.

Aims To identify predictive factors for suicidal thoughts, plans and attempts, and to investigate the rate of suicides and other deaths during the 5 years after first diagnosis and initiation of treatment.

Method A longitudinal, prospective, 5-year follow-up study of 547 individuals with first-episode schizophrenia spectrum psychosis. Individuals presenting for their first treatment in mental health services in two circumscribed urban areas in Denmark were included in a randomised controlled trial of integrated v. standard treatment. All participants were followed in the Danish Cause of Death Register for 5 years. Suicidal behaviour and clinical and social status were assessed using validated interviews and rating scales at entry, and at 1- and 2-year follow-ups.

Results Sixteen participants died during the follow-up. We found a strong association between suicidal thoughts, plans and previous attempts, depressive and psychotic symptoms and young age, and with suicidal plans and attempts at 1- and 2-year follow-up.

Conclusions In this first-episode cohort depressive and psychotic symptoms, especially hallucinations, predicted suicidal plans and attempts, and persistent suicidal behaviour and ideation were associated with high risk of attempted suicide.