A longitudinal study of adolescent psychotic experiences and later development of substance use disorder and suicidal behavior

Abstract Introduction Psychotic experiences are associated with later substance use disorder and suicidal behavior, but individual psychotic experiences have not been examined in a longitudinal data set. Also, the potential dose–response relationship between these phenomena remains unknown. Method Cohort study including 9242 adolescents who participated in The Child and Adolescent Twin Study in Sweden (CATSS). At ages 15 and/or 18, seven psychotic experiences (auditory and visual hallucinations, and five delusions) were assessed via questionnaires. Outcomes at follow-up were physician-assigned diagnoses of substance use disorder and suicide attempts ascertained from the Swedish Patient Register. Associations were estimated with Cox regressions and expressed as hazard ratios. Results All psychotic experiences were associated with later substance use disorder and/or suicide attempts, with hazard ratios ranging from 1.6 to 3.0. A dose–response relationship was observed between psychotic experiences and later substance use disorder, and suicide attempt. Discussion Auditory and visual hallucinations as well as delusions in adolescence are associated with later development of substance use disorder and suicide attempt, and there is a dose–response relationship between the load of psychotic experiences and these adverse outcomes. Clinicians should assess subclinical hallucinations as well as delusions in psychiatric evaluations of adolescents.