A large U.S. analysis found that suicidal thoughts and suicide attempts became less likely over two years among young people receiving care for first-episode psychosis. The findings are encouraging, but they do not prove that coordinated specialty care alone caused the decline.
The 2026 EPINET analysis included 2,951 consecutive admissions to specialty clinics between 2019 and 2024. At entry, 34% of participants reported suicidal thoughts and 7% had attempted suicide during the previous six months.
What changed during two years of care
Compared with admission, the adjusted odds of a suicide attempt were 75% lower at six months, with an odds ratio of 0.25. At 24 months, the odds were about 85% lower, with an odds ratio of 0.15.
The pattern was similar for suicidal thoughts. Adjusted odds were 59% lower at six months and about 76% lower at 24 months. Every follow-up time point differed significantly from admission, with p < 0.001.
These are changes in adjusted odds, not the percentage of participants who still had suicidal thoughts or had attempted suicide at each later visit. That distinction matters: the analysis shows a strong downward pattern, but it does not provide a simple later prevalence figure.
What coordinated specialty care includes
EPINET linked coordinated specialty care programs across 87 community clinics in 15 states. These programs usually last about two years and combine medication management, psychotherapy, family education and support, case management, and help returning to school or work.
The participants had an average age of 21.5 years. Sixty-five percent were male, 45% were White, 37% were Black, and 20% were Hispanic. Sixty-five percent had schizophrenia-spectrum disorders, and 71% had previously been admitted to a psychiatric hospital before reaching coordinated specialty care.
Earlier treatment and previous attempts mattered
The analysis also pointed to factors linked with higher risk. Each additional year of untreated psychosis was associated with 11% higher odds of suicidal thoughts and 8% higher odds of a suicide attempt.
Participants with a previous attempt had about seven times the rate of attempts during follow-up. Those hospitalized before entering coordinated specialty care had 72% higher odds of an attempt and about four times the rate of attempts during follow-up.
The median duration of untreated psychosis was six months, but one-quarter of participants had waited at least 16 months. These findings underscore the importance of reaching specialized services earlier, while also showing that the study cannot establish that shortening untreated psychosis would by itself prevent suicide attempts.
Women reported more suicidal thoughts, while men had lower odds of suicidal thoughts and about one-third the rate of attempts during follow-up. Six participants, all men, died by suicide during follow-up. The researchers cautioned that this may be an undercount because deaths were identified from discharge records and programs may lose contact with people.
Why the results need careful interpretation
EPINET did not have a comparison group. As a result, the reductions cannot be attributed definitively to coordinated specialty care. Improvement after an acute psychotic episode, differences in measurement, and higher-risk participants leaving follow-up could also have contributed.
Those lost to follow-up had more suicidal thoughts at admission than those who remained in the analysis—38% compared with 32%—although their attempt rates were similar, at 8% and 7%. The study also did not measure the method or lethality of attempts, and depressive symptoms were not included consistently in the models.
Evidence from other research points to a more modest effect. A 2025 meta-analysis linked early-intervention programs with about one-third lower odds of suicide death and suicide attempts, with an adjusted odds ratio of 0.66 for each outcome. In a Hong Kong study, suicide deaths totaled 4.4% among patients receiving a two-year early-intervention program, compared with 7.5% among those receiving standard psychiatric care.
Together, the evidence supports early, coordinated help as an important approach for people experiencing first-episode psychosis, while leaving the exact size of its effect uncertain. The EPINET study followed people for two years and does not measure suicide risk later in life. A separate long-term cohort study of 2,723 people found that 1.9% died by suicide; risk was highest in the first year, but the median time to suicide was 5.6 years.
AI tools were used to assist with the preparation of this article.
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