Depression during first episode psychosis and subsequent suicide risk: A systematic review and meta-analysis of longitudinal studies

Jessica McGinty, Sayeed Haque, Rachel Upthegrove*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)
315 Downloads (Pure)


Evidence suggests first episode psychosis (FEP) is associated with suicide, and the influence of depression on suicidal behaviour in cross sectional studies is clear. However the influence of depression during FEP on longer-term mortality is not certain. Existing evidence was synthesised to understand the influence of depressive symptoms during FEP on subsequent suicidal behaviour.

Medline, Embase, PsycINFO, Cochrane Library, Web of Science, OpenGrey, and NICE Evidence were searched from inception to Jan 25, 2017. Longitudinal observational studies assessing the relationship between depressive symptoms during FEP with a measure of s at a specified follow-up time were included. Summary estimates were extracted. The Downs and Black Instrument was used to appraise study quality. Odds ratio (OR) of suicidal behaviour were calculated using random effects meta-analyses. The study protocol was registered with PROSPERO (CRD42017055881).

Of 4210 articles found, 23 fulfilled eligibility criteria. 13 were included in meta-analysis (n=3002). 428 participants demonstrated suicidal behaviour in the study periods. Odds of suicidal behaviour during follow-up were significantly higher amongst patients with depressive symptoms during FEP compared to those without (OR=1.59, 95% CI 1.14–2.21; I2=50.0%, p=0.02). Meta-regression demonstrated no evidence of influence of length of follow-up on results.

Depressive symptoms during FEP are associated with increased longer-term risk of suicidal behaviour. This association should be acknowledged during early management planning. Large-scale clinical trials are needed to identify efficacious management of depression during FEP.
Original languageEnglish
JournalSchizophrenia Research
Early online date2 Oct 2017
Publication statusE-pub ahead of print - 2 Oct 2017


  • Depression
  • First episode psychosis
  • Meta-analysis
  • Schizophrenia
  • Suicidal risk

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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