The dynamic interplay between anxiety-related, psychotic, and suicidal experiences: a qualitative study

TL;DR

This study explores how anxiety, psychosis, and suicidal thoughts interact in people with non-affective psychosis using qualitative interviews.

Contribution

The study introduces a novel qualitative framework revealing complex emotional and cognitive pathways linking anxiety, psychosis, and suicidal experiences.

Findings

Anxiety and psychosis interact in multiple dynamic pathways that worsen suicidal experiences.

Emotional states like fear, hopelessness, and feeling overwhelmed are central to these interactions.

Depressed mood can combine with psychosis and anxiety to trigger suicidal thoughts.

Abstract

Suicidal experiences are highly prevalent in people with non-affective psychosis, as are anxiety problems. Understanding the interplay between suicidal and anxiety-related experiences in people with psychosis has been somewhat neglected. The over-arching aim of the current study was to redress this gap using a qualitative approach.

A secondary Framework Analysis was applied to qualitative interviews with 18 people with recent suicidal and psychotic experiences.

Qualitative analyses evidenced a complex dynamic between psychotic, anxiety-related, and suicidal experiences. An emotional and cognitive-emotional dynamic was central which reflected: (a) the prominence of fear; (b) the perceived relentlessness of mental health problems; (c) feeling overpowered, overwhelmed, thwarted, and defeated; (d) perceptions of no hope and no future; and (e) wanting an unlikely end to the trap of ‘mental illness’. Within the emotional and cognitive-emotional dynamic, two pathways were clearly discernible: i.a. direct influence of anxiety on suicidal experiences with psychosis exacerbating anxiety-related experiences; and ii. an explicit pathway between psychotic and suicidal experiences with anxiety worsening psychotic experiences. A third pathway captured a non-discernible ‘mixture’ of anxiety-related, psychotic, and suicidal experiences. A fourth pathway illustrated how depressed and low mood states could interact with psychosis and anxiety to trigger and/or worsen suicidal states of mind.

It is vital to better understand the interplay between psychosis, anxiety-related, and suicidal experiences whilst conjointly developing suicide-focused psychological therapies so that they directly address ways in which different manifestations of anxiety interact with psychosis to lead to, and worsen, suicidal experiences.

ClinicalTrials.gov (NCT03114917), first submitted 29th March 2017 (29/03/2017), first submitted that met QC Criteria 10th April 2017, first posted 14th April 2017 (14/04/2017). ISRCTN (reference ISRCTN17776666 10.1186/ISRCTN17776666); 5th June 2017, (05/06/2017). Registration was recorded prior to participant recruitment commencing.

The online version contains supplementary material available at 10.1186/s12888-025-07547-z.

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