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: 7.99). 11/1997; 171(4):355-9. DOI: 10.1192/bjp.171.4.355
Source: PubMed


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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Available from: Preben B Mortensen, Jun 09, 2014
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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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    • "Evidence also tells us that the strongest predictor of future suicide and SA is a previous attempt [9,3]. Other key risk factors include depressive symptoms and recent discharge from hospital [7,10-13]. One way to reduce the risk of suicide at discharge is to provide an enhanced support system for the young person throughout the discharge process and peer support may be ideal in this area. "
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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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