Indian Journal of Private Psychiatry

Register      Login

VOLUME 12 , ISSUE 1 ( January-June, 2018 ) > List of Articles

REVIEW ARTICLE

Suicide in Schizophrenia Spectrum Disorders: A Review of Sociodemographic and Clinical Correlates

Hemendra Singh

Keywords : Psychotic symptoms, Schizophrenia spectrum disorders, Suicide, Suicide attempt, Suicide prevention

Citation Information : Singh H. Suicide in Schizophrenia Spectrum Disorders: A Review of Sociodemographic and Clinical Correlates. Ind J Priv Psychiatry 2018; 12 (1):20-26.

DOI: 10.5005/jp-journals-10067-0013

License: CC BY-ND 3.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Suicide is the most common cause of mortality among patients with schizophrenia. Literature shows that about 20 to 40% of schizophrenic patients make suicide attempts. Studies show that a history of past suicide attempts is a strong predictor of future suicide and increases the risk of future suicide. Suicide rates among patients with schizophrenia spectrum disorders (SSDs) range between 5 and 13%. There are various associated risk factors for suicide risk assessment, such as genetic vulnerability, gender, hopelessness, depression, underlying substance use, early phase of illness, and duration of untreated psychosis (DUP). However, the role of psychotic symptoms is also equally important while assessing for suicide risk. Hence, future research is required from appropriate risk assessment and suicide prevention among patients with SSD.


