Suicide and schizophrenia: A systematic review of rates and risk factors

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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Available from: Mark Taylor, Oct 05, 2015
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    • "In the United States, suicide attempts account for some 400,000 emergency room visits annually [3]. Commonly identified risk factors for suicidal behaviors include affective disorders, substance use disorder , prior suicide attempt, adverse childhood experiences, family history of psychiatric disorders including substance abuse, family history of suicide, family violence, exposure to suicidal behaviors of others, schizophrenia , anxiety disorders [12] [13] [14] and incarceration [6] [15] [16]. An emerging body of literature suggests that sleep complaints including objective and subjective sleep disturbances such as insomnia, nightmares and poor sleep quality are risk factors for suicidal ideation, suicide attempts and completed suicide [1,4,17–21]. "
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    ABSTRACT: To examine the independent and joint relationships of poor subjective sleep quality and antepartum depression with suicidal ideation among pregnant women. A cross-sectional study was conducted among 641 pregnant women attending prenatal care clinics in Lima, Peru. Antepartum depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Antepartum subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression procedures were performed to estimate odds ratios (aOR) and 95% confidence intervals (95% CI) adjusted for confounders. Overall, the prevalence of suicidal ideation in this cohort was 16.8% and poor subjective sleep quality was more common among women endorsing suicidal ideation as compared to their counterparts who did not (47.2% vs. 24.8%, P<.001). After adjustment for confounders including maternal depression, poor subjective sleep quality (defined using the recommended criteria of PSQI global score of >5 vs. ≤5) was associated with a 1.7-fold increased odds of suicidal ideation (aOR=1.67; 95% CI 1.02-2.71). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in an 18% increase in odds for suicidal ideation, even after adjusting for depression (aOR=1.18; 95% CI 1.08-1.28). Women with both poor subjective sleep quality and depression had a 3.5-fold increased odds of suicidal ideation (aOR=3.48; 95% CI 1.96-6.18) as compared with those who had neither risk factor. Poor subjective sleep quality was associated with increased odds of suicidal ideation. Replication of these findings may promote investments in studies designed to examine the efficacy of sleep-focused interventions to treat pregnant women with sleep disorders and suicidal ideation. Copyright © 2015. Published by Elsevier Inc.
    General hospital psychiatry 05/2015; 37(5). DOI:10.1016/j.genhosppsych.2015.04.014 · 2.61 Impact Factor
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    • "In our study, greater severity of illness is likely to explain the difference in suicidal behavior and lends indirect validity to the construct of depression in this setting. Diagnosed MDD in isolation, or when co-morbid with another axis I disorder, is a well-established major risk factor for suicidal behavior worldwide [17,38,42]. "
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    ABSTRACT: Background People with severe mental disorders (SMD) are at higher risk of suicide. However, research into suicide attempts and completed suicide in people with SMD in low- and middle-income countries is mostly limited to patients attending psychiatric facilities where selection bias is likely to be high. Methods A population-based cohort of 919 people with SMD from rural Ethiopia (who received standardized clinician diagnoses of schizophrenia (n = 358) major depressive disorder (n = 216) and bipolar I disorder (n = 345)) were followed up annually for an average of 10 years. The Longitudinal Interval Follow-up Evaluation chart was administered by psychiatrists and used to evaluate systematically suicidal behavior and risk factors, which may be amenable to intervention. Results Over the follow-up period, the cumulative risk of suicide attempt was 26.3% for major depression, 23.8% for bipolar I disorder and 13.1% for schizophrenia, (p < 0.001). The overall incidence of completed suicide was 200.2/100,000 person-years (CI = 120.6, 312.5). Hanging was the most frequent method used (71.5%) for both attempters and completers. Most people who completed suicide were successful on the first attempt (84.2%), but the case-fatality rate for suicide attempt was 9.7%. In the adjusted logistic regression model, being currently married (Adjusted OR) =2.17, 95% CI = 1.21, 3.91), and having a diagnosis of bipolar I disorder (Adjusted OR = 2.59, 95% CI = 1.57, 4.26) or major depression (Adjusted OR = 2.71, 95% CI = 1.60, 4.58) were associated significantly with increased risk of suicide attempts. Conclusion In this sample of people with SMD from a rural setting, the rate of suicide was high. Initiatives to integrate mental health service into primary care need to focus on limiting access to suicide methods in people with SMD in addition to expanding access to mental health care.
    BMC Psychiatry 05/2014; 14(1):150. DOI:10.1186/1471-244X-14-150 · 2.21 Impact Factor
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    • "This study indicates that about 9.7% of all suicides suffered from schizophrenia in rural China. It is higher than what was found in the previous studies in the West, which reported that the lifetime risk of suicide was about 5% (Brian et al., 2005; Hor and Taylor, 2010). However , it is close to the findings in Pompili's (2007) previous study. "
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    ABSTRACT: Background There has been much literature on schizophrenia, but very little is known about the characteristics of suicides with schizophrenia in comparison with the suicides with other diagnosed psychiatric disorders and without psychiatric disorders. Methods Thirty-eight suicides with schizophrenia, 150 suicides with other psychiatric disorder, and 204 suicides without a psychiatric disorder were entered in current study. Psychological autopsy (PA) was applied to collect information of the suicides. Social demographic factors and clinical characteristics of the suicides were measured. The well validated standard scales were applied: Beck Hopelessness Scale (BHS), Landerman's Social Support Scale (DSSI), Dickman's Impulsivity Inventory (DII), Spielberger State-Trait Anxiety Inventory (STAI) and Hamilton Depression Scale (HAMD). Suicide intents were appraised by the Beck Suicide Intent Scale (SIS). The SCID based on the Diagnostic and Statistical Manual of Mental Disorders—IV (DSM-IV) was applied to assess the psychiatric status of individuals. Demographic characteristics, clinical characteristics, method of suicide and suicide intents of suicides were compared among the three groups (schizophrenia group, other psychiatric disorders group, and none psychiatric disorders group). Results There were 9.7% of suicides who suffered schizophrenia. The current study found that being female was the risk factor for suicides with schizophrenia in rural China, which was opposite to the previous studies. The suicides with psychiatric disorder scored higher on hopelessness, anxiety, and depression, but lower on social support and impulsivity than suicides without psychiatric disorder. The suicides with psychiatric disorder were less impulsive than none psychiatric disorders group, too. The schizophrenia group did not show more violence than other psychiatric disorders group. Conclusions This research compared the demographic characteristics, clinical characteristics, method of suicide and suicide intents among the suicides with schizophrenia, with other diagnosed psychiatric disorder and without psychiatric disorders. The result indicated that each groups showed their unique characteristics, which gave us new viewpoints to control and prevent the prevalence of suicides according to their different characteristics.
    Schizophrenia Research 05/2014; 155(1-3). DOI:10.1016/j.schres.2014.02.018 · 3.92 Impact Factor
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