What are the risk factors for suicide and deliberate self-harm in schizophrenia?
Jon Deeks with Keith Hawton, Lesley Sutton and Camilla Haw (Oxford)
Many risk factors have been linked to suicide among schizophrenics. This review has identified 25 studies, and looked at relationships of suicide and attempted suicide with 55 different risk factors covering demographic factors, physical illnesses, previous and current psychiatric illnesses, previous suicidal behaviour, life events and alcohol and drug abuse. Factors investigated in at least two studies associated with an increased risk of suicide included male gender (odds ratio = 1.53; confidence interval, 1.23-1.88), white ethnicity (odds ratio = 4.59; confidence interval, 1.21-17.30), living alone (odds ratio = 1.64; confidence interval, 1.09-2.47), recent loss (odds ratio = 4.03; confidence interval, 1.37-11.80), family history of depression (odds ratio = 2.95; confidence interval, 1.13-7.67), hopelessness (odds ratio = 21.40; confidence interval, 1.71-268.00), fear of mental disintegration (odds ratio = 12.10; confidence interval, 1.81-81.30), poor compliance with treatment (odds ratio = 3.75; confidence interval, 2.20-6.37), previous suicide attempts (odds ratio = 4.19; confidence interval, 2.76-6.36), previous depressive disorders (odds ratio = 3.03; confidence interval, 2.06-4.46) and drug abuse (odds ratio = 3.21; confidence interval, 1.99-5.17) Reduced risk was associated with hallucinations (odds ratio = 0.53; confidence interval, 0.35-0.81). On the basis of this data, prevention of suicide in schizophrenia is likely to result from treatment of affective symptoms, improving compliance with treatment, and maintaining special vigilance in patients with risk factors (e.g. previous suicide attempts, drug misuse, fear of mental disintegration), especially after loss events. The characteristics of the schizophrenic disorder appear to be less important.
Information on the relationship between 29 risk factors and episodes of deliberate self-harm in schizophrenia were considered in a separate systematic review of cohort and case-control studies of patients with schizophrenia or related diagnoses. Five variables (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Inadequate information was available for many of the other variables to exclude them as risk factors. The review concluded that schizophrenic patients with the proven risk factors need careful follow-up and monitoring, with treatment of any associated co-morbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.
Publication: 174