PDF Share
  1. Conwell Y, Cholette J, Duberstein PR. Suicide and schizophrenia: Identifying Risk Factors and Preventive Strategies. Medscape Mental Health 1998;3(3).
  2. Sartorius N, Jablensky A, Korten A, Ernberg G, Anker M, Cooper JE, Day R. Early manifestations and first contact incidence of schizophrenia in different cultures. Psychol Med 1986 Nov;16(4):909-928.
  3. Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, et al. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007;6:10.
  4. Miles CP. Conditions predisposing to suicide: a review. J Nerv Ment Dis 1977 Apr;164(4):231-246.
  5. Brown S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997 Dec;171:502-508.
  6. Caldwell CB, Gottesman II. Schizophrenia, a high-risk factor for suicides: clues to risk reduction. Suicide Life Threat Behav 1992Winter;22(4):479-493.
  7. Pompili M, Mancinelli I, Ruberto A, Kotzalidis GD, Girardi P, Tatarelli R. Where Schizophrenic Patients Commit Suicide: A review of Suicide Among Inpatients and former inpatients. Int J Psychiatry Med 2005;35(2):171-190.
  8. Palmer BA, Pankratz VS, Bostwick JM. The Lifetime Risk of Suicide in Schizophrenia: A Reexamination. Arch Gen Psychiatry 2005 Mar;62(3):247-253.
  9. Inskip HM, Harris EC, Barraclough B. Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Br J Psychiatry 1998 Jan;172:35-37.
  10. Meltzer HY. Suicidality in schizophrenia: pharmacologic treatment. Clin Neuropsychiatry 2005;2:76-83.
  11. Tsuang MA, Woolson RF, Fleming JA. Premature deaths in schizophrenia and affective disorders: an analysis of survival curves and variables affecting the shortened survival. Arch Gen Psychiatry 1980 Sep;37(9):979-983.
  12. Cheng KK, Leung CM, Lo WH, Lam TH. Risk factors of suicide among schizophrenics. Acta Psychiatr Scand 1990 Mar;81(3): 220-224.
  13. Siris SG, Mason SE, Shuwall MA. Histories of substance abuse, panic and suicidal ideation in schizophrenic patients with histories of post-psychotic depressions. Prog Europsychopharmacol Biol Psychiatry 1993;17:609-617.
  14. Munk-Jorgensen P. Has deinstitutionalization gone too far? Eur Arch Psychiatry Clin Neurosci 1999;249(3):136-143.
  15. Osby U, Correia N, Brandt L, Ekbom A, Sparen P. Mortality and causes of death in schizophrenia in Stockholm County, Sweden. Schizophr Res 2000 Sep;45(1-2):21-28.
  16. Wolfersdorf M, Keller F, Schmidt-Michel PO, Weiskittel C, Vogel R, Hole G. Are hospital suicides on the increase? A survey of reports on hospital suicides in the psychiatric literature of the 19th and 20th century. Soc Psychiatry Psychiatr Epidemiol 1988 Dec;23(4):207-216.
  17. Nordentoft M, Laursen TM, Agerbo E, Qin P, Hoyer EH, Mortensen PB. Change in suicide rates for patients with schizophrenia in Denmark, 1981–97: nested case-control study. BMJ 2004 Jul;329(7460):261.
  18. Havaki-Kontaxaki BJ, Kontaxakis VP, Protopappa VA, Christodoulou GN. Suicides in a large psychiatric hospital: risk factors for schizophrenic patients. Bibl Psychiatr 1994; 165:63-71.
  19. Roy A. Suicide in schizophrenia. In Roy A, editor. Suicide. Baltimore, MD: Williams and Wilkins; 1986. pp. 97-112.
  20. Landmark J, Cernovsky ZZ, Merskey H. Correlates of suicide attempts and ideation in schizophrenia. Br J Psychiatry 1987 Jul;151:18-20.
  21. Planasky K, Johnston R. The occurrence and characteristics of suicidal preoccupation and acts in schizophrenia. Acta Psychiatr Scand 1971;47(4):473-483.
  22. Drake RE. Suicide attempts and completed suicides among schizophrenia patients. In Tatarelli R, Pompili M, Girardi P, editors. Suicide in schizophrenia. New York, NY: Nova Science Publishers Inc.; 2006.
  23. Meltzer HY, Fatemi H. Suicide in schizophrenia: the effect of clozapine. Clin Neuropharmacol 1995;18:S18-S24.
  24. Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am J Psychiatry 1995 Feb;152(2):183-190.
  25. Harkavy-Friedman JM, Nelson EA, Venarde DF, Mann JJ. Suicidal behavior in schizophrenia and schizoaffective disorder: examining the role of depression. Suicide Life Threat Behav 2004 Spring;34(1):66-76.
  26. Kelly DL, Shim JC, Feldman SM, Yu Y, Conley RR. Lifetime psychiatric symptoms in persons with schizophrenia who died by suicide compared to other means of death. J Psychiatr Res 2004 Sep-Oct;38(5):531-356.
