Yeates Conwell, MD, Jill Cholette, BA, Paul R. Duberstein, PhD

Abstract

As many as 1 out of 4 persons with schizophrenia commits suicide, some even while they are under psychiatric care. Specialists in the study of suicide outline risk factors for suicide in schizophrenic patients and the implications for preventive strategies.

Suicide is a major cause of death among patients with schizophrenia, with young adulthood to midlife being the age range of greatest risk. A past history of suicide attempts is common among schizophrenic suicide victims, as are affective symptomatology and feelings of hopelessness and demoralization. Active paranoia may increase risk, whereas negative symptoms may decrease the risk of self-destructive acts in schizophrenic patients. Many suicides occur during hospitalization or shortly after discharge. Methodical assessment of suicidal ideation and aggressive treatment with psychological, social, and pharmacologic approaches are vital aspects of patient management. [Medscape Mental Health 3(3), 1998. © 1998 Medscape, Inc.]

Introduction

Individuals with schizophrenia have a shortened life expectancy.[1] Compared with both the general population and persons with other mental disorders, these patients have increased mortality risk due to physical illness, accidents, and other causes of violent death, especially suicide.[2-4] Studies estimate that from 9% to 24% of individuals with schizophrenia will die by their own hand.[4-7] Data from cohort and record-linkage studies indicate an age-adjusted rate for suicide among people with schizophrenia of 350-600/100,000,[3] up to 50 times greater than the risk for the general population of the US.[8]

The design of effective suicide-prevention strategies hinges on the identification of risk factors characteristic of the individual or group, the strength of the causal relationship between the risk factor and the disease, and the alterability of that causal (risk) factor.[9] It is vital that efforts to prevent suicide in schizophrenic patients are tailored to the demographic and clinical characteristics of this population. Describing the clinical cases of 20 patients with schizophrenia or schizoaffective disorder who committed suicide, this review summarizes the risk factors for suicide in schizophrenia and their implications for preventive strategies.

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Article: Suicide and Schizophrenia: Identifying Risk Factors and Preventive Strategies

Dr. Conwell is Associate Professor of Psychiatry and Oncology and Director of the Laboratory of Suicide Studies, Department of Psychiatry, University of Rochester School of Medicine in Rochester, N.Y. Ms. Cholette is a medical student at the University of Rochester School of Medicine. Dr. Duberstein is Assistant Professor of Psychiatry (Psychology) and Oncology and Associate Director of the Laboratory of Suicide Studies, Department of Psychiatry, University of Rochester School of Medicine.