Unraveling Suicidal Ideation and Behaviors in a Global Cohort of Individuals at Clinical High-Risk for Psychosis: Multivariable Correlates and Subthreshold Psychotic Symptoms.
INTRODUCTION Suicidal ideation and behaviors (SIB) are common among individuals at clinical high risk for psychosis (CHR-P), but their relationship with the overall clinical profile remains unclear. This study aimed to identify sociodemographic/clinical factors associated with SIB in CHR-P individuals and to examine whether subthreshold psychotic symptom severity increases with suicidal risk. METHODS Data from the AMP SCZ initiative included 1443 CHR-P participants aged 12-30 years. SIB were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). Three Elastic Net regression models examined associations between suicidal ideation severity, intensity, and behaviors using 54 variables spanning sociodemographics, general psychopathology, subthreshold psychotic symptoms, and socio-occupational functioning. Moreover, ANCOVA compared overall psychotic symptom severity across five groups defined by increasing severity on the C-SSRS. RESULTS Sixty-eight percent of participants reported lifetime suicidal ideation, and 26% reported previous suicidal behaviors. Model performance was modest but significant (cross-validated ideation severity: R2 = 0.161, RMSE = 0.916; ideation intensity: R2 = 0.193, RMSE = 0.898; suicidal behavior: accuracy = 0.685; AUC = 0.675; p < 0.001). Across all models, concurrent depressive symptoms, present/past diagnosis of depression, female sex at birth, cannabis use, visual/gustatory abnormalities, guilt, and lower role functioning were the most consistent correlates of SIB. Ideation was associated with lower disorganized communication expression and lower negative symptoms, whereas behaviors were associated with schizotypal personality disorder. Other core CHR-P symptoms, including Unusual Thoughts and Experiences, did not contribute to any model. ANCOVA (p < 0.001, partial η2 = 0.041) indicated increasing overall subthreshold psychotic symptoms across the SIB spectrum. CONCLUSION SIB in CHR-P individuals reflects a multidimensional clinical profile primarily outside of core psychosis-risk symptoms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05905003.