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Substance Use and Suicidality in People at Ultra-High-Risk of Psychosis: A Systematic Review.

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Title: Substance Use and Suicidality in People at Ultra-High-Risk of Psychosis: A Systematic Review.
Authors: Hui ATJ; Faculty of Biology, Medicine & Health, School of Health Sciences, Division of Psychology & Mental Health, University of Manchester, Manchester, UK., Mulligan LD; Faculty of Biology, Medicine & Health, School of Health Sciences, Division of Psychology & Mental Health, University of Manchester, Manchester, UK.
Source: Early intervention in psychiatry [Early Interv Psychiatry] 2026 Aug; Vol. 20 (8), pp. e70236.
Publication Type: Journal Article; Systematic Review; Review
Language: English
Journal Info: Publisher: Wiley-Blackwell Country of Publication: Australia NLM ID: 101320027 Publication Model: Print Cited Medium: Internet ISSN: 1751-7893 (Electronic) Linking ISSN: 17517885 NLM ISO Abbreviation: Early Interv Psychiatry Subsets: MEDLINE
Imprint Name(s): Original Publication: Carlton,VIC, Australia : Wiley-Blackwell
MeSH Terms: Substance-Related Disorders*/psychology , Substance-Related Disorders*/complications , Substance-Related Disorders*/epidemiology , Psychotic Disorders*/psychology , Psychotic Disorders*/complications , Psychotic Disorders*/epidemiology , Suicide*/psychology , Suicide*/statistics & numerical data , Suicide, Attempted*/psychology , Suicide, Attempted*/statistics & numerical data , Suicidal Ideation*, Humans ; Risk Factors
Abstract: Aim: Substance use and suicidality are prevalent among individuals at ultra-high-risk (UHR) of psychosis, yet their relationship remains unclear. This systematic review synthesises evidence on the relationship between substance use and suicidality-comprising suicidal ideation, self-harm, suicide attempts, and suicide deaths-in the UHR population.
Methods: A pre-registered systematic review (PROSPERO: CRD42024614852) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches of Embase, Medline, PsycINFO, and Web of Science identified studies examining substance use and suicidality in individuals at UHR. Two reviewers independently extracted data and assessed quality using the Mixed Methods Appraisal Tool. Findings were narratively synthesised.
Results: Twelve studies (13 papers; n = 2198) met inclusion criteria. Of 40 analyses, only 13 reported significant associations between substance use and suicidality, most of which were derived from a single study. Tobacco use showed the most consistent preliminary associations with suicidal ideation and self-harm. Alcohol and cannabis were linked to ideation and self-harm in some analyses, and cocaine to ideation only, particularly when continuous measures were used. In contrast, composite substance use variables were largely unrelated to suicide outcomes. Methodological quality varied, with major limitations including reliance on cross-sectional data and the use of dichotomous substance use outcomes.
Conclusion: At present, there is insufficient high-quality evidence to establish a reliable association between substance use and suicidality in individuals at UHR for psychosis. Rigorous longitudinal studies using validated, substance-specific measures are needed to better understand these relationships and inform risk assessment and early intervention.
(© 2026 The Author(s). Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)
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Grant Information: NIHR203308 NIHR Manchester Biomedical Research Centre
Contributed Indexing: Keywords: psychosis; review; substance use; suicide; ultra‐high‐risk (UHR)
Entry Date(s): Date Created: 20260728 Date Completed: 20260729 Latest Revision: 20260731
Update Code: 20260731
PubMed Central ID: PMC13414632
DOI: 10.1111/eip.70236
PMID: 42521509
Database: MEDLINE
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