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

BACKGROUND: 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. METHODS: A secondary Framework Analysis was applied to qualitative interviews with 18 people with recent suicidal and psychotic experiences. RESULTS: 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. IMPLICATIONS: 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. TRIAL REGISTRATION: 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 https://doi.org/10.1186/ISRCTN17776666 ); 5th June 2017, (05/06/2017). Registration was recorded prior to participant recruitment commencing.