Potential mechanisms between psychotic-like experiences and suicidal ideation in the context of COVID-19: A longitudinal study

Objective Although many studies have found an association between psychotic-like experiences (PLEs) and suicidal ideation (SI), the underlying psychological mechanisms have not been well established. Therefore, we conducted a longitudinal study in technical secondary school and college students to explore the role of fear-response to the COVID-19 and depression in the association between PLEs and SI in the context of the COVID-19 pandemic. Methods PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Depression, fear, and SI were assessed using the Psychological Questionnaire for Public Health Emergency (PQPHE). PLEs were evaluated before the pandemic (T1), and fear, depression, and SI were measured during the pandemic (T2). Result A total of 938 students completed both waves of the survey through electronic questionnaires. PLEs, fear, depression, and SI were all correlated with each other (all p < 0.01). T2 depression partly (58.2 %) mediated the relationship between T1 PLEs and T2 SI (b = 0.15, 95%CI = 0.10, 0.22). T2 Fear moderated the relationship between T1 PLEs and T2 depression (b = 0.05, 95%CI = 0.01, 0.09) and the relationship between T1 PLEs and T2 SI (b = 0.11, 95%CI = 0.06, 0.16). Conclusion PLEs are both directly and indirectly related to SI. Depression can result from PLEs and lead to the subsequent SI. Additionally, high levels of fear during the COVID-19 pandemic can aggravate the adverse impact of PLEs on mental health problems. These findings provide potential targets for future suicide prevention.