***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose Whilst psychotic experiences are associated with suicidal behaviour in a number of studies the value of psychotic experiences for the prediction of suicidal behaviour and the role of depressive symptoms in this relationship is not clear . We examined the association between psychotic experiences and subsequent suicidal behaviour and examine the role of depressive symptoms in this relationship . Methods  Psychotic experiences and depressive symptoms  at age 12 and 16 years , and suicidal behaviour at age 16 years were assessed in participants ( prospect i ve analysis n = 3171 ; cross-sectional analysis n = 3952 ) from a population -based cohort . Results Psychotic experiences ( OR 1.75 95 % CI 1.20 , 2.54 ) and depression ( OR 3.97 95 % CI 2.56 , 6.15 ) at 12 years were independently associated with suicidal behaviour at 16 years after adjustment for confounding . There was no evidence that the relationship between psychotic experiences and suicidal behaviour was stronger in participants who were also depressive . A ROC analysis showed that adding information on psychotic experiences to measures of depressive symptoms had hardly any effect on improving prediction of suicidal behaviour ( AUC increased from 0.64 to 0.65 ) . Whereas adding a measure of depressive symptoms to the measure of psychotic experiences improved prediction substantially ( AUC 0.56–0.65 ) . Conclusions Psychotic experiences and depression are independently associated with suicidal behaviour although the association with depression is substantially stronger . Psychotic experiences alone are not a strong predictor of later suicidal behaviour and add little to predicting the risk of suicidal behaviour over and above the information provided by depressive symptoms Little is known about the occurrence and predictors of the psychosis spectrum in large non- clinical community sample s of U.S. youths . We aim ed to bridge this gap through assessment of psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort , a collaborative investigation of clinical and neurobehavioral phenotypes in a prospect ively accrued cohort of youths , funded by the National Institute of Mental Health . Youths ( age 11 - 21 ; N=7,054 ) and collateral informants ( caregiver/legal guardian ) were recruited through the Children 's Hospital of Philadelphia and administered structured screens of psychosis spectrum symptoms , other major psychopathology domains , and substance use . Youths were also administered a computerized neurocognitive battery assessing five neurobehavioral domains . Predictors of psychosis spectrum status in physically healthy participants ( N=4,848 ) were examined using logistic regression . Among medically healthy youths , 3.7 % reported threshold psychotic symptoms ( delusions and /or hallucinations ) . An additional 12.3 % reported significant sub-psychotic positive symptoms , with odd/unusual thoughts and auditory perceptions , followed by reality confusion , being the most discriminating and widely endorsed attenuated symptoms . A minority of youths ( 2.3 % ) endorsed sub clinical negative/disorganized symptoms in the absence of positive symptoms . Caregivers reported lower symptom levels than their children . Male gender , younger age , and non-European American ethnicity were significant predictors of spectrum status . Youths with spectrum symptoms had reduced accuracy across neurocognitive domains , reduced global functioning , and increased odds of depression , anxiety , behavioral disorders , substance use and suicidal ideation . These findings have public health relevance for prevention and early intervention IMPORTANCE Up to 1 million persons die by suicide annually . However , a lack of risk markers makes suicide risk assessment one of the most difficult areas of clinical practice . OBJECTIVE To assess psychotic symptoms ( attenuated or frank ) as a clinical marker of risk for suicide attempt . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1112 school-based adolescents ( aged 13 - 16 years ) , assessed at baseline and at 3 and 12 months for self-reported psychopathology , psychotic symptoms , and suicide attempts . MAIN OUTCOMES AND MEASURES Suicide attempts at the 3- and 12-month follow-up and acute suicide attempts ( defined as those occurring in the 2 weeks before an assessment ) . RESULTS Of the total sample , 7 % reported psychotic symptoms at baseline . Of that sub sample , 7 % reported a suicide attempt by the 3-month follow-up compared with 1 % of the rest of the sample ( odds ratio [ OR ] , 10.01 ; 95 % CI , 2.24 - 45.49 ) , and 20 % reported a suicide attempt by the 12-month follow-up compared with 2.5 % of the rest of the sample ( OR , 11.27 ; 95 % CI , 4.44 - 28.62 ) . Among adolescents with baseline psychopathology who reported psychotic symptoms , 14 % reported a suicide attempt by 3 months ( OR , 17.91 ; 95 % CI , 3.61 - 88.82 ) and 34 % reported a suicide attempt by 12 months ( OR , 32.67 ; 95 % CI , 10.42 - 102.41 ) . Adolescents with psychopathology who reported psychotic symptoms had a nearly 70-fold increased odds of acute suicide attempts ( OR , 67.50 ; 95 % CI , 11.41 - 399.21 ) . Differences were not explained by nonpsychotic psychiatric symptom burden , multimorbidity , or substance use . In a causative model , the population -attributable fraction of suicide attempts would be 56 % to 75 % for psychotic symptoms . CONCLUSIONS AND RELEVANCE Adolescents with psychopathology who report psychotic symptoms are at clinical high risk for suicide attempts . More careful clinical assessment of psychotic symptoms ( attenuated or frank ) in mental health services and better underst and ing of their pathological significance are urgently needed BACKGROUND Non-suicidal self-injury ( NSSI ) is the deliberate and direct injuring of body tissue without suicidal intent for purpose s not socially sanctioned . Few studies have examined the correlates of NSSI among young adults . This study aim ed to identify predictors of lifetime and past-year NSSI , and describe motives for NSSI and disclosure of NSSI to others . METHOD Interviews were conducted annually with 1081 students enrolled in the College Life Study , a prospect i ve longitudinal study conducted at a large public mid-Atlantic university . NSSI characteristics were assessed at Year 4 . Demographic and predictor variables were assessed during Years 1 to 4 . Multivariate logistic regression models were used to identify correlates of lifetime NSSI and predictors of past-year NSSI . RESULTS The prevalence of past-year and lifetime NSSI