“This has to end right now”: An interpretative phenomenological analysis of first episode psychosis and suicidal behaviour and clinical research portfolio

Background: A disproportionate number of people with psychosis end their own lives in comparison to those in the general population. One of the risky times for this group is during their first episode of psychosis (FEP). This study interviewed individuals with FEP about making a suicide attempt. It also explored how individuals with a FEP made sense of their suicide attempt, what role, if any, their psychosis had in that experience and how they coped after their suicide attempt. Methods: Participants were recruited from Early Intervention Services for individuals with FEP in the West of Scotland. Participants were those who had a diagnosis of FEP. Interviews were conducted using a semi-structured interview guide and the transcribed data were analysed using Interpretative Phenomenological Analysis. Results: Three super-ordinate themes with inter-related subthemes emerged from the analysis. 1) Psychosis exposed self-evaluation: this theme explored how experiencing psychosis prompted participants to make self-evaluations. This shaped their perception of how others viewed them, and impacted on how they interacted with others. 2) Psychosis triggered the suicide attempt: this theme explored participants’ appraisals of being out of control, their fear of their hallucinations and their belief about suicide as a means of protecting others. 3) Increased awareness: this theme explored how participants became more observant of their thought content following their suicide attempt as they viewed it as a way of preventing themselves from re- experiencing psychosis. Conclusions: Central to participants’ experience of suicide was how they evaluated and responded to their psychotic experiences. These accounts provide a rich insight into the experience of a suicide attempt for those with FEP and highlights implications for future research