Ten-year prospective follow-up study of the mortality by suicide in schizophrenic patients

Department of Psychiatry, University of Reims, Robert Debré Hospital, Reims, France.
Schizophrenia Research (Impact Factor: 3.92). 09/2007; 94(1-3):23-8. DOI: 10.1016/j.schres.2007.04.031
Source: PubMed


This ten-year follow-up study examined the prevalence and the most relevant baseline predictors of suicide in schizophrenic patients. In 1993, 3470 patients meeting the ICD-10 criteria for schizophrenia were assessed. We used national death certificate data to identify patients that had died by suicide for each year included in the study. In this way, we calculated standardized mortality ratios, adjusting for age and sex relative to the general population. We used Cox's proportional hazards models to investigate potential sociodemographic and clinical risk factors. There were 141 suicides in the cohort during the follow-up period, corresponding to a risk of suicide that was approximately 16 times higher than that of the general population. Women had slightly higher standardized mortality ratios than men. Suicide was the cause of death in more than half (53.9%) of deaths occurring during the first year of follow-up and nearly one-third (31.8%) of those occurring in the ten-year period of the study. There were four significant baseline predictors of suicide remaining in the final logistic regression model: male gender, drug abuse, previous suicide attempts, and short duration of illness. Sex, age, history of suicide attempt should be particularly considered in the assessment of suicide risk in schizophrenic patients. Our findings also emphasize the need for detection and effective management of associated comorbid drug abuse.

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    • "In common with many studies of first-episode samples (Limosin et al., 2007; Harris et al., 2008; Pompili et al., 2011), focus on suicide alone fails to accommodate the competing nature of different causes of mortality. Premature death may also result from heightened risk of accident, drug use and mortality related to lifestyle factors (Ruschena et al., 1998). "
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    ABSTRACT: Objective To determine mortality-related estimates and causes of death in young people with first-episode psychosis (FEP), and to identify baseline predictors of mortality. Method Mortality outcomes in 723 young people presenting to an early psychosis service were prospectively ascertained up to 20 years. Predictors of all-cause and unnatural death were investigated using survival techniques. Results Forty-nine participants died by study end. Most deaths (n = 41) occurred within 10 years of service entry. All-cause mortality was 5.5% at 10 years, rising to 8.0% after 20 years. Unnatural death rates at 10 and 20 years were 5.0% and 5.9%, respectively. Three risk factors consistently predicted all-cause mortality and unnatural deaths. Conclusion A substantial proportion of excess mortality was due to non-suicide unnatural death, and, later, natural deaths. This suggests that mental health services should expand their current focus on suicide to incorporate strategies to prevent accidental death and promote healthier lifestyles.
    Full-text · Article · Oct 2014 · Schizophrenia Research
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    • "Healthcare providers might evaluate suicide attempts in patients with schizophrenia by asking simple questions (Melrose 2009). For example, suicidal risk has been associated with demographic characteristics such as younger age and male gender (Limosin et al. 2007, Ran et al. 2007, Haukka et al. 2008). Other well-known suicide predictors "
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    ABSTRACT: Aims and objectives.  To explore suicide predictors in rural outpatients with schizophrenia. Background.  Suicide is a major cause of mortality in patients with schizophrenia. Evidence indicates that patients in rural areas are at high risk for inadequate health care services. However, information is limited on suicide risk in outpatients with schizophrenia in rural areas. Design.  Cross-sectional survey. Methods.  Data were collected on individuals enrolled in the 2007 Taiwan National Health Insurance program as diagnosed with schizophrenia, ≥18 years, and living in a rural county. Eligible individuals (n = 1655) were assessed by 12 community-based nurses at 12 public health centres. Participants' personal information was retrieved from National Health Insurance records using a personal data sheet, and treatment experiences were obtained by interviewing patients with a 10-item risk-assessment inventory. Data were collected over 18 months (2007-2008) and analysed by descriptive statistics and regression analyses. Results.  Risk of suicide attempt in the previous year had four significant predictors: number of self-harm incidents during the previous year, violent incidents towards others during the previous year, number of follow-ups by mental health clinics and number of involuntary hospitalisations during the previous year (R(2)  = 0·337, adjusted R(2)  = 0·334, F = 133·19, p = 0·000). Conclusion.  Health care providers should assess rural outpatients with schizophrenia for suicidal thoughts by asking simple questions to evaluate for a history of self-harm and violence and by comparing this information with health system data on follow-ups by mental health clinics and involuntary hospitalisations. Relevance to clinical practice.  Community-based health providers may use these results to prioritise assessments when they have a high case load of patients with schizophrenia. Community-based nurses need to be trained to recognise these four predictors to increase their sensitivity to suicidality among patients with schizophrenia.
    Full-text · Article · Aug 2012 · Journal of Clinical Nursing
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    • "This estimate may even become higher when persons with other psychiatric disorders (e.g., depression) could have been excluded from the pool of controls. High SMRs have also been observed in Sweden (15.7 for male schizophrenia patients and 19.7 for female patients) and France (15.8 for male patients and 17.7 for female patients) (Osby et al., 2000; Limosin et al., 2007 "
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    ABSTRACT: There is an increased incidence of non-affective psychotic disorders (NAPD) among first- and second-generation migrants in Europe. The purpose of this population-based study was to compare the risk of suicide in Dutch natives and immigrants with or without NAPD. Cases of NAPD (n=12 580) from three Dutch psychiatric registers were linked to the cause of death register of Statistics Netherlands and were compared to matched controls (n=244 792) from the population register, who had no such diagnosis. Hazard ratios (HRs) of suicide were estimated and adjusted for age and gender by Cox regression analysis. The presence of NAPD was strongly associated with suicide risk in each ethnic group. However, for all ethnic minority groups the HRs were somewhat lower than among Dutch natives, for whom the HR was 23.4 (95%-CI; 18.5-29.7). A closer examination revealed that suicide risk was influenced by the history of migration. While the risk for immigrants of the first generation, diagnosed with NAPD, was significantly lower than that for native Dutch patients (HR=0.45; 95%-CI: 0.28-0.73), the risk for those of the second generation was more similar to that for the Dutch (HR=0.85; 95%-CI: 0.51-1.40) (P value of history of migration=0.005). Immigrants diagnosed with NAPD of the first generation appear to be protected against suicide, whereas this protection is waning among those of the second generation. This is the first study worldwide on suicide in migrants with NAPD and the first study of suicide in patients with NAPD in the Netherlands.
    Full-text · Article · Apr 2012 · Schizophrenia Research
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