SUICIDE ATTEMPTS AT THE TIME OF FIRST ADMISSION AND DURING EARLY COURSE SCHIZOPHRENIA: A POPULATION BASED STUDY

Abstract

Background: Early schizophrenia is a period of increased suicide risk, yet past research does not use national population based data to examine the extent of suicide attempts in first admission schizophrenia and risk factors associated with subsequent suicide attempts. This study aims to examine suicide attempt rates at time of first admission and risk factors for subsequent suicide attempts over the early course of illness in national population-based data. Methods: All first admissions for schizophrenia in a national population based Israeli cohort from 1989 to 1992 were followed through 1996 (n=2293). The data were from the National Psychiatric Hospitalization Case Registry of the State of Israel, a complete national registry of psychiatric admissions that includes suicide attempt data prior to admission. Results: Attempted suicide rates were: 8.5% (n=196) at the time of first admission and 6.6% (n=151) over the follow-up period. Of those with a suicide attempt at first admission, 31.6% (n=62) made a subsequent suicide attempt during the follow-up period (OR=10.44, 95% CIs=7.22 to 15.09). Binary logistic regression modeling showed that protective factors of subsequent attempts included being female, aged 36 to 40 at time of first hospitalization, completion of more formal education, whereas a suicide attempt at first hospitalization increased risk ten-fold. Risk profiles from recursive partitioning were derived to predict sub-groups of patients at risk of a subsequent suicide attempt. For example, those characterized by an attempt at time of first admission, college educated, female and not married were at salient risk (45.9% (17/ 37), OR=13.46, 95% CIs= 6.89 to 26.3). The risk profiles together correctly classified 90.7% (137/151) of subsequent suicide attempts. Discussion: Suicide attempts at time of first admission and premorbid years of education have long-term prognostic utility and risk profiles are available.