A Population-Based Analysis of Interpersonal Trauma, Psychosis, and Suicide : Evidence, pathways, and implications

Background: Subthreshold psychotic experiences are known to confer a risk for suicidality. Yet, despite evidence of a strong aetiological trauma-psychosis pathway, the coalesced effect of such concurrences on suicide risk is largely discounted. Objective: Our aims were to examine the impact of different manifestations of lifespan trauma and psychotic-like experiences (PE) on the risk of suicidal thoughts and attempts using an exploratory person-centred approach. Method: Data from the Adult Psychiatric Morbidity Survey (N= 7,403) was analysed. Psychotic-like experiences were assessed using the Psychosis Screening Questionnaire (PSQ) alongside items probing childhood and adult trauma, in addition to twelve-month suicide thoughts and attempt. Results: A manual 3-step latent class analysis elicited four distinct profiles, namely a socially disconnected/high PE, a sexual victimisation/moderate PE, a lifespan trauma/low PE and a baseline class. The socially disconnected class, characterised by a moderate likelihood of social disconnection, a high probability of various PE endorsements, yet a low likelihood of other significant trauma, showed the greatest risk of twelve-month suicide ideation (OR=13.0, 95%CI=8.539 – 19.021) and attempt (OR=24.2, 95%CI=10.349 – 56.860). Conclusions: Neither multiple nor recurrent traumatic experiences invariably result in the emergence of PEs. Instead, a sense of social disconnection may be either resultant of PEs, or alone sufficient to cultivate such symptom presentations, even in the absence of prior traumas. Moreover, just as traumatic encounters increase the risk of suicidality, so too might seemingly more innocuous adversities such as poor-quality social relationships further elevate the risk, particularly when proximal and coupled with the simultaneity of PEs.