Suicide Risk in Schizophrenia, a 20 Year Cohort Study, Part 1: Outcome and associated social factors

Abstract

Objective: This study prospectively followed up, after a period of 20 years, a group of patients with schizophrenia who were considered to be at high risk for suicide. In Part 1, we reported on outcome and associated social factors, and in this paper we discuss re-evaluated suicide risk in these patients and investigated symptomology and pharmacotherapy over the last 2 decades.

Method: The subjects were interviewed, and a questionnaire evaluating suicide risk was completed. The Beck Hopelessness Scale (BHS) was administered and ratings were compared to those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was also administered. Cross tabulations were then performed to identify factors associated with increased suicide risk. For those subjects who committed suicide since the original study, a psychological autopsy was performed.

Results: Fourteen of the original 33 high suicide risk schizophrenia patients were found. Three subjects committed suicide during the 20 year period. Among the living subjects, risks for suicide were found to be lower than 20 years ago. Hopelessness and depressive symptoms correlated with independently evaluated suicide risk. Social withdrawal, blunting of affect and delusions were also associated with elevated risk. Good insight into illness and a history of previous suicide attempts correlate with high suicide risk. Cannabis abuse, poor or periodic adherence to treatment, as well as weight gain, akathisia and parkinsonian adverse effects were also associated with an increase in risk for suicide. Formal thought disorder, avolition and cognitive impairment were associated with lower risk of suicide.

Conclusion: Hopelessness, depression, certain positive symptoms and adverse effects of medication, found in this study to be congruent with suicide risk in patients with schizophrenia, coincide with those mentioned in the literature. Despite current knowledge about this subject, suicide remains notoriously and ominously unpredictable in patients with schizophrenia.