  27. Heila H, Isometsa ET, Henriksson MM, Heikkinen ME, Marttunen MJ, Lonnqvist JK. Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sexspecific clinical characteristics of 92 suicide victims with schizophrenia. Am J Psychiatry 1997 Sep;154(9):1235-1242.
  28. Waltzer H. Suicide in young schizophrenics. Gen Hosp Psychiatry 1984;6(3):219-225.
  29. King E. Suicide in the mentally ill: an epidemiological sample and implications for clinicians. Br J Psychiatry 1994;165: 658-663.
  30. Black DW, Winokur G, Warrack G. Suicide in schizophrenia: the Iowa Record Linkage Study. J Clin Psychiatry 1985 Nov;46(11 Pt 2):14-17.
  31. Muller DJ, Barkow K, Kovalenko S, Ohlraun S, Fangerau H, Kolsch H, Lemke MR, Held T, Nothen MM, Maier W, et al. Suicide attempts in schizophrenia and affective disorders with relation to some specific demographical and clinical characteristics. Eur Psychiatry 2005 Jan;20(1): 65-69.
  32. Rossau CD, Mortensen PB. Risk factors for suicide in patients with schizophrenia: nested case-control study. Br J Psychiatry 1997 Oct;171:355-359.
  33. Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/ViolencePrevention/pdf/Suicide_DataSheet-a.pdf
  34. Allebeck P, Wistedt B. Mortality in schizophrenia: a ten-year follow-up based on the Stockholm County Inpatient Register. Arch Gen Psychiatry 1986 Jul;43(7):650-653.
  35. Allebeck P. Schizophrenia: a life-shortening disease. Schizophr Bull 1989 Jan;15(1):81-89.
  36. Allebeck P, Varla A, Kristjansson E, Wistedt B. Risk factors for suicide among patients with schizophrenia. Acta Psychiatr Scand 1987 Oct;76(4):414-419.
  37. Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry 2005 Apr;62(4):427-432.
  38. Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry 2005 Jul;187:9-20.
  39. Roy A. Family history of suicide. Arch Gen Psychiatry 1983 Sep;40(9):971-974.
  40. Drake RE, Gates C, Cotton PG, Whitaker A. Suicide among schizophrenics: who is at risk? J Nerv Ment Dis 1984 Oct;172(10):613-617.
  41. Roy A. Suicide in chronic schizophrenia. Br J Psychiatry 1982;141(2):171-177.
  42. Cotton PG, Drake RE, Gates C. Critical treatment issues in suicide among schizophrenics. Hosp Community Psychiatry 1985 May;36(5):534-536.
  43. Nyman AK, Jonsson H. Pattern of self destructive behavior in schizophrenia. Acta Psychiatr Scand 1986 Mar;73(3): 252-262.
  44. Raymont V. Suicide in schizophrenia: how can research influence training and clinical practice? Psychiatrist 2001 Feb;25(2):46-50.
  45. Modestin J, Zarro I, Waldvogel D. A study of suicide in schizophrenic in-patients. Br J Psychiatry 1992 Mar;160:398-401.
  46. Altamura AC, Mundo E, Bassetti R, Green A, Lindenmayer JP, Alphs A, Meltzer, HY. Transcultural differences in suicide attempters: analysis on a high-risk population of patients with schizophrenia or schizoaffective disorder. Schizophr Res 2007 Jan;89(1-3):140-146.
  47. Bhatia T, Thomas P, Semwal P, Thelma BK, Nimgaonkar VL, Deshpande SN. Differing correlates for suicide attempts among patients with schizophrenia or schizoaffective disorder in India and USA. Schizophr Res 2006 Sep;86(1-3):208-214.
  48. Wolfersdorf M, Keller F, Schmidt-Michel PO, Weiskittel C, Vogel R, Hole G. Are hospital suicides on the increase? A survey of reports on hospital suicides in the psychiatric literature of the 19th and 20th century. Soc Psychiatry Psychiatr Epidemiol 1988 Oct;23(4):207-216.
  49. De Hert M, McKenzie K, Peuskens J. Risk factors for suicide in young people suffering from schizophrenia: a long-term follow-up study. Schizophr Res 2001 Mar;47(2-3):127-134.
  50. Fenton WS. Depression, suicide, and suicide prevention in schizophrenia. Suicide Life Threat Behav 2000 Spring;30(1): 34-49.
  51. Dingman CW, McGlashan TH. Discriminating characteristics of suicides. Chestnut Lodge follow-up sample including patients with affective disorder, schizophrenia and schizoaffective disorder. Acta Psychiatr Scand 1986 Jul;74(1):91-97.
  52. Strauss JS, Carpenter WT Jr. The prediction of outcome in schizophrenia: I. characteristics of outcome. Arch Gen Psychiatry 1972 Dec;26:739-746.
