An update meta-analysis on the relationship between psychotic experiences and self-injurious thoughts and behaviors in children and adolescents

Previous meta-analyses have shown that psychotic experiences are a potential clinical risk marker for self-injurious thoughts and behaviors. However, it is unclear whether hallucinations and delusions have different effects on self-injurious thoughts and behavior. The study was to provide an updated meta-analysis of the associations between different types of psychotic experiences and self-injurious thoughts and behaviors in children and adolescents. Fifteen cross-sectional and twenty-one longitudinal studies were included after searching for articles published before January 2025 according to PRISMA guidelines. This study was registered with PROSPERO (CRD42024523854). Random-effect models were used to obtain estimates of effect sizes and study quality was rated. Results showed that children and adolescents with psychotic experiences were more likely to engage in self-injurious thoughts and behaviors, with a 3.00-fold (95% CI: 2.15–4.20) and a 2.18-fold (95% CI: 1.92–2.46) increase in cross-sectional and longitudinal studies. After adjusting for co-occurring psychopathology, psychotic experiences still remained to be significant in cross-sectional (OR = 2.52, 95% CI: 1.94–3.28) and longitudinal studies (OR = 1.60, 95% CI: 1.30–1.97). Hallucinations (OR = 2.07, 95% CI: 1.90–2.25) were significantly more strongly associated with an increased risk of self-injurious thoughts and behavior compared to delusions (OR = 1.70, 95% CI: 1.51–1.92) in longitudinal studies. These findings highlighted the importance of assessing hallucinations as part of suicide prevention strategies in children and adolescents.