Article

Risk factors for suicide in patients with schizophrenia: Nested case- control study

Institute for Basic Psychiatric Research, Department of Psychiatric Demography, Psychiatric Hospital in Aarhus, University of Aarhus, Denmark.
The British Journal of Psychiatry (Impact Factor: 7.34). 11/1997; 171:355-9. DOI: 10.1192/bjp.171.4.355
Source: PubMed

ABSTRACT Of 9156 patients admitted to psychiatric hospitals in Denmark between 1970 and 1987 and diagnosed for the first time as having schizophrenia, 508 committed suicide. The purpose of the study was to identify risk factors for suicide among patients with schizophrenia, particularly factors relating to hospitalisation.
From the cohort of all 9156 patients, the 508 who had committed suicide were individually matched to 10 controls from the same cohort, and data were analysed using conditional logistic regression.
Suicide risk was particularly high during the first 5 days after discharge, and increased risk was also associated with multiple admissions during the previous year, previous suicide attempts, previous diagnosis of depression, male gender, and previous admissions to general hospitals for physical disorders. After adjusting for these factors, no effect was found for age. There was some evidence of an excess of suicides during temporary leave from the psychiatric department.
The findings suggest that preventive measures could be focused on the first period after discharge, when closer monitoring and better social support may be needed. This may also apply to patients on temporary leave during a period of admission.

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    • "This concurs with previous reports from Denmark (Mortensen and Juel, 1993) and Sweden (Ösby et al., 2000). A further Danish study found that this effect was explained by shorter duration of illness (Rossau and Mortensen, 1997). We showed that suicide risk is higher in men with schizophrenia, consistent with a recent meta-analysis of studies reporting sex differences (Lester, 2006). "
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    ABSTRACT: Currently there is a lack of strong epidemiological evidence for violent offending and intelligence quotient (IQ) level as predictors of suicide risk among people with schizophrenia. We interlinked several Swedish routinely collected national registers, including the Hospital Discharge, Crime, Conscript, Migration and Cause of Death Registers, to identify 13,804 patients admitted at least twice with a schizophrenia diagnosis during 1973-2004. All deaths by specific cause were ascertained and suicides identified, and rate ratios were estimated using Poisson regression models with adjustment for age and period effects. There were 871 suicides: 6.3% of the cohort. Almost 80% of these cases were aged 20-39 years, and 80% occurred within 10 years of second discharge, with almost a quarter taking place within a year. The following risk factors were identified: younger age, 15-19 versus 40 years and older (rate ratio 3.18, 95% confidence interval 1.82-5.56), male sex (rate ratio 1.37, 1.18-1.59) and history of violent offending (rate ratio 1.45, 1.21-1.73). Intelligence quotient data were unavailable for women, but in men, lower IQ appeared protective compared to those of average or higher levels of intelligence (rate ratio 0.71, 0.58-0.86). Further stratified analyses to identify effect modification indicated that the elevated risk associated with past violent offending was restricted to males, and specifically to those with a lower IQ. Further research is needed to identify additional risk and protective factors for suicide that may be unique to people diagnosed with schizophrenia, and also other modifiers of the increased risk linked with violent offending.
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    • "Clinical contact may exert a protective influence, as suggested by the fact that outpatients with schizophrenia commit suicide at a higher rate than inpatients (Helgason, 1990). The first weeks (Qin and Nordentoft, 2005) or months (Rossau and Mortensen, 1997) after hospital discharge are a critical period. Other risk factors include high premorbid socioeconomic class and high IQ (Siris, 2001), better cognitive functioning (Nangle et al., 2006), greater insight into the illness (Schennach-Wolff et al., 2010), living alone, social fragmentation (Evans et al., 2004), and duration of untreated psychosis longer than one year (Altamura et al., 2003). "
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    • "Whether the causes of suicide are identical in different psychiatric diseases is unknown, but suicidal behavior is known to be particularly frequent at certain stages of each disorders. In schizophrenia most suicides occur within the first years after the onset of disease [2] [3]. "
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