Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm - a cross-sectional study

Erlend Mork,Ole A Andreassen,Jill M Harkavy-Friedman,Elizabeth A Barrett,Lars Mehlum,Nils E Steen,Fredrik A Walby,Steinar Lorentzen,Ingrid Melle

doi:10.1186/1471-244x-13-255

Abstract

BackgroundTo investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt.MethodsUsing a cross-sectional design, 251 patients (18–61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm.ResultsSuicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only.ConclusionsPatients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay.

Highlights

To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt
When the most recent self-harm episode was non-suicidal self-harm (NSSH) (n = 54), it had little or no risk of death (n = 52/96%), the behavior had been planned for less than an hour in 35 cases (65%), and the most commonly used method was cutting (n = 42/78%). Among those with suicide attempts (SA) + NSSH, almost all patients reported cutting as method, when the most recent episode was NSSH (n = 17/94%), indicating that NSSH in this group primarily consists of self-injury
Our main findings are that a history of SA + NSSH in patients with schizophrenia is associated with an earlier onset of psychotic symptoms and a longer duration of untreated psychosis (DUP) compared to patients with SA only or No suicide attempt (NoSA)

Summary

Introduction

To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. More common forms of NSSH, such as repeated cutting, burning and self-hitting are frequently reported in other diagnostic groups with high risk for completed suicide, but have not received notable attention in studies of patients with schizophrenia [12]. NSSH has been found to be an independent risk factor for both attempted [13] and completed suicide [14] in other clinical populations. Both self-reports, laboratory studies and clinical observations indicate that regulation of negative affect is an important mechanism underlying NSSH [15]. Stanley and colleagues [17] found that patients with cluster B personality disorders who had a history of both SA and NSSH tended to be more depressed, have more persistent suicidal ideation, and more symptoms of affective instability and impulsivity than individuals with SA only

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