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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    • "Schizophrenia has been known since ancient times (McNally, 2009). From the beginning of 20 th century the attitude adopted towards the " schizophrenia " is the fragmentation of the old perception of madness in " diseases " (psychosis) (Hor, & JOPER® JOPER 2 Taylor, 2010), to reach nowadays at the " spectrum of psychoses " (DSM-V)."

    Full-text · Article · Dec 2015
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    • "Stressful events or circumstances , including poverty, unemployment, living situation (including whether or not there are infants or children in the home), loss of loved ones, arguments with family or friends, a breakdown in relationships and legal or work-related problems (Platt, 1984; Kaltiala-Heino et al., 1999; Cavanagh et al., 1999; Thacore and Varma, 2000; Jacobs and Brewer, 2004), often act as " triggers " to suicide among people who are predisposed or vulnerable to selfharm . Predisposing risk factors include alcohol abuse, drug abuse, adverse childhood experiences, and social isolation (Murphy and Wetzel, 1990; Felts et al., 1992; Draper, 1994; Santa Mina and Gallop, 1998; Brown et al., 1999; Afifi et al., 2008; Arria et al., 2009; WHO/London School of Hygiene and Tropical Medicine, 2010), as well as depression, posttraumatic stress disorder (PTSD), anxiety disorders, schizophrenia, and a general sense of hopelessness (Beck et al., 1985; Harris and Barraclough, 1997; Hor and Taylor, 2004; Britton et al., 2008; Wang et al., 2012; Hauser et al., 2013). Physical illnesses, particularly those that are painful or disabling, are also important factors (De Leo et al., 1999; Vera et al., 2011; Eneroth et al., 2014). "
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    ABSTRACT: Background: Suicidal ideation is one of the strongest predictors of recent and future suicide attempt. This study aimed to develop and validate a risk prediction algorithm for the recurrence of suicidal ideation among population with low mood METHODS: 3035 participants from U.S National Epidemiologic Survey on Alcohol and Related Conditions with suicidal ideation at their lowest mood at baseline were included. The Alcohol Use Disorder and Associated Disabilities Interview Schedule, based on the DSM-IV criteria was used. Logistic regression modeling was conducted to derive the algorithm. Discrimination and calibration were assessed in the development and validation cohorts. Results: In the development data, the proportion of recurrent suicidal ideation over 3 years was 19.5 (95% CI: 17.7, 21.5). The developed algorithm consisted of 6 predictors: age, feelings of emptiness, sudden mood changes, self-harm history, depressed mood in the past 4 weeks, interference with social activities in the past 4 weeks because of physical health or emotional problems and emptiness was the most important risk factor. The model had good discriminative power (C statistic=0.8273, 95% CI: 0.8027, 0.8520). The C statistic was 0.8091 (95% CI: 0.7786, 0.8395) in the external validation dataset and was 0.8193 (95% CI: 0.8001, 0.8385) in the combined dataset. Limitations: This study does not apply to people with suicidal ideation who are not depressed. Conclusions: The developed risk algorithm for predicting the recurrence of suicidal ideation has good discrimination and excellent calibration. Clinicians can use this algorithm to stratify the risk of recurrence in patients and thus improve personalized treatment approaches, make advice and further intensive monitoring.
    Full-text · Article · Dec 2015 · Journal of Affective Disorders
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    • "Similarly, a national cohort study on psychotic patients indicated that patients who had completed their academic obligations (as opposed to those who had not completed their academic obligations) from compulsory school were at increased risk of suicide (Björkenstam et al., 2014). A systematic review also indicated that a higher level of education was associated with increased risk of suicide among schizophrenia patients (Hor and Taylor, 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.
    Full-text · Article · Oct 2015 · Schizophrenia Research
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