Suicide and schizophrenia: A systematic review of rates and risk factorsFrom
Journal of Psychopharmacology
People with schizophrenia are known to die much earlier than expected. Up to 40% of this excess premature mortality can be attributed to suicide. This article reviews 128 studies looking at suicide and schizophrenia. Findings indicate that strong association with suicide include being young, male, and with a high level of education. Risk assessment is a core skill in psychiatry. Risk prediction for suicide in schizophrenia is known to be complex. This article emphasises the importance of prevention by identifying those individuals at risk, and treating depression and substance misuse, as well as providing best available treatment for psychotic symptoms. An important part of prevention should focus on optimizing adherence to medication, and earlier use of clozapine, as the only antipsychotic medication which has demonstrated efficacy for the management of suicidality in schizophrenia.
Risk assessment is a core skill in psychiatry. Risk prediction for suicide in schizophrenia is known to be complex. We undertook a systematic review of all original studies concerning suicide in schizophrenia published since 2004. We found 51 data-containing studies (from 1281 studies screened) that met our inclusion criteria, and ranked these by standardized quality criteria. Estimates of rates of suicide and risk factors associated with later suicide were identified, and the risk factors were grouped according to type and strength of association with suicide. Consensus on the lifetime risk of suicide was a rate of approximately 5%. Risk factors with a strong association with later suicide included being young, male, and with a high level of education. Illness-related risk factors were important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide, and comorbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment. Prevention of suicide in schizophrenia will rely on identifying those individuals at risk, and treating comorbid depression and substance misuse, as well as providing best available treatment for psychotic symptoms.
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Hor, K., & Taylor, M. (2010). Review: Suicide and schizophrenia: a systematic review of rates and risk factors Journal of Psychopharmacology, 24 (4 Suppl), 81-90 DOI: 10.1177/1359786810385490