Mortality and suicide in schizophrenia: 21-year follow-up in rural China

Abstract

Background Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia. Aims To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China. Method This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan–Meier survival analysis and Cox hazard regressions were conducted. Results Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01–1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93–0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide. Conclusions Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

“…An initial search retrieved 8,345 abstracts; removal of duplicates resulted in 6,390 abstracts for review. Of these, a total of 135 studies 5‐10,38‐166 were included, after excluding 463 articles upon full text assessment (see Figure 1, Table 1 and supplementary information). We ultimately included 4,536,447 individuals with schizophrenia who were compared with 1,115,600,059 control subjects from the general population.…”

Childhood maltreatment increases the suicidal risk in Chinese schizophrenia patients

“…Schizophrenia (SCZ) is a complex dysfunction of genetic, heterogeneous behavioral and cognitive syndrome that is prevalent in ~1% of the general population around the world, whose origins etiology appear to lie in genetic and/or environmental disruption of brain development ( 1 ). Life expectancy for people with SCZ is probably 10–25 years shorter than that for the general people ( 2 , 3 ). It has long been recognized that individuals with traumatic experiences among persons are at increased risk of subsequently developing poor outcomes, including substance abuse ( 4 ), cognitive deficits ( 5 ), sexual dysfunction ( 6 ), personality disorders ( 7 ) and dissociative disorders ( 8 ).…”

Characteristics of Families with Members Going Out for Work and Associated Factors among Persons with Schizophrenia in Rural China

“…‘Going out for work’ was defined as a family member going out to work for more than half a year in another county or city in China. Our previous publications contain more detailed information about this mental health survey [ 19 , 20 , 21 , 22 ]. In sum, all participants were identified through screening procedures for schizophrenia (e.g., trained investigators conducted face-to-face interviews with the head of each household and the key informants) and general psychiatric interviews.…”

“…The social functioning of the participants was measured by trained psychiatrists using the Global Assessment of Functioning (GAF) scale, which is validated and has been widely used in schizophrenia studies, including studies of persons with schizophrenia in China [ 21 , 23 , 24 ]. The total score range of the GAF is from 0 to 100; a higher score means better social functioning.…”