Auditory Hallucinations, Depressive Symptoms, and Current Suicidal Ideation or Behavior Among Patients with Acute-episode Schizophrenia

Abstract

Suicide risk and auditory hallucinations are common in schizophrenia, but less is known about its associations. This cross-sectional study aimed to determine whether the presence and severity of auditory hallucinations were associated with current suicidal ideation or behavior (CSIB) among patients with schizophrenia. We interviewed 299 individuals with schizophrenia and acute symptoms and reviewed their medical records. Measurement included the Psychotic Symptom Rating Scale (PSYRATS-AH), the Calgary Depression Scale for Schizophrenia (CDSS), and the Positive and Negative Syndrome Scale. Logistic regression and path analysis were used. The CSIB prevalence was higher among patients with current auditory hallucination than those without (19.5% vs. 8.6%, crude odds ratio = 2.58, p = .009). Lifetime auditory hallucination experience (adjusted odds ratio [AOR] = 3.81; 95% CI: 1.45–10.05) or current auditory hallucination experience (AOR = 3.22; 95% CI: 1.25–8.28) can elevate the likelihood of CSIB while controlling for depressive symptoms and lifetime suicide-attempt history. Among those with auditory hallucinations, the emotional score of the PSYRATS-AH was positively associated with the CDSS score and there was a small indirect effect of the CDSS score on the association between the emotional domain score and CSIB (bias-corrected 95% CI, 0.02–0.20). In conclusion, the presence of auditory hallucinations was strongly associated with CSIB, independent of depressive symptoms and lifetime suicide attempts. Suicide risk assessment should consider auditory hallucination experience and patients’ appraisal of its emotional characteristics. Future cohort studies are necessary to provide more conclusive evidence for the mediating pathways between auditory hallucinations and CSIB.

HIGHLIGHTS

• The presence of auditory hallucinations was associated with current suicidality.

• Auditory hallucinations’ emotional severity was related to depressive symptoms.

• The severity of auditory hallucination was not directly associated with suicidality.

Keywords:

• Depression
• hallucinations
• schizophrenia
• suicide attempt
• suicidal ideation

DISCLOSURE STATEMENT

Dr. Hong has received or is planning to receive research funding or consulting fees from Mitsubishi, Your Energy Systems LLC, Neuralstem, Taisho, Heptares, Pfizer, Sound Pharma, Luye Pharma, Takeda, and Regeneron. None was involved in the design, analysis, or outcomes of the study. Other authors declare that the research was conducted without any relationships that could be interpreted as a potential conflict of interest or financial conflict.

AUTHOR NOTES

Yi Yin, Jinghui Tong, Junchao Huang, Baopeng Tian, Song Chen, Shuping Tan, Zhiren Wang, Fude Yang, Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China.

Yongsheng Tong, Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China; Beijing Suicide Research and Prevention Center, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, P. R. China.

Fengmei Fan, Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China.

Peter Kochunov, Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA

Yunlong Tan, Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China

L. Elliot Hong, Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [Y. Tan, 81761128021, 81771452], Beijing Natural Science Foundation [Y. Tan, 7151005], the National Institutes of Health [L. E. Hong, R01MH112180]. Funders have no roles in data analysis, interpretation of the findings, or decision to publish the findings.