was 2 % and 7 % respectively ( > 70 % were female for both lifetime and past-year NSSI ) . Seven percent of NSSI cases self-injured once , whereas almost half self-injured six or more times . Independent predictors of past-year NSSI were maternal depression , non-heterosexual orientation , affective dysregulation and depression . Independent predictors of lifetime NSSI were depression , non-heterosexual orientation , paternal depression and female sex . One in six participants with NSSI had attempted suicide by young adulthood . The three most commonly reported motives for NSSI were mental distress , coping and situational stressors . Most ( 89 % ) told someone about their NSSI , most commonly a friend ( 68 % ) . CONCLUSIONS This study identified unique predictors of NSSI , which should help to eluci date its etiology and has implication s for early identification and interventions CONTEXT It has been reported that childhood psychotic symptoms are common in the general population and may signal neurodevelopmental processes that lead to schizophrenia . However , it is not clear whether these symptoms are associated with the same extensive risk factors established for adult schizophrenia . OBJECTIVE To examine the construct validity of children 's self-reported psychotic symptoms by testing whether these symptoms share the risk factors and clinical features of adult schizophrenia . DESIGN Prospect i ve , longitudinal cohort study of a nationally representative birth cohort in Great Britain . PARTICIPANTS A total of 2232 twelve-year-old children followed up since age 5 years ( retention , 96 % ) . Main Outcome Measure Children 's self-reported hallucinations and delusions . RESULTS Children 's psychotic symptoms are familial and heritable and are associated with social risk factors ( eg , urbanicity ) ; cognitive impairments at age 5 ; home-rearing risk factors ( eg , maternal expressed emotion ) ; behavioral , emotional , and educational problems at age 5 ; and comorbid conditions , including self-harm . CONCLUSIONS The results provide a comprehensive picture of the construct validity of children 's self-reported psychotic symptoms . For research ers , the findings indicate that children who have psychotic symptoms can be recruited for neuroscience research to determine the pathogenesis of schizophrenia . For clinicians , the findings indicate that psychotic symptoms in childhood are often a marker of an impaired developmental process and should be actively assessed BACKGROUND Childhood psychotic symptoms have been used as a sub clinical phenotype of schizophrenia in etiological research and as a target for preventative interventions . However , recent studies have cast doubt on the specificity of these symptoms for schizophrenia , suggesting alternative outcomes such as anxiety and depression . Using a prospect i ve longitudinal birth cohort we investigated whether childhood psychotic symptoms predicted a diagnosis of schizophrenia or other psychiatric disorders by 38 years of age . METHOD Participants were drawn from a birth cohort of 1037 children from Dunedin , New Zeal and , who were followed prospect ively to 38 years of age ( 96 % retention rate ) .  Structured clinical interviews were administered at age 11 to assess psychotic symptoms and study members underwent psychiatric assessment s at ages 18 , 21 , 26 , 32 and 38 to obtain past-year DSM-III-R/IV diagnoses and self-reports of attempted suicides since adolescence . RESULTS Psychotic symptoms at age 11 predicted elevated rates of research diagnoses of schizophrenia and posttraumatic stress disorder ( PTSD ) and also suicide attempts by age 38 , even when controlling for gender , social class and childhood psychopathology . No significant associations were found for persistent anxiety , persistent depression , mania or persistent substance dependence . Very few of the children presenting with age-11 psychotic symptoms were free from disorder by age 38 . CONCLUSIONS Childhood psychotic symptoms were not specific to a diagnosis of schizophrenia in adulthood and thus future studies of early symptoms should be cautious in extrapolating findings only to this clinical disorder . However , these symptoms may be useful as a marker of adult mental health problems more broadly CONTEXT It has been suggested that patients with major depressive disorder ( MDD ) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes . OBJECTIVE To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD . DESIGN Open treatment followed by sequential r and omized controlled trials . SETTING Primary and specialty psychiatric outpatient centers in the United States . PARTICIPANTS Male and female out patients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression ( STAR*D ) study . INTERVENTIONS Open treatment with citalopram followed by up to 3 sequential next-step treatments . MAIN OUTCOME MEASURES Number of treatment levels required to reach protocol -defined remission , as well as failure to return for the postbaseline visit , loss to follow-up , and psychiatric adverse events . For this secondary analysis , putative bipolar spectrum features , including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Question naire , were examined for association with treatment outcomes . RESULTS Of the 4041 subjects who entered the study , 1198 ( 30.0 % ) endorsed at least 1 item on the psychosis scale and 1524 ( 38.1 % ) described at least 1 recent maniclike/hypomaniclike symptom . Irritability and psychoticlike symptoms at entry were significantly associated with poorer outcomes across up to 4 treatment levels , as were shorter episodes and some neurovegetative symptoms of depression . However , other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance . CONCLUSION Self-reported psychoticlike symptoms were common in a community sample of out patients with MDD and strongly associated with poorer outcomes . Overall , the data do not support the hypothesis that unrecognized bipolar spectrum illness contributes substantially to antidepressant treatment resistance 
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Subanalyses showed that PE were associated with self-harm , suicidal ideation as well as suicidal attempts .
All studies had scope for considerable residual confounding ; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression .
PE are associated with self-injurious behaviour , suggesting they have potential as passive markers of suicidality .
Given evidence that PE represent an indicator of severity of non-psychotic psychopathology , the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress