Suicide in schizophrenia – how can research influence training and clinical practice?

Abstract

Suicide has consistently been the most common cause of premature death in schizophrenia. A large 5-year World Health Organization study consisting of the follow-up of 1056 patients exhibiting psychotic symptoms found the most common cause of death in those with schizophrenia was suicide (Sartorius et al, 1986). In their review of the subject Caldwell and Gottesman (1990) found that 9–13% of patients with schizophrenia eventually commit suicide. At least 20–40% make suicide attempts (Meltzer & Fatemi, 1995) and 1–2% go on to complete in their attempt within the next 12 months (Meltzer & Okayli 1995). Therefore, suicide in schizophrenia has long been a major area of concern and research efforts.

Suicide Among Patients with Schizophrenia: A Consideration of Risk and Protective Factors

“…Men in the general population of the United States commit suicide more frequently than women (1). The same trend is seen among men with schizophrenia (29,48,49), therefore being male is consistently cited as a risk factor (5,10,16,26,29,33,36,37,47,48,50). It is unclear whether this increased risk is related to a worsened course of illness or an earlier onset of disease -both of which are frequently observed among men (12,51).…”

“…People with schizophrenia are no exception (5,16,25,33,36,37). Possessing a supportive network of family, friends, co-workers, or mental health professionals can mitigate thoughts of suicide.…”

“…When are patients most likely to commit suicide or voice suicidal ideation? It has been noted that the majority of suicides for this population occur within the first 10 years of illness onset (5,10,16,33,37,39,43), with approximately 50% of suicides occurring within the first two years (31).…”

The correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness in schizophrenic patients

“…İngiltere'de ulusal bir araştırmadan elde edilen sonuçlara göre, 1996-1998 döneminde özkıyım kurbanlarının %20'sinin şizofreni tanılarının olduğu, hastaların %50'sinin önceki 7 gün içinde psikiyatri kurumlarına başvurdukları ve bunların %85'inin düşük risk altında olduğunun düşünüldüğü saptanmıştır (8). Yine başka bir çalışmada, özkıyım nedeniyle yaşamını yitirmiş 17 şizofreni hastası incelendiğinde, 16'sının psikiyatrik tedavilerini sürdürdüğü, bu hastalarla ilgilenen doktorların %76'sının hastalarının özkıyım riski altında olduğunu düşünmediği, özkıyım öncesinde hastaların üçte birinin kendine zarar veren davranışının saptandığı bildirilmiştir (9).…”

Mental Disordersand Suicide

“…Suicide is more likely to occur earlier in the course of the illness. If we are to prevent suicide in persons with schizophrenia it is vital that all staff working in mental health receive dedicated training in both risk assessment and management, something that is too often left to experience to provide [19]. Training should also emphasize the importance of addressing co-morbid conditions that have been found to heighten risk, such as depression, substance use and loss of functioning.…”