Psychotic symptoms and uric acid linked to suicidal ideation in schizophrenia

Greater psychotic symptom burden and higher serum uric acid were associated with current suicidal ideation in a cross-sectional study of 134 people with schizophrenia treated at Shanghai Jing’an District Mental Health Center. Twenty-three participants, representing 17.2% of the sample, had current suicidal ideation, defined in the study as a nonzero response to either of two relevant items on the Chinese Beck Scale for Suicide Ideation during the preceding week. The investigators reported that total Positive and Negative Syndrome Scale (PANSS) scores and serum uric acid remained associated with current ideation in a logistic regression adjusted only for age and sex.

They described uric acid as an exploratory biochemical correlate, not a mechanistic risk factor or validated biomarker. The research included patients treated at the Shanghai center from May 2021 through October 2023. Researchers assessed psychotic symptoms with the PANSS and obtained fasting blood samples for routine biochemical measurements.

Current suicidal ideation was assessed with the Chinese version of the Beck Scale for Suicide Ideation, using item 4 or 5: any nonzero response to either item during the preceding week classified a participant as having current ideation. The analysis compared participants with and without ideation, fitted a prespecified limited-adjustment logistic regression and conducted auxiliary receiver operating characteristic analyses. Because the study was cross-sectional, its findings describe relationships measured at one point in time and do not establish whether symptom burden or serum uric acid preceded, caused or contributed to suicidal ideation.

Participants with current suicidal ideation had higher PANSS total, positive and general psychopathology scores and higher serum uric acid levels than participants without ideation. In the model adjusted for age and sex, each 10-point increase in the total PANSS score was associated with 2.05 times the odds of current suicidal ideation (95% confidence interval, 1.27–3.31; P = 0.003). Each 100-micromole-per-liter increase in serum uric acid was associated with 2.46 times the odds of current suicidal ideation (95% confidence interval, 1.16–5.25; P = 0.019).

The odds ratios are statistical estimates of association, not measures of causal effect. Three receiver operating characteristic analyses examined the apparent discrimination of models based on symptoms, biochemical measures and their combination. The combined model had the numerically highest area under the ROC curve, at 0.768, with a 95% confidence interval of 0.657–0.865.

These unmeasured factors limit the ability to isolate the relationship between serum uric acid and suicidal ideation. Serum uric acid, the end product of purine metabolism, was evaluated as a routinely available peripheral measure linked in the study’s rationale to antioxidant, oxidative-inflammatory and metabolic processes. The results show that higher concentrations occurred alongside more severe psychotic symptoms and current suicidal ideation in this sample.

They do not show that uric acid generates suicidal thoughts, that lowering uric acid would reduce ideation, or that serum uric acid can independently identify people at elevated risk. Likewise, the PANSS result concerns the observed relationship between total psychotic symptom burden and current ideation rather than a validated prediction rule. The authors concluded that the combined model cannot be used for clinical prediction without further validation.

Subject of Research: Exploratory associations of psychotic symptoms and serum uric acid with current suicidal ideation in schizophrenia

Article Title: Psychotic symptom burden and serum uric acid as correlates in a limited-adjustment analysis of current suicidal ideation in schizophrenia: a cross-sectional study

Article References: Chen, H., Lv, J., Xu, Y., & Xiang, L. (2026). Psychotic symptom burden and serum uric acid as limited-adjustment correlates of current suicidal ideation in schizophrenia: a cross-sectional study. Frontiers in Psychiatry, 17, 1921230. https://doi.org/10.3389/fpsyt.2026.1921230

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1921230

Keywords: schizophrenia, suicidal ideation, serum uric acid, psychotic symptoms, PANSS, cross-sectional study, logistic regression, ROC analysis, Psychotic, symptom, burden, serum