Peer-reviewed article

Psychotic experiences as a predictor of transition from suicidal ideation or non-suicidal self-injury to suicidal behaviours in youth.

Brian Moosa, Man Hei Marcus Kam, Reagan Lee, Colm Healy, Ian Kelleher et al. · 22 Sept 2026

Abstract

BACKGROUND: Psychotic experiences (PEs) have been linked to suicidality, including transition from suicidal ideation to behaviour. However, it is unclear if this relationship is independent of co-occurring psychopathology, or if PEs also predict the transition from non-suicidal self-injury (NSSI) to suicidal behaviours. Our aim was to investigate whether PEs were associated with transition from suicidal ideation or NSSI to suicidal behaviours in young people, after adjusting for other psychopathology and sociodemographic factors. METHODS: Participants were from the ABCD Study, a large longitudinal cohort (n = 11,878 enrolled at ages 9-10) with six years of annual follow-up assessments. Unadjusted and adjusted logistic regression models were used to examine associations between PEs and transition from suicidal ideation or NSSI to suicidal behaviours in the following year, adjusting for psychopathology (depression, anxiety, ADHD, somatic, oppositional, and conduct symptoms), age, sex, and family income. RESULTS: Of 1811 participants with suicidal ideation, 104 (5.7%) transitioned to suicidal behaviour. PEs were significantly associated with transition in unadjusted (odds ratio [OR] = 1.32; 95% confidence interval [CI]: 1.12-1.54) and models adjusted for co-occurring psychopathology (OR = 1.32; 95% CI = 1.10-1.57). Among 1025 participants with NSSI, 50 (4.9%) transitioned to suicidal behaviour. PEs were not significantly associated with transition (OR = 1.14; 95% CI = 0.84-1.50), though depressive symptoms (OR = 1.65; 95% CI = 1.13-2.41) and conduct disorder symptoms (OR = 1.48; 95% CI = 1.06-2.05) were. CONCLUSION: PEs predict the transition from suicidal ideation to behaviour in young people independently of co-occurring psychopathology. However, PEs do not appear to predict the transition from NSSI to suicidal behaviour.