A reduction in suicide among individuals with mental illness is an international public-health priority. Approximately 10% of patients with schizophrenia will die by suicide.
The goal of this study was to describe social and clinical characteristics of people with schizophrenia who completed suicide, including aspects of the clinical care they received.
A national clinical survey was conducted based on a 4-year (1996-2000) sample of people in England and Wales who had died by suicide and had been in contact with mental health services in the previous 12 months.
Of 20,927 individuals who committed suicide, 5,099 (24%) were known to have been in contact with mental health services in the year prior to death. Completed questionnaires were returned on 4,859 cases of suicide. Of these, 960 (20%) were diagnosed with schizophrenia. These suicides were characterized by more violent modes of death, with over a quarter (27%) jumping from a height or in front of a moving vehicle compared to 10% of the remaining sample. They were more likely than the other individuals in the sample to be young, male, unmarried, and from an ethnic minority with high rates of unemployment. Rates of previous violence and drug abuse were high and they were proportionally more likely to be inpatients at the time of death and to have been noncompliant with medication. Patients with schizophrenia and comorbid substance abuse showed particularly complex social and clinical morbidity.
Measures that may prevent suicide among patients with schizophrenia include improved ward safety, closer supervision in both inpatient and community settings, particularly for those with poor medication compliance, and effective treatment of substance abuse.
"Most notably, natural-cause mortality increased sevenfold with a longer time to first remission (>2 years), and unnatural-cause mortality increased threefold with illicit drug use in the year before baseline. The finding that full family involvement at first contact may have such a profound impact on reducing the risk of unnatural-cause mortality suggests that appropriate involvement of family and caregivers could be an important element of risk management and suicide prevention in early psychosis (Hunt et al., 2006; Power et al., 2003). Further research should also be conducted because family involvement may be a proxy for other factors such as socio-economic status, family cohesion, and level of education. "
[Show abstract][Hide abstract] ABSTRACT: It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome. We have synthesized information on mortality, clinical and social outcomes from the ÆSOP-10 multicenter study, a 10-year follow-up of a large epidemiologically characterized cohort of 557 people with first-episode psychosis. Symptomatic remission and recovery were more common than previously believed. Distinguishing between symptom and social recovery is important given the disparity between these; even when symptomatic recovery occurs social inclusion may remain elusive. Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement. These results suggest that researchers, clinicians and those affected by psychosis should countenance a much more optimistic view of symptomatic outcome than was assumed when these conditions were first described.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Journal of nervous and mental disease 04/2015; 203(5). DOI:10.1097/NMD.0000000000000295 · 1.69 Impact Factor
"While previous work suggests that suicide may be more closely associated with violent behavior in schizophrenia as compared to other psychiatric disorders (Hunt et al., 2006), less work has investigated the association between suicidality and violence in these individuals. Attempts to address this question, moreover, have not provided clear evidence of a significant association as two systematic reviews have reached divergent conclusions regarding whether violence predicts suicide in those with schizophrenia (Hawton et al., 2005; Montross et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: Suicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness.
The aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia.
Data for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk.
Suicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior.
Suicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.
Schizophrenia Research 02/2014; 154(1-3). DOI:10.1016/j.schres.2014.02.001 · 3.92 Impact Factor
"In keeping with this, up to 5 domains are currently considered: (1) awareness of having a mental illness, (2) recognition of need for treatment, (3) awareness of the social consequences of the illness, (4) awareness of psychotic symptoms, and (5) attribution of symptoms to mental disorder  . Almost 50% of patients with schizophrenia will make a suicide attempt (SA) within their lifetime , often using potentially lethal methods such as hanging  or jumping from a height    . After a first episode of psychosis (FEP), 1 study estimates a 3% risk of suicide completion (SC) and 18% risk of SA over a 5-year follow-up period . "
[Show abstract][Hide abstract] ABSTRACT: Suicide has been shown to represent the major single cause of premature death among patients with schizophrenia spectrum disorders. Insight has been proposed to increase such risk. However, this subject has not been sufficiently investigated, and inconclusive results have been reported.
The objective of this study is to systematically examine the role of insight in the risk of suicide attempts and completed suicide among patients with schizophrenia and related disorders.
Articles assessing insight and suicidality in patients with schizophrenia spectrum disorders published between 1977 and 2010 were reviewed. A MEDLINE search strategy was used to identify studies using keywords. Application of meta-analytic techniques to selected studies was not possible because of important methodological differences between them.
Fifteen studies met predetermined selection criteria. Ten failed to demonstrate a positive association between insight and risk for suicide.
There is little evidence to support the suggestion that insight may represent a risk factor for suicide in patients with schizophrenia. If there is an association between such risk and insight, it appears to be mediated by other variables such as depression and, above all, hopelessness. Further studies with larger samples and longer follow-up periods in naturalistic conditions, in which insight should be evaluated from a multidimensional approach, are required to analyze this issue in depth, given the crucial implications that it may have on the development of a model for suicide prevention in schizophrenia.
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