# Understanding suicidality in adolescents and young adults at clinical high risk for psychosis: a narrative review on risk factors and clinical insights

## TL;DR

This review explores why adolescents and young adults at risk for psychosis are more likely to experience suicidal thoughts and behaviors, highlighting key risk factors and the need for better prevention strategies.

## Contribution

The paper provides a comprehensive analysis of suicidality in clinical high-risk psychosis populations, emphasizing the interplay of symptoms and psychosocial stressors.

## Key findings

- Suicidality in clinical high-risk psychosis individuals is linked to depressive symptoms, positive and negative symptomatology, and psychosocial stressors.
- Anhedonia and suspiciousness are independent predictors of suicidality in this population.
- Suicidality rates are higher in community-recruited clinical high-risk samples compared to those seeking help.

## Abstract

The prodromal stage of psychosis, referred to as the Clinical High Risk (CHR) phase, represents a critical period of heightened vulnerability to suicidality. Although suicidality is highly prevalent in CHR for psychosis (CHR-P) populations, research on this topic remains limited, often focusing more on the prevalence rates rather than the clinical implications. In this review, covering the past decade, we examined the prevalence and clinical significance of suicidality in adolescents and young adults at CHR-P. Our findings suggest that suicidality in CHR individuals arises from a complex interplay of depressive symptoms and both negative and positive symptomatology. Additionally, psychosocial stressors such as perceived stigma and discrimination further exacerbate suicide risk. Key risk factors include prior suicide attempts, impaired social functioning, psychiatric comorbidities, and stigma-related distress. Furthermore, anhedonia and suspiciousness emerged as independent predictors of suicidality. Suicidality rates vary by context, with higher prevalence in community-recruited CHR samples than in help-seeking individuals. This review highlights the need for a multidimensional suicide prevention approach, integrating early identification, comprehensive assessment, and targeted interventions. Future research should refine diagnostic tools, clarify the clinical trajectory from CHR to psychosis, and develop tailored intervention strategies to mitigate suicide risk in this population.