Is poor premorbid functioning a risk factor for suicide attempts in first-admission psychosis?

Background: While poor premorbid functioning is associated with poorer outcomes in psychotic illnesses, little is known about whether it is also a risk factor for suicide attempts. Objective: The current study examined the association of premorbid functioning and suicide attempts in a county-wide cohort of first-admission inpatients. Method: Data were derived from participants of the Suffolk County Mental Health Project (n = 444) over the course of 48-month follow-up. Premorbid functioning was estimated and categorized (good vs. poor/declining) using the Premorbid Adjustment Scale (PAS). Results: Poorer premorbid functioning was significantly associated with increased likelihood of a suicide attempt prior to first psychiatric hospital admission. Specifically, 33.0% of participants with poor/declining premorbid functioning had a history of suicide attempts compared to 23.5% with good premorbid functioning. Among participants with a prior attempt (n = 126), poor premorbid functioning was significantly associated with an increased likelihood of additional attempts during the four years after first hospitalization. Conclusion: Identifying those with poor premorbid functioning and prior histories of attempts could help clinicians target high-risk patients. Thus, greater attention to persons with both risk factors may form the basis for early interventions aimed towards reducing the risk for subsequent suicide attempts.