An Examination of Discordance in Suicidal Ideation Disclosure & Identification for Those Experiencing First Episode Psychosis

Bryony Isabel Stokes

doi:10.7273/000006371

Background: People with first episode psychosis (FEP) are more likely to die from suicide than the general public. Coordinated specialty care (CSC) programs are early intervention programs for those experiencing FEP. CSC programs are associated with improved patient outcomes and recommended by the Center of Disease Control and the National Institute of Mental Health. Despite these benefits, suicide reduction in CSC programs has been limited. One key step in preventing suicide is screening for suicidal thinking and behavior. Consistent with the principles of measurement-based care (MBC), regular assessment of suicidal thinking and behavior is the first step in reducing suicide in CSC patients. This thesis explores factors associated with the discordance between self-reported and clinician-rated suicidal ideation during CSC treatment, with the goal of improving the way suicidality is assessed in CSC programs. Methods: First, a secondary data analysis of CSC program’s concordance and discordance of patient and clinician-reported suicidal ideation was documented. Predictors of discordance, such as clinician-rated symptoms of psychosis, self-reported symptoms of psychosis, hospitalizations, and living situation were identified. Simple and multiple linear regression models were used to examine the association between the suicidal ideation measures of the 107 individuals who had received services through New Journeys (service users) and clinical, functional, and demographic variables (e.g., symptoms of psychosis, age, living situation). To further explore challenges to assessing suicidal ideation in CSC programs, 19 qualitative interviews were conducted with current and previous CSC practitioners. Interviews were conducted and analyzed using reflexive thematic analysis. Results: Discordance occurred with 48% (n=51) of service users. In the backwards stepwise regression model, clinician-rated symptoms of hallucinations (B=.061; SE=.026) and delusions (B=.066; SE=.032) were significantly associated with discordance between suicidal ideation measures (p=.002). No other variables were independently associated with discordance. Qualitative analyses identified three main themes related to the identification of suicidal ideation in service users: service users, family members, and practitioners. Each theme had subthemes that influenced the effectiveness of suicidal ideation identification in the themes. Conclusion: Discordance between measures of service use and clinician suicidal ideation are frequent in CSC programs and presents a problem for suicide prevention. Higher levels of psychotic symptoms were associated with increased likelihood of discordance. Strategies for improving screening of suicidality, especially in service users with more severe symptoms is needed. Qualitative results suggest that family members may be an untapped resource for identifying suicidality in service users.

An Examination of Discordance in Suicidal Ideation Disclosure & Identification for Those Experiencing First Episode Psychosis

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