Objective: Suicide is a leading cause of premature mortality among individuals with psychosis, particularly during its early stages. This study aimed to examine the direct and indirect effects of formal thought disorders (FTDs) on suicidal ideation and behavior in early psychosis, while also evaluating the roles of depressive symptoms and social functionality as both independent contributors to suicide risk and potential mediators of the relationship between FTDs and suicidality.
Method: The study included 64 patients diagnosed with early psychosis (≤12 months since initial treatment), 30 of whom had recently attempted suicide. Participants were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS), Thought and Language Index (TLI), Personal and Social Performance Scale (PSP), Calgary Depression Scale for Schizophrenia (CDSS), and the Positive and Negative Syndrome Scale (PANSS).
Results: Patients with a history of suicide attempts scored significantly lower on the TLI-Impoverishment of Thought Subscale (TLI-ITS) (p=0.001), and significantly higher on the TLI-Disorganization Subscale (p=0.036), the CDSS (p<0.001), and the PANSS Positive Subscale (p=0.003). They also had significantly lower total PSP scores (p<0.001). Mediation analysis revealed that the effect of TLI-ITS on suicide attempts was negative and significantly mediated through both CDSS and the Personal and Social Performance Scale – Dysfunction subscale (PSP-D). Lower TLI-ITS scores were associated with higher CDSS scores and lower PSP-D scores, each of which contributed to an increased risk of suicide attempts (p<0.001 and p=0.026, respectively).
Conclusion: The prominence of impoverishment of thought may be associated with lower levels of depressive symptoms and increased disruptive and aggressive behaviors, which, in turn, could be linked to a reduced risk of suicidal thoughts and attempts. These findings could serve as an important point of consideration for clinicians when assessing suicidal ideation and behavior in early psychosis.