  53. Pompili M, Girardi P, Ruberto A, Tatarelli R. Toward a new prevention of suicide in schizophrenia. World J Biol Psychiatry 2004;5(4):201-210.
  54. Drake RE, Gates C, Whitaker A, Cotton PG. Suicide among schizophrenics: a review. Compr Psychiatry 1985 Jan-Feb; 26(1):90-100.
  55. Harkavy-Friedman JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, Gorman JM. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry 1999 Aug;156(8): 1276-1278.
  56. Guze SB, Robbins E. Suicide and primary affective disorders. Br J Psychiatry 1970 Oct;117(539):437-438.
  57. Fawcett J, Scheftner W, Clark D, Hedeker D, Gibbons R, Coryell W. Clinical predictors of suicide of patients with major affective disorders: a controlled prospective study. Am J Psychiatry 1987 Jan;144(1):35-40.
  58. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999 Feb;156(2):181-189.
  59. Roy A. Suicidal behavior in schizophrenics. In: Williams R, Dalby JT, editors. Depression in schizophrenics. New York, NY: Plenum Press; 1989. pp. 137-152.
  60. Drake RE, Bartels SJ, Torrey WC. Suicide in schizophrenia: clinical approaches. In: Williams R, Dalby JT, editors. Depression in schizophrenics. New York, NY: Plenum Press; 1989. pp. 153-169.
  61. Roy A, Mazonson A, Pickar D. Attempted suicide in chronic schizophrenia. Br J Psychiatry 1984 Mar;144(3):303-306.
  62. Jones JS, Stein DJ, Stanley B, Guido JR, Winchel R, Stanley M. Negative and depressive symptoms in suicidal schizophrenics. Acta Psychiatr Scand 1994 Feb;89(2):81-87.
  63. Pickar D, Roy A, Breier A, Doran A, Wolkowitz O, Colison J, Agren H. Suicide and aggression in schizophrenia. Neurobiologic correlates. Ann N Y Acad Sci 1986;487:189-196.
  64. Drake RE, Cotton PG. Depression, hopelessness and suicide in chronic schizophrenia. Br J Psychiatry 1986 May;148(5): 554-559.
  65. Gupta S, Black DW, Arndt S, Hubbard WC, Andreasen NC. Factors associated with suicide attempts among patients with schizophrenia. Psychiatr Serv 1998 Oct;49(10):1353-1355.
  66. Cohen LJ, Test MA, Brown RL. Suicide in schizophrenia: data from a prospective community treatment study. Am J Psychiatry 1990 May;147(5):602-607.
  67. Fenton WS, McGlashan TH, Victor BJ, Blyler CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry 1997 Feb;154(2):199-204.
  68. Harkavy-Friedman JM, Kimhy D, Nelson EA, Venarde DF, Malaspina D, Mann JJ. Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry 2003 Aug;64(8):871-874.
  69. Singh H, Reddi VSK, Chandra PS. Role of auditory hallucinations in suicide. Indian J Private Psychiatry 2015 Apr;9(1): 42-51.
  70. Singh H, Chandra PS, Reddi VSK. Clinical correlates of suicide in suicidal patients with schizophrenia spectrum disorders and affective disorders. Indian J Psychol Med 2016 Nov- Dec;38(6):517-523.
  71. Schwartz-Stav O, Apter A, Zalsman G. Depression, suicidal behavior and insight in adolescents with schizophrenia. Eur Child Adolesc Psychiatry 2006 Sep;15(6):352-359.
  72. Tarrier N, Gooding P, Gregg L, Johnson J, Drake R. Suicide schema in schizophrenia: the effect of emotional reactivity, negative symptoms and schema elaboration. Behav Res Therapy 2007 Sep;45(9):2090-2097.
  73. Fenton WS, McGlashan TH. Natural history of schizophrenia subtypes, I: longitudinal course of paranoid, hebephrenic, and undifferentiated schizophrenia. Arch Gen Psychiatry 1991 Nov;48(11):969-977.
  74. Fenton WS, McGlashan TH. Natural history of schizophrenia subtypes, II: positive and negative symptoms and long-term course. Arch Gen Psychiatry 1991 Nov;48(11):978-986.
  75. Barbee JG, Clarck PD, Crapanzaro MS, Heintz GC, Kehoe CE. Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service. J Nerv Ment Dis 1989 Jul;177(7):400-407.
  76. Osher FC, Drake RE, Teague GB, Hurlbut SC, Beaudett MS, Paskus TS. Correlates of alcohol abuse among rural schizophrenic patients. New Hampshire-Dartmouth: Psychiatric Research Center; 1991. pp. 30-38.
  77. Yesavage JA, Zarcone V. History of drug abuse and dangerous behavior in inpatient schizophrenics. J Clin Psychiatry 1983;44(7):259-261.
  78. Safer DJ. Substance abuse by young adult chronic patients. Hosp Community Psychiatry 1987 May;38(5):511-514.
  79. Drake RE, Wallach MA. Substance abuse among the chronic mentally ill. Hosp Community Psychiatry 1989 Oct;40(10):1041-1046.
