Associated risks
 
 
 
What Is the Relationship Between Schizophrenia and Suicide?
 
 
 
Introduction
 
People with schizophrenia are at increased risk for suicide.  More than a third of people with schizophrenia will attempt suicide at some point.  One in ten persons suffering from schizophrenia commits suicide.1  Male sex and the presence of chronic illness increase risk.  Males are much more likely to attempt suicide than females.  Higher levels of education and high pre-morbid expectations also are associated with a higher risk.
 
 
Risk in the General Population
 
Most people in the general population who commit suicide have a history of depressive symptoms.  These symptoms are also common in people with schizophrenia.  Depressive symptoms should be treated aggressively.
 
Factors that may predict suicide in the general population include:
 
  1. loosing a job  
  2.  
  3. loosing a significant other (as in break-ups or divorces)  
  4.  
  5. disability  
  6.  
  7. feelings of worthlessness  
  8.  
  9. access to means
 
These conditions often exist in people with Schizophrenia.
 
Access to a means by which a person may end their life is an important risk factor.  Those means include firearms, tall buildings, bridges, railways, open water, cold temperatures, and stores of medications or large quantities of drugs.
 
Other factors that influence risk include:
 
 
High Risk Periods
 
They include:  
 
  1. the period immediately following a hospital stay  
  2.  
  3. times when people are left alone  
  4.  
  5. when someone else has committed suicide  
  6.  
  7. periods when sufferers experience intense symptoms of psychosis  
  8.  
  9. several months after beginning medications.  
 
It has been postulated that this represents a time when people with schizophrenia can see things clearly and better appreciate all of the negative consequences of their illness.
 
 
Indicators
 
Indicators of impending suicide include:
 
  1. notes that reflect despair and hopelessness  
  2.  
  3. giving away personal belongings  
  4.  
  5. an unexpected dramatic improvement in mood.  This may occur because the person has resolved themselves to commit this act.  
  6.  
  7. morbid thoughts, writings, or other demonstrations of negative thinking or mood states
 
 
Obvious Risk Factors
 
Obvious risk factors include previous attempts, a current formulated plan, and expressed intent.
 
 
Passive Suicidal Ideation
 
Passive suicidal ideation should never be taken lightly.  This is when a person has no plan, but is ambivalent about living.  Many people in this situation disregard standard precautions, such as looking both ways before they cross an intersection, taking care when they are on a roof or a ladder, or being cautious around electrical appliances or power lines.  While they may not consciously intend to end their lives, these people often succumb to accidents that result from their apathy.
 
 
Additional Information
 
 "Thirty-two studies were composed of any type of patient, and 29 observed                  schizophrenics from date of admission or illness onset. The studies were as small as a few tens of patients, to over 9,000. Most involved several hundred patients, followed up for two to 22 years.
 
For the first-admission and new onset studies, the case fatality estimate (percentage of original sample who died by suicide) was 4.9% (95% CI 4.3 to 5.6%). About 31% of the deaths were deaths by suicide. Among the mixed samples the case fatality estimate was 2.3% (1.5 to 3.5%) and 6% of the deaths was by suicide.
 
Analysis of data by time of follow up suggested that suicide risk was greater sooner rather than later after diagnosis or onset."2  
 
In summary, approximately 5% of people with schizophrenia commit suicide during their lifetime, typically near the onset of their illness.
 
The Epidemiologic Catchment Area (ECA) study3  indicated that 28 percent of individuals with schizophrenia had attempted suicide.
 
Estimates of suicide rates for people with schizophrenia range from 10 to 13 percent.4
 
This rate is more than four times the rate from similar studies completed between 1913 and 1960.  This dramatic increase in the suicide rate corresponds with the period of widespread deinstitutionalization.5  
 
A 1992 survey6 of people with schizophrenia and bipolar disorder found that 19 percent threatened or attempted suicide in the year before the survey.
 
 
 
1World Fellowship for Schizophrenia and Allied Disorders
Pamphlet #23
2BA Palmer et al. The lifetime risk of suicide in schizophrenia. Archives of General Psychiatry 2005 62: 247-252    
3Robins LN and Regier DA. Psychiatric Disorders in America New York: Free Press, 1991, p. 50
4Caldwell C and Gottesman I. Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin 16:571-589, 1990
5Stephens J et al. Suicide in patients hospitalized for schizophrenia: 1913-1940. Journal of Nervous and Mental Disease 187:10-14, 1999
6Steinwachs DM et al. Family perspectives on meeting the needs for care of severely mentally ill relatives: a national survey. School of Public Hygiene and Public Health, Johns Hopkins University, 1992.
 
 
(Sources: The author's knowledge base, unless otherwise noted.)
______________________________________________________________________
 
Related Articles:
 
Schizophrenia and Alcohol Abuse or Dependence
______________________________________________________________________