Prevalence of suicide attempts in individuals with schizophrenia: a meta-analysis of observational studies.

Li Lu,Gang Wang,Xiao-Min Zhu,Ling Zhang,Chee H Ng,Gabor S Ungvari,Yu-Tao Xiang,Min Dong

doi:10.1017/s2045796019000313

Abstract

Suicide attempt is an important indicator of suicide and potential future mortality. However, the prevalence of suicide attempts has been inconsistent across studies. This meta-analysis aimed to examine the prevalence of suicide attempts in individuals with schizophrenia and associated correlates. Relevant publications in Embase, PsycINFO, PubMed, Web of science and Cochrane were systematically searched. Data on the prevalence of suicide attempts in individuals with schizophrenia were pooled using a random-effects model. Thirty-five studies with 16 747 individuals with schizophrenia were included. The pooled lifetime prevalence of suicide attempts was 26.8% (95% CI 22.1-31.9%; I2 = 97.0%), while the 1-year prevalence, 1-month prevalence and the prevalence of suicide attempts from illness onset were 3.0% (95% CI 2.3-3.7%; I2 = 95.6%), 2.7% (95% CI 2.1-3.4%; I2 = 78.5%) and 45.9% (95% CI 42.1-49.9%; I2 = 0), respectively. Earlier age of onset (Q = 4.38, p = 0.04), high-income countries (Q = 53.29, p < 0.001), North America and Europe and Central Asia (Q = 32.83, p < 0.001) were significantly associated with a higher prevalence of suicide attempts. Suicide attempts are common in individuals with schizophrenia, especially those with an early age of onset and living in high-income countries and regions. Regular screening and effective preventive measures should be implemented as part of the clinical care.

Highlights

Schizophrenia is a chronic and severe psychiatric disorder with a massive global health burden, accounting for 7.4% (5.0–9.8) of disability-adjusted life years caused by mental and substance use disorders (Bhugra, 2005; Whiteford et al, 2013)
Twenty-eight studies (11 756 patients) reported the lifetime prevalence, one study reported both the lifetime and 1-month prevalence (Radomsky et al, 1999), two studies reported the 1-year prevalence (Tang et al, 2007; Lee et al, 2012) and one study reported the 1-month prevalence of suicide attempts (Malandain et al, 2018), and two studies reported the prevalence of suicide attempts since illness onset (Prasad and Kellner, 1988; Assefa et al, 2012)
This was the first meta-analysis that examined the prevalence of suicide attempts in individuals with schizophrenia across studies worldwide

Summary

Introduction

Schizophrenia is a chronic and severe psychiatric disorder with a massive global health burden, accounting for 7.4% (5.0–9.8) of disability-adjusted life years caused by mental and substance use disorders (Bhugra, 2005; Whiteford et al, 2013). Compared with the general population, persons with schizophrenia have 3.7 times higher risk of premature death (Olfson et al, 2015); men and women with schizophrenia have a reduced life-expectancy of around 19 and 16 years, respectively (Laursen, 2011). Among those with schizophrenia, the lifetime suicide rate is about 5% (Palmer et al, 2005; Hor and Taylor, 2010), and suicide is a major cause of premature death (Caldwell and Gottesman, 1992; Brown, 1997; Olfson et al, 2015). Comorbid substance use (Togay et al, 2015; Fuller-Thomson and Hollister, 2016; Duko and Ayano, 2018) and more severe psychotic symptoms (Kao et al, 2012; Shrivastava et al, 2016) could increase the risk of suicide attempts

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