  80. Lindqvist P, Allebeck P. Schizophrenia and assaultive behaviour: the role of alcohol and drug abuse. Acta Psychiatr Scand 1990 Sep;82(3):191-195.
  81. Pompili M, Tatarelli C, Kotzalidis GD, Tatarelli R. Suicide risk in substance abusers with schizophrenia. In: Tatarelli R, Pompili M, Girardi P, editors. Suicide in schizophrenia. New York, NY: Nova Science Publishers Inc; 2006.
  82. Rich CL, Fowler RC, Fogarty LA, Young D. San Diego suicide study. III. Relationship between diagnosis and stressors. Arch Gen Psychiatry 1988 Jun;45(6):589-592.
  83. Bowers MB Jr., Mazure CM, Nelson JC, Jatlow PI. Psychotogenic drug use and neuroleptic response. Schizophr Bull 1990;16(1):81-85.
  84. Pompili M, Mancinelli I, Girardi P, Tatarelli R. Preventing suicide in young schizophrenics who are substance abusers. Subst Use Misuse 2004 Jul;39(9):1437-1441.
  85. Berglund M. Suicide in alcoholism. A prospective study of 81 suicides. I. The multidimensional diagnosis at first admission. Arch Gen Psychiatry 1984 Sep;41(9):888-891.
  86. Murphy GE, Robins E. Social factors in suicide. JAMA 1967 Jan;199(5):303-308.
  87. Murphy GE, Amstrong JW, Herlene SL, Fischer JR, Clendenin WW. Suicide and alcoholism: interpersonal loss confirmed as a predictor. Arch Gen Psychiatry 1979 Jan;36(1):65-69.
  88. Soyka M. Substance abuse, psychiatric disorders and violent and disturbed behaviour. Br J Psychiatry 2000 Apr;176(4): 345-350.
  89. Dassori AM, Mezzich JE, Keshavan M. Suicidal indicators in schizophrenia. Acta Psychiatr Scand 1990 May;81(5): 409-413.
  90. Earle KA, Forquer SL, Volo AM, McDonnell M. Characteristics of outpatient suicides. Hosp Comm Psychiatry 1994 Feb;45(2):123-126.
  91. Cohen LJ, Test MA, Brown RL Suicide in schizophrenia: data from a prospective community treatment study. Am J Psychiatry 1990 May;147(5):602-607.
  92. Altamura AC, Mundo E, Bassetti R, Green A, Lindenmayer JP, Alphs A, Meltzer HY. Transcultural differences in suicide attempters: analysis on a high-risk population of patients with schizophrenia or schizoaffective disorder. Schizophr Res 2007 Jan;89(1-3):140-146.
  93. Rich CL, Motooka MS, Fowler RC, Young D. Suicide by psychotics. Biol Psychiatry 1988;24:595-601.
  94. Fowler RC, Rich CL, Young D. San Diego suicide study. II. Substance abuse in young cases. Arch Gen Psychiatry 1986 Oct;43(10):962-965.
  95. Harkavy-Friedman JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, Gorman JM. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry 1999 Aug;156(8):1276-1278.
  96. Licht RW, Mortensen PB, Gouliaev GH, Lund J. Mortality in Danish psychiatric long-stay patients, 1972–82. Acta Psychiatr Scand 1993;87:336-341.
  97. Westermeyer JF, Harrow M, Marengo J. Risk for suicide in schizophrenia and other psychotic and nonpsychotic disorders. J Nerv Ment Dis 1991 May;179(5):259-265.
  98. Barrett EA, Sundet K, Faerden A, Nesvåg R, Agartz I, Fosse R, Mork E, Steen NE, Andreassen OA, Melle I. Suicidality before and in the early phases of first episode psychosis. Schizophr Res 2010 Jun;119(1-3):11-17.
  99. Altamura AC, Bassetti R, Bignotti S, Pioli R, Mundo E. Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res 2003 Mar;60(1):47-55.
  100. Clarke M, Whitty P, Browne S, Mc TO, Kinsella A, Waddington JL, Larkin C, O'Callaghan E. Suicidality in first episode psychosis. Schizophr Res 2006 Sep;86(1-3):221-225.
  101. Harvey SB, Dean K, Morgan C, Walsh E, Demjaha A, Dazzan P, Morgan K, Lloyd T, Fearon P, Jones PB, Murray RM. Self-harm in first episode psychosis. Br J Psychiatry 2008 Mar;192(3):178-184.
  102. Foley S, Jackson D, McWilliams S, Renwick L, Sutton M, Turner N, Kinsella A, O'Callaghan E. Suicidality prior to presentation in first-episode psychosis. Early Interv Psychiatry 2008 Nov;2(4):242-246.
  103. Nordentoft M, Jeppesen P, Abel M, Kassow P, Petersen L, Thorup A, Krarup G, Hemmingsen R, Jorgensen P. OPUS study: suicidal behaviour, suicidal ideation and hopelessness among patients with first episode psychosis. One-year follow-up of a randomised controlled trial. Br J Psychiatry 2002 Sep;(Suppl 43):s98-s106.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.