Suicide and schizophrenia: A systematic review of rates and risk

NHS Scotland, Ballenden House, Edinburgh, UK.
Journal of Psychopharmacology (Impact Factor: 3.59). 11/2010; 24(4 Suppl):81-90. DOI: 10.1177/1359786810385490
Source: PubMed


Risk assessment is a core skill in psychiatry. Risk prediction for suicide in schizophrenia is known to be complex. We undertook a systematic review of all original studies concerning suicide in schizophrenia published since 2004. We found 51 data-containing studies (from 1281 studies screened) that met our inclusion criteria, and ranked these by standardized quality criteria. Estimates of rates of suicide and risk factors associated with later suicide were identified, and the risk factors were grouped according to type and strength of association with suicide. Consensus on the lifetime risk of suicide was a rate of approximately 5%. Risk factors with a strong association with later suicide included being young, male, and with a high level of education. Illness-related risk factors were important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide, and comorbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment. Prevention of suicide in schizophrenia will rely on identifying those individuals at risk, and treating comorbid depression and substance misuse, as well as providing best available treatment for psychotic symptoms.

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    • "A related potential limitation is that our study population included Jews almost exclusively, and some underreporting may be driven by the stigma on suicide in Judaism. The rate of suicide in this cohort is 0.9%, lower than many of the reported rates of suicide in schizophrenia (Hor and Taylor, 2010). However, the results from the current study are very similar to a population-based study on suicide in first-episode psychosis in the UK (Dutta et al., 2010). "
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    ABSTRACT: Suicide is a major cause of death in schizophrenia. Identifying factors which increase the risk of suicide among schizophrenia patients might help focus prevention efforts. This study examined risk of suicide in male schizophrenia patients using population-based data, examining the timing of suicide in relation to the last hospital discharge, and the effect of premorbid IQ on risk of suicide. Data on 930,000 male adolescents from the Israeli military draft board were linked with data from the Israeli Psychiatric Hospitalization Case Registry and vital statistics from the Israeli Ministry of Health. The relationship between premorbid IQ and risk for suicide was examined among 2881 males hospitalized with schizophrenia and compared to a control group of 566,726 males from the same cohort, who were not hospitalized for a psychiatric disorder, using survival analysis methods. Over a mean follow-up period of 9.9years (SD=5.8, range: 0-22years), 77/3806 males with schizophrenia died by suicide (a suicide rate of 204.4 per 100,000person-years). Approximately 48% of the suicides occurred within a year of discharge from the last hospital admission for schizophrenia. Risk of suicide was higher in male schizophrenia patients with high premorbid IQ (HR=4.45, 95% CI=1.37-14.43) compared to those with normal premorbid IQ. These data indicate that male schizophrenia patients with high premorbid IQ are at particularly high risk of suicide, and the time of peak risk is during the first year after the last hospitalization discharge.
    Schizophrenia Research 10/2015; DOI:10.1016/j.schres.2015.10.006 · 3.92 Impact Factor
    • "Our patient admits to auditory accusatory hallucinations secondary to schizophrenia. Male sex, young age, higher levels of education, depressive symptoms and active hallucinations have been found to be strongly associated with suicide in schizophrenia [11]. Suicide prediction in schizophrenia is complex and efforts on prevention should also focus on ensuring compliance with medications [6]. "
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    ABSTRACT: Genital self-mutilation is an uncommon event that is commonly associated with psychotic disorders. Such injuries have also been reported secondary to complex religious beliefs and delusions regarding sexual guilt. Even though few case reports of male genital self-mutilation are available in literature, it is rare to have a combined self-genital mutilation and attempted suicide by cut throat occurring in the same patient at presentation. We presented the case of a 38-yr-old male who presented to the accident and emergency centre of a tertiary hospital in Accra, Ghana.
    Open Journal of Psychiatry 10/2015; 5(4):330-333. DOI:10.4236/ojpsych.2015.54037
    • "A family history of suicide and co-morbid alcohol and drug use were factors strongly associated with suicide. Adequate treatment for schizophrenia and related comorbid disorders was the only protective factor identified (Hor and Taylor, 2010). The CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness ) study compared the effectiveness and tolerability of first versus second generation antipsychotics in a multi-phase randomized controlled trial (Stroup and Lieberman, 2010). "
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    ABSTRACT: The aim of this survey was to identify predictors of suicide attempts that immediately followed a violent crime in patients with schizophrenia. Documentations of patients diagnosed with schizophrenia and released in a 10 years period from the National Institute of Forensic Psychiatry were reviewed. Twenty-six out of 223 patients attempted suicide after the violent crime. The young age of the victim, and living in partnership were those factors differentiating suicidal violent offenders from their non-suicidal counterparts.
    10/2015; DOI:10.1016/j.psychres.2015.10.027
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