Understanding the impact of supporting someone with psychosis who is actively suicidal in the community

在精神病患者中，感知到的家庭支持水平越高，阳性精神病症状（如幻觉）的减少和住院治疗的减少就越相关（Norman等，2005）。然而，已经确定的是，支持患有精神病的亲属可能是苛刻的，并且可能导致家庭成员自身身心健康的恶化（Lobban & Barrowclough, 2016）。精神病的定性研究经常记录亲密个人关系的破裂，包括与家庭成员（mc - kathy - jones et al., 2013）。这与研究强调缺乏社会支持可能是精神病患者自杀的重要风险因素有关（Bolton, Gooding, Kapur, Barrowclough, & Tarrier, 2007），其中自杀风险估计是一般人群的12倍（Dutta et al., 2010）。家庭成员报告说，他们很难理解亲属试图传达自杀想法的行为，理解障碍包括使用间接语言和难以判断意图的诚意（Owens et al., 2012）。家庭成员在解释自杀亲属的警告信号和知道何时联系精神卫生服务方面也遇到困难（Owens et al., 2011）。目前尚不清楚这些挑战如何与精神病症状相互作用。例如，有自杀倾向的精神病患者可能会出现一些症状，使家庭成员难以理解他们的痛苦，比如有声音告诉他们试图自杀（Harkavy-Friedman et al., 2003）。

In individuals with psychosis, higher levelsof perceived family support areassociated with a reduction in positive psychotic symptoms, such as hallucinations, and a reduction in hospitalizations (Norman et al., 2005). However, it has been well established that supportinga relative with psychosis can be demanding and may contribute to a deterioration of family members' own physical and mental health (Lobban & Barrowclough, 2016). Qualitative studies of psychosis frequently document the breakdown of close personal relationships, including with family members (Mc-Carthy-Jones et al., 2013). This is pertinent in light of research highlighting how an absence of social support may be an important risk factor for suicide in those experiencing psychosis (Bolton, Gooding, Kapur, Barrowclough, & Tarrier, 2007), amongst whom the risk of suicide is estimated to be 12 times that of the general population (Dutta et al., 2010).Family members report difficulties interpreting their relatives' attempts to communicate suicidal thoughts, with barriers to understanding including the use of indirect language and difficulty judging the sincerity of intent (Owens et al., 2012). Family members also experience difficulties with interpreting warning signs in suicidal relatives and knowing when to contact mental health services (Owens et al., 2011).It is currently unknown how these challenges interact with psychotic symptoms. For example, people with psychosis who are suicidal may experience symptoms that make it difficult for family members to understand their distress, such as voices telling the individual to attempt suicide (Harkavy-Friedman et al., 2003).