Anhedonia is the inability to feel pleasure in situations or activities that are normally pleasing (Pelizza et al., 2012). Recent meta-analysis revealed a robust association between anhedonia and current suicidal ideation, independent of clinical depression severity and psychiatric disorders (Ducasse et al., 2018). Traditionally, anhedonia has been considered as a key symptom of both schizophrenia and major depression, as well as a marker of psychosis vulnerability within the schizotypy construct (Naguy et al., 2020). Along the clinical staging of psychosis, also Ultra-High Risk (UHR) individuals are characterized by hedonic deficits (Jhung et al., 2016), which are currently considered as putative predictors of both psychosis conversion (Bang et al., 2019) and poor social/role functioning (Cohen et al., 2020). However, there is some evidence that anhedonia is different in psychosis and in major depressive disorder (Strauss and Gold, 2012). Specifically, schizophrenia spectrum disorders seem to be characterized by a disorganization (rather than a deficiency) in reward processing and cognitive function, including energy expenditure and focus on irrelevant cues (Kring and Barch, 2014; Gooding and Pflum, 2014; Lambert et al., 2018). Differently, major depressive disorder has been characterized by deficits in anticipatory pleasure, development of reward associations, and integration of information from past experience (Pelizza and Ferrari, 2009; Pelizza et al., 2021a; Pizzagalli and Der-Avakian, 2022).

In a recent 2-year longitudinal study, we examined the risk of suicide in a clinical sample of UHR adolescents and young adults within an “Early Intervention in Psychosis” (EIP) program (Pelizza et al., 2020a). Our findings specifically showed a significant association between suicidal ideation (rated by the “Suicidal thoughts and wishes” item 9 of the Beck Depression Inventory – II Edition [BDI-II]) (Beck et al., 2006) and “Anhedonia” (as measured on item 4.3 subscore of the Comprehensive Assessment of At-Risk Mental States [CAARMS]) (Yung et al., 2005). To the best our knowledge, this was the first longitudinal study investigating the relationship between anhedonia and suicidal ideation in UHR subjects.

However, our follow-up study had some methodological limitations and additional data analyses could further be done, especially to better explore the association between suicide risk and hedonic deficit. First, CAARMS “Anhedonia” is just a single item and its subscores may be quite unstable overtime. Thus, more stable scores computed as a sum of different items (such as the BDI-II “Anhedonia” subscale score, combining items 4, 12, 15 and 21 subscores) (Winer et al., 2014a) should be preferred. Second, given the high prevalence of depressive disorders in UHR individuals at the first contact with adolescent and adult mental health services (Pelizza et al., 2018), the potential influence of depression on the relationship between suicidal ideation and anhedonia should also be controlled. Specifically, as suicidal thoughts was rated after both 12- and 24-month follow-up periods in our previous longitudinal analysis, whether anhedonia symptoms predicts suicidal ideation both at baseline and after the 2 years of follow-up could also be examined. Third, in our previous study, we did not compare these relationships between UHR individuals and help-seeking peers with First Episode Psychosis (FEP).

As evidence showed that recent change in anhedonia severity was most predictive of suicidal ideation (Hawes et al., 2018), the main aim of the present retrospective research was thus to investigate the association between current (2-week) anhedonia levels and current (2-week) suicidal thoughts along a 2-year follow-up period in distinct clinical samples of adolescents and young adults identified through the CAARMS criteria (i.e., FEP vs. UHR vs. non-UHR/FEP) (Yung et al., 2005).