Suicide Ideation and Behavior as Risk Factors for Subsequent Suicide in Schizophrenia: A Nested Case–Control Study

Clapham, Eric; Bodén, Robert; Brandt, Lena; Jönsson, Erik G.; Bahmanyar, Shahram; Ekbom, Anders; Ösby, Urban; Reutfors, Johan

doi:10.1111/sltb.12499

Cited by 14 publications

(13 citation statements)

References 29 publications

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“…Compared with the general population, their suicide risk is elevated by approximately 10-30 times (Ko et al, 2018;Plana-Ripoll et al, 2019) and peaks in the early stage or the first year of diagnosis (Ventriglio et al, 2016). A robust predictor for their subsequent suicides is histories of suicide attempts (SAs) and suicidal ideation (SI; Clapham et al, 2019;Fazel, Wolf, Palm, & Lichtenstein, 2014). Thus, elucidating the underlying mechanisms among individuals with first-episode schizophrenia (FES) who have attempted suicide or presented SI is essential for managing their suicide risk.…”

Section: Introductionmentioning

confidence: 99%

Suicidal ideation, suicide attempts, and neurocognitive dysfunctions among patients with first‐episode schizophrenia

Yin

Tong

Huang

et al. 2020

Suicide & Life Threat Behav

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Objective To determine whether suicidal ideation or suicide attempts are linked to poor neurocognitive function among individuals with first‐episode schizophrenia (FES). Method We performed a cross‐sectional study on 159 Chinese inpatients (Mage = 27.1 years; 52.2% females) with minimal‐treated FES and collected their suicidal history through interviews and medical records. Neurocognitive performance, psychopathology, and depressive symptoms were assessed using the MATRICS Consensus Cognitive Battery, the Positive and Negative Syndrome Scale, and the Calgary Depression Scale for Schizophrenia, respectively. Results Approximately 1/10 FES inpatients had any suicide attempts, and more than 1/4 reported lifetime suicidal ideation. Inpatients with a suicide attempt or suicidal ideation scored significantly worse in the overall seven neurocognitive domains compared with those without past suicidal ideation or a suicide attempt. Linear regression suggested that suicide attempts were mainly associated with lower scores in working memory and speed of processing, after adjusting for education levels. The associations remained robust after further controlling for psychopathological and depressive symptoms. Conclusion First‐episode schizophrenia patients with suicide attempts had more severely impaired neurocognitive performances in specific domains. Fundamental neurocognitive dysfunctions should be assessed, detected, and treated after their suicide risk assessments.

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Section: Introductionmentioning

confidence: 99%

Suicidal ideation, suicide attempts, and neurocognitive dysfunctions among patients with first‐episode schizophrenia

Yin

Tong

Huang

et al. 2020

Suicide & Life Threat Behav

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“…In schizophrenia patients, suicidal thoughts and suicide planning and attempts were significantly associated with completed suicide in the following year (35). In first-episode patients, more symptoms of depression, longer duration of untreated psychosis, and positive symptoms, such as hallucinations and delusions, were found to increase the odds of experiencing suicidal ideation (36).…”

Section: Mortality In Schizophreniamentioning

confidence: 99%

Effects of Aerobic Exercise on Metabolic Syndrome, Cardiorespiratory Fitness, and Symptoms in Schizophrenia Include Decreased Mortality

