Impact of a specialized early psychosis treatment programme on suicide. Retrospective cohort study

Background: Younger people, early in the course of psychotic illness, are at high risk of suicide. Aim: To investigate the impact of a specialized early psychosis (EP) treatment programme on risk of suicide up to 8.5 years following first contact with mental health services. Methods: A population-based, retrospective cohort study of 7760 individuals with a psychotic disorder, aged 15-29 years at first contact, ascertained from a statewide psychiatric case register. Suicides were identified by linking the psychiatric register to a coronial register of unnatural deaths. Cox proportional hazards models were used to investigate potential risk factors, including specialized EP treatment, for suicide. Results: Our principal hypothesis, that suicide risk over the entire follow-up period would be significantly lower for those who received specialized EP treatment compared with those who did not, was not supported. However, a secondary analysis found that, after adjusting for other socio-demographic, clinical and treatment factors, suicide risk was 50% lower in the first 3 years following first contact with mental health services among those exposed to specialized EP treatment compared with those who were not. History of inpatient treatment, more treatment days per annum, and shorter time to establish a psychotic diagnosis were associated with increased risk. Non-participation in the labour force or in study, compared with being unemployed, exerted a protective effect. Conclusions: The EP treatment model may afford protection from suicide whilst the EP intervention is delivered and for a limited period afterwards.