Background: Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed
by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated
with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia
spectrum disorders.
Methods: One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric
ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at
the time of admission were examined with multinominal logistic regression and structural equation
modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation.
Results: Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative
symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only
Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety,
Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight
with Suicidal ideation and Suicide plans.
Conclusions: The study contributes to an increasing evidence base supporting an association between
hallucinations and suicide risk. We want to emphasise the importance of treating depression and
hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing
drug abuse in order to lower suicide risk.