Change in suicide rates for patients with schizophrenia in Denmark, 1981–97: Nested case-control study

Aarhus University, Aarhus, Central Jutland, Denmark
BMJ (online) (Impact Factor: 17.45). 08/2004; 329(7460):261. DOI: 10.1136/bmj.38133.622488.63
Source: PubMed


To study the change in risk of suicide among patients with schizophrenia and related disorders.
Nested case-control design with linked data.
4 longitudinal Danish registers.
18,744 people aged up to 75 years who committed suicide in 1981-97 individually matched with 20 controls.
Over the time studied the reduction in suicide rate among patients with schizophrenia and schizophrenia spectrum disorder was similar to that seen in the general population (incidence rate ratio 1.00, 95% confidence interval 0.98 to 1.03). The reduction among patients with other psychosis in the schizophrenia spectrum was faster than the reduction seen in the general population. Among people admitted to hospital with schizophrenia the risk of suicide was highest in the first year after first admission, and the excess risk was largest in the younger age groups-that is, the risk decreased per year for every additional year of age.
The suicide rate among patients with a diagnosis of schizophrenia and related disorders has fallen. This may be due to better psychiatric treatment, reduced access to means of suicide, or improvements in treatment after suicide attempts.

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    • "Our data indicate that excess mortality, irrespective of whether it is due to diseases or to external causes, peaks during the first year after discharge. This has previously been documented for suicide in several studies [16], [30], [50], [51] Regarding deaths due to diseases and medical conditions, excess death following hospitalization due to a mental disorder not only indicates that a current mental disorder is a risk factor contributing to death from a physical disorder; it also indicates a systematic failure of the health system to prevent, identify and treat physical diseases during hospitalization for a mental disorder. This interpretation is supported by studies documenting that patients with psychiatric disorders receive less treatment for physical conditions than people without psychiatric disorders.[44], "
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    ABSTRACT: BACKGROUND: Excess mortality among patients with severe mental disorders has not previously been investigated in detail in large complete national populations. OBJECTIVE: To investigate the excess mortality in different diagnostic categories due to suicide and other external causes of death, and due to specific causes in connection with diseases and medical conditions. METHODS: In longitudinal national psychiatric case registers from Denmark, Finland, and Sweden, a cohort of 270,770 recent-onset patients, who at least once during the period 2000 to 2006 were admitted due to a psychiatric disorder, were followed until death or the end of 2006. They were followed for 912,279 person years, and 28,088 deaths were analyzed. Life expectancy and standardized cause-specific mortality rates were estimated in each diagnostic group in all three countries. RESULTS: The life expectancy was generally approximately 15 years shorter for women and 20 years shorter for men, compared to the general population. Mortality due to diseases and medical conditions was increased two- to three-fold, while excess mortality from external causes ranged from three- to 77-fold. Mortality due to diseases and medical conditions was generally lowest in patients with affective disorders and highest in patients with substance abuse and personality disorders, while mortality due to suicide was highest in patients with affective disorders and personality disorders, and mortality due to other external causes was highest in patients with substance abuse. CONCLUSIONS: These alarming figures call for action in order to prevent the high mortality.
    Full-text · Article · Jan 2013 · PLoS ONE
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    • "The lifetime suicide attempt rate in schizophrenia is lower than that in major depressive disorder [3], but attempts are more dangerous, resulting in physical harm significantly more often (44% vs 16%) [4]. Successful lifetime suicide rates in schizophrenia seem to vary considerably from country to country: they have been reported to be approx 20–30:100,000 in Denmark [5] versus 67:100,000 in China [6]. "
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    ABSTRACT: To identify risk factors for suicide using data from a large, 3-year, multinational follow-up study of schizophrenia (SOHO study). Baseline characteristics of 8,871 adult patients with schizophrenia were included in a logistic regression post-hoc analysis comparing patients who attempted and/or committed suicide during the study with those who did not. 384 (4.3%) patients attempted or committed suicide. Completed suicides were 27 (0.3%). The significant risk factors for suicide behaviors were previous suicidality, depressive symptoms, prolactin-related adverse events, male gender and history of hospitalization for schizophrenia. In view of the observational design of the study and the post-hoc nature of the analysis, the identified risk factors should be confirmed by ad-hoc specifically designed studies.
    Full-text · Article · Jul 2012 · BMC Psychiatry
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    • "The first psychotic break down is usually seen in adolescence or early adulthood and has a serious impact on young peoples' lives through interference with their social lives and work. Furthermore, patients with psychosis often suffer from substance abuse, depression [2], suicide [3], and are often associated with high rates of violence and legal problems[4]. The direct cost of schizophrenia in European countries has been estimated to two percent of the national health expenditures[5], - a similar order of magnitude to cancer or ischaemic heart disease. "
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