After Psychosis, Friendships Can Help Save Lives

As a teen, I walked through a time of confusion. One psychiatrist called it 'psychosis.' Whatever it was, my thinking clouded and others around me seemed freaked out. At times, I was not sure if I would see past it. I felt alone and alien. Yet, I got better. Today, I am surrounded by friends, I have a career as a therapist that holds incredible meaning to me, and I'm grateful to be alive.

As a therapist, I have seen the pain of others after a mental health change. It's real. Friends, family, and community are often critical in making it through.

Suicide After Psychosis

Emerging from an experience of psychosis is equivalent to disorientation to the tenth degree. Psychosis often first strikes in adolescence or young adulthood, just as someone is making sense of themselves, exploring romantic relationships, entering the workforce or beginning college. An episode of psychosis can disrupt plans, affect friendships, and leave one with newfound questions about the possibility of managing a more serious mental health condition.

Suicide is a real risk, with the highest being in the first years after diagnosis. A 2021 study that followed 241 individuals between ages 14 and 35 in early psychosis over three years found that 13% of these individuals died by suicide within that relatively short period (Pelissa et al., 2021). This is especially tragic as among those who survive an initial episode of psychosis, recovery is common, with research suggesting that 50% find symptomatic remission after four years (Catalan et al., 2021). Many work, attend college and have meaningful relationships in recovery (Frawley et al., 2023). Death by suicide eliminates all these possibilities.

We don't have to accept this. Suicide in individuals who have experienced psychosis is preventable.

Friendships Can Save Lives

Symptoms of psychosis, such as hearing voices, paranoia, and changes in motivation, present a heavy burden to individuals with psychotic disorders. One might assume that thoughts of suicide might relate directly to these difficulties. Yet, there is often more to the picture.

According to Dr. Thomas Joiner's Interpersonal Theory of Suicide, a sense of not belonging and being a problem for others are two of three primary factors that lead one to suicidal ideation (Joiner et al., 2012). After psychosis, it is common for someone to withdraw from school or work. Friends and family might not understand what one is going through and may drop. Yet, after an experience like this, when one needs their friends the most.

A study of 12,195 individuals with a psychotic disorder found that social isolation was one of the greatest predictors of suicide in this high-risk cohort, even more so than symptoms as a standalone (Bornheimer et al., 2020).

Next Steps

Preventing suicide among young adults who have experienced an episode of psychosis may take more than psychiatric intervention. It's something we can all participate in through community inclusion. Public health initiatives focusing on acceptance, education, and preserving relationships among those affected are all worthwhile considerations.

If you have a friend who is acting strangely, expressing odd beliefs, or talking about unusual experiences, you may feel lost. It might be tempting to leave them be until they "figure it out." Still, the support of a friend can mean a lot. You don't have to be their therapist, but just by doing what you've always done, you can be a support. It might just save their life.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.