03 Jun 2010

The recent tragedies of youth suicides arouse public concerns on the mental health of youth. Previous studies show that psychosis can lead to a substantial increase in suicide risk (>50 times). The Psychosis Studies and Intervention (PSI) Unit of the Department of Psychiatry, The University of Hong Kong Li Ka Shing Faculty of Medicine studied and estimated the level of suicidal ideations in young early psychosis patients and found that amongst all factors, the psychological factors such as hopelessness appears to be the strongest leading to suicidal ideation, while the clinical symtoms of psychosis are comparatively less important.

Psychosis is a complex condition in which patients may experience hallucinations and delusions. The life time suicide risk for psychotic disorders is 5-10% and most of the suicides occur in the first few years of the disorder, according to previous studies.

The research was conducted from 2005 to 2010 by the HKU PSI Unit in collaboration with EASY services at Kwai Chung Hospital and Queen Mary Hospital. Since the introduction of the early intervention programme ‘EASY’ by the Hospital Authority, the suicide rate amongst youth psychosis patients reduced from 3.4% to 1.1%.

The leading researcher of the study, Professor Eric Chen Yu-hai of the Department of Psychiatry, HKU Li Ka Shing Faculty of Medicine, says, “Some phases during the illness are more prone to suicide, such as during remission from the first episode illness, relapse period, times in which the remitted patients are unable to get back to school or work. Thus, some people such as school teachers, social workers and also the family members of the patients can play a key role in identifying the suicidal ideation of psychosis patients.”

Aim of the Study:

Most suicides are preceded by suicidal ideation. In this study, processes and risk factors leading to suicidal ideation in a group of early psychosis youths in the EASY service were explored.

Research Methodology:

A cross-sectional study was carried out since 2005 comparing suicidal ideation between early psychosis patients with first-episode psychosis (n=89) and normal controls (people without psychosis) (n=71) matched for age, gender, and education level. Suicidal ideation, i.e. the intention to kill oneself, was assessed by the 21-item self-rated Beck Scale for Suicidal Ideation (Beck et al., 1979). The study compared background, clinical, psychological, cognitive, and treatment related factors between psychosis patients with and without suicidal ideation.

Research Findings:

The study finds a significantly higher suicidal ideation rate in patients (40.5%) than controls (21.1%) (p=0.01). Three groups of risk factors are found to underlie suicidal ideation in psychosis. The most important group of factors are general psychological factors, including hopelessness and negative future outlook. These factors are also found in the normal population, but they are intensified by the illness. The second are psychological factors relating to the illness, these include impulsivity and external locus of control. Finally, clinical factors including less severe symptoms and better insight also contribute to suicidal ideation.

Study Implications:

Although specialized early intervention has reduced suicide rates in early psychosis patients, suicide prevention remains a serious challenge. Suicidal ideation in early psychosis is the result of interaction between complex factors. Identification of these factors helps to identify patient with increased risks for suicide. Such factors also suggest potential intervention strategies such as psychological interventions addressing hopelessness and impulsivity. It is important to provide specialized service which foster a holistic approach.

Recommendations:

The results suggest that intervention should go beyond symptomatic treatment, and psychological support, and instillation of hope and meaning is particularly important as patients learn to cope with the impact of the illness and its consequences. The results highlight the importance of focused and specialized approaches to support people recovering from a first episode psychosis. Further research and intervention development are required.

About EASY service:

The EASY service (Early Assessment Service for Youth with Psychosis) was set up by the Hospital Authority in 2001 to provide comprehensive service for youth (aged 15 to 25) with psychotic disorders. Five EASY teams in the territory serve over 600 new cases each year.

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