Among teens in a new study from Ireland, those who reported hearing voices were at greatly elevated risk of attempting suicide within the year compared to their peers with or without mental disorders who did not experience voices.

Considered a symptom of psychosis, hearing voices was linked to a nearly 70-fold higher likelihood of a suicide attempt over the course of a year in the study of 13-to-16 year olds. That could make the symptom a valuable early-warning sign for parents to act on, according to the study’s authors.

The relationship between suicide and these symptoms had not previously been known, lead author Dr. Ian Kelleher, of the department of psychiatry at Beaumont Hospital in Dublin, told Reuters Health.

He and colleagues used data they gathered for a larger European study to follow 1,112 Irish adolescents for one year, checking in with them three times over the year and asking them to report any psychotic symptoms or suicide attempts.

At the first assessment, 77 of the teens reported having some psychotic symptoms - which include hearing voices or other sounds that are not there.

Of the kids who had such auditory hallucinations, seven percent reported a suicide attempt by the next check-in three months later, compared to one percent of the kids without psychotic symptoms at the first assessment.

At one year, 20 percent of the kids who heard voices reported a suicide attempt compared to 2.5 percent of the other kids, according to the results in JAMA Psychiatry.

The group at highest risk was kids who had other psychiatric illnesses like anxiety, depression or obsessive compulsive disorder, and also reported hearing voices. Thirty-four percent of them reported a suicide attempt by the one-year mark.

“The important thing here is that we know that individuals with psychiatric illness are at higher risk of suicidal behavior than the rest of the population but still the large majority of these individuals will never attempt suicide,” Kelleher said.

Just having a psychiatric illness is not a good indicator that someone will attempt suicide, but that in combination with hearing voices is an excellent way to identify high-risk groups, he said.

“While it’s not surprising that people with psychotic symptoms are at higher suicide risk, what’s really noteworthy in this study is the magnitude of the increase in risk,” said Ian Colman, who researches mental health epidemiology and suicide risk at the University of Ottawa in Canada.

According to the paper, more than half of teen suicide attempts could be prevented if “hearing voices” could be unilaterally cured, said Colman, who was not involved in the study.

There is evidence that many factors contribute to hearing voices, including genetics or a history of physical or sexual abuse in childhood, he said.

Kids who hear voices or sounds that nobody else hears don’t usually tell their friends or family, but trained doctors can usually get young people to open up Kelleher said.

“These are clinical symptoms that a doctor should carefully assess in patients presenting with psychiatric illness, just as a doctor would assess for (irregular heart rhythms) in a patient presenting with shortness of breath,” he said.

Even with these striking new results, predicting who will attempt suicide remains very difficult, Colman said.

“Suicidal behavior is strongly linked to mental illness, so one of the best things we can do to prevent suicide is to encourage children and their parents to seek treatment if they are concerned about their mental health,” he said.

“More generally, we can try to create environments in our homes, our schools and our communities where adolescents feel comfortable to come forward if they are struggling with their mental health or thinking about suicide,” he said.

###

SOUCE: JAMA Psychiatry, online July 17, 2013

###