Self-harm in first-episode psychosis

Abstract

Background: Little is known about self-harm occurring during the period of untreated first-episode psychosis. Aims: To establish the prevalence, nature, motivation and risk factors for self-harm occurring during the untreated phase of first-episode psychosis. Method: As part of the ÆSOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study, episodes of self-harm were identified among all incident cases of psychosis presenting to services in south-east London and Nottingham over a 2-year period. Results: Of the 496 participants, 56 (11.3%) had engaged in self-harm between the onset of psychotic symptoms and first presentation to services. The independent correlates of self-harm were: male gender, belonging to social class I/II, depression and a prolonged period of untreated psychosis. Increased insight was also associated with risk of self-harm. Conclusions: Self-harm is common during the pre-treatment phase of first-episode psychosis. A unique set of fixed and malleable risk factors appear to operate in those with first-episode psychosis. Reducing treatment delay and modifying disease attitudes may be key targets for suicide prevention. Suicide is the main cause of premature death among individuals with schizophrenia.1 There is some evidence that the risk factors for self-harm may be different for those with schizophrenia compared with other groups.2 In addition, there is some emerging evidence that risk factors for self-harm may alter during the course of a psychotic illness.3, 4 It is well established that suicidal behaviour is more common during the early phases of a psychotic illness.5 The period between the onset of psychotic symptoms and an individual’s first contact with services may be a time of particularly high risk,4 although few studies have examined this period in detail. In this study we aimed to describe both the frequency and the nature of self-harm in individuals presenting with psychosis for the first time, and to investigate whether there were any identifiable pre-treatment differences between those who engaged in self-harm and those who did not. We aimed to specifically focus on self-harm that occurred during the period between the onset of psychotic symptoms and an individual’s first presentation to services.