(PS3-B49) Psychosis-spectrum Symptoms and Related Distress Are Linked to Suicidal Ideation and Attempts in Psychiatrically Hospitalized Adolescents

Background: Research indicates that psychosis-spectrum symptoms are associated with suicidal thoughts and behaviors (STBs) in youth. There is little research, however, on how distress in response to these symptoms may impact suicidality. It is hypothesized that teens’ reactions to their psychosis-spectrum symptoms, i.e. related distress, will be uniquely associated with STBs, and that distress will be more strongly associated with STBs than ratings of symptom presence.

Methods: The current sample includes teens (n = 164) aged 11-18 years (Mage = 15.04 years, 63.6% female) admitted to a psychiatric inpatient unit for acute safety concerns. Teens completed the PRIME Screen-Revised (a psychosis-spectrum screen), the PROMIS Depression scale, the Suicidal Ideation Questionnaire-Junior (SIQ-Jr.), and questions about suicide attempts (SA) at intake. The PRIME Symptoms Scale asks about the presence of 12 positive symptoms. The PRIME Distress Scale then asks teens to rate the extent to which each endorsed symptom causes distress and/or interference. The PROMIS Depression scale probes the frequency of eight symptoms. The SIQ-Jr. assesses the current frequency of suicidal thoughts. Additionally, lifetime, 12-month, and 1-month SAs were each assessed via a yes/no question. Correlations were used to explore the interrelation of the PRIME scales, depression, SI, and SA. Regressions were used to explore the PRIME Symptoms and Distress scales in relation to SIQ scores, controlling for depression, age, and sex at birth.

Results: PRIME Symptoms and Distress scales are highly correlated in this sample (r = .77, p < .001). Correlations indicate that SIQ is significantly correlated (p < .001) with PRIME Symptoms (r = .44) and Distress (r = .42). PRIME Symptoms and Distress are positively correlated (p < .020) with all SA timeframes: lifetime (rpbs = .32; rpbd = .27), 12-month (rpbs = .24; rpbd = .22) , and 1-month (rpbs = .16; rpbd = .14). Depression scores were also correlated (p < .001) with both PRIME Symptoms (r = .36) and Distress (r = .34), as well as SIQ (r = .69). Linear regression was used to explore the relative associations of PRIME Symptoms and Distress with SIQ. Given that SIQ is correlated with female sex (rpb = .28) and age is correlated with PRIME Symptoms (r = -.13), age and sex were included as covariates. Regression results indicate that both PRIME scales, Symptoms (β = .23, p =.035) and Distress (β = .25, p = .021), are uniquely associated with SIQ, controlling for sex (β = .29, p < .001), and age (β = .02, p = .786; R2 = .28). When adding depression to the model (R2 = .53), the distress scale remained a trend-level predictor of SIQ (β = .17, p = .060) but the symptom scale did not (β = .10, p = .294).

Discussion: Results indicate that both psychosis-spectrum symptoms and distress are associated with increased STBs. When accounting for depression symptoms, PRIME Distress may be more strongly related to SI than PRIME Symptoms. We will also characterize the average distress ratings associated with each PRIME symptom, and we will discuss the relations between specific PRIME items and STBs. Given the high rates of STBs among teens with psychosis-spectrum conditions, it is important to understand how symptom-related factors might influence suicide risk.