et al. 2018

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Schizophrenia is a severe psychiatric disorder with a lifetime prevalence of about 1%. People with schizophrenia have a 4-fold higher prevalence of metabolic syndrome than the general population, mainly because of antipsychotic treatment but perhaps also because of decreased physical activity. Metabolic syndrome is a risk factor for cardiovascular diseases, and the risk of these diseases is 2- to 3-fold higher in schizophrenia patients than in the general population. The suicide risk is also higher in schizophrenia, partly as a result of depression, positive, and cognitive symptoms of the disease. The higher suicide rate and higher rate of cardiac mortality, a consequence of the increased prevalance of cardiovascular diseases, contribute to the reduced life expectancy, which is up to 20 years lower than in the general population. Regular physical activity, especially in combination with psychosocial and dietary interventions, can improve parameters of the metabolic syndrome and cardiorespiratory fitness. Furthermore, aerobic exercise has been shown to improve cognitive deficits; total symptom severity, including positive and negative symptoms; depression; quality of life; and global functioning. High-intensity interval endurance training is a feasible and effective way to improve cardiorespiratory fitness and metabolic parameters and has been established as such in somatic disorders. It may have more beneficial effects on the metabolic state than more moderate and continuous endurance training methods, but to date it has not been investigated in schizophrenia patients in controlled, randomized trials. This review discusses physical training methods to improve cardiorespiratory fitness and reduce metabolic syndrome risk factors and symptoms in schizophrenia patients. The results of studies and future high-quality clinical trials are expected to lead to the development of an evidence-based physical training program for patients that includes practical recommendations, such as the optimal length and type of aerobic exercise programs and the ideal combination of exercise, psychoeducation, and individual weight management sessions.

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“…A number of risk factors have been identified as significant predictors of completed suicide among individuals with SZ including depressive mood, sleep difficulties, poor cognition, more severe positive and negative symptoms, and the number of previous hospitalizations [11][12][13][14][15]. Additionally, a recent review and meta-analysis has implicated a number of factors related to increased suicide risk in SZ including hopelessness, physical comorbidity, substance use, poor medication adherence, family history of psychiatric illness, and higher intelligence quotient [15].…”

Section: Introductionmentioning

confidence: 99%

Suicide Reduction in Schizophrenia via Exercise (SUnRISE): study protocol for a multi-site, single-blind, randomized clinical trial of aerobic exercise for suicide risk reduction in individuals with schizophrenia

Beck-Felts

Goodman

Ospina

et al. 2020

Trials

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Background Suicide risk among individuals with schizophrenia (SZ) is intractably high, with over 40% of individuals attempting to take their own lives during their lifetime and an estimated 5–10% completing suicide. At present, available pharmacological and psychotherapeutic treatments offer limited risk reduction benefits, and thus, there remains an urgent need to explore novel interventions that will ameliorate this risk. Aerobic exercise (AE) has been shown to improve a number of predictors of suicide risk (e.g., depressed mood, sleeping difficulties). As individuals with SZ display a highly sedentary lifestyle, AE may reduce suicide risk. Methods Employing a multi-site, single-blind, randomized clinical trial design, we will examine the impact of AE on risk for suicide and related variables in individuals with SZ. Participants will be randomized to one of two 12-week exercise interventions: AE or a stretching and toning (ST) control intervention. Primary outcome measures will include suicide risk (Columbia Suicide Severity Rating Scale, C-SSRS) and aerobic fitness (VO2max), along with additional measures of suicide risk, mood, emotion regulation, sleep, cognition, and physical activity, with assessments completed at baseline and after 6 and 12 weeks of interventions. Discussion It is hypothesized that AE will reduce suicide risk among individuals with SZ. This study may offer support for a more efficacious treatment method for this population in addition to the pre-existing pharmacological and psychotherapeutic treatment regimens. Trial registration Clinicaltrials.gov, NCT03270098. Registered on September 1, 2017.

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Suicide Ideation and Behavior as Risk Factors for Subsequent Suicide in Schizophrenia: A Nested Case–Control Study

Cited by 14 publications

References 29 publications

Suicidal ideation, suicide attempts, and neurocognitive dysfunctions among patients with first‐episode schizophrenia

Suicidal ideation, suicide attempts, and neurocognitive dysfunctions among patients with first‐episode schizophrenia

Effects of Aerobic Exercise on Metabolic Syndrome, Cardiorespiratory Fitness, and Symptoms in Schizophrenia Include Decreased Mortality

Suicide Reduction in Schizophrenia via Exercise (SUnRISE): study protocol for a multi-site, single-blind, randomized clinical trial of aerobic exercise for suicide risk reduction in individuals with schizophrenia

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