Abstract
Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A lifetime suicide rate in individuals with schizophrenia is approximately 10%. Suicide is the largest contributor to the decreased life expectancy in individuals with schizophrenia. Demographic and psychosocial factors that increase a risk of suicide in individuals with schizophrenia include younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being well-educated, good premorbid adjustment or functioning, having high personal expectations and hopes, having an understanding that life’s expectations and hopes are not likely to be met, having had recent (i.e., within past 3 months) life events, having poor work functioning, and having access to lethal means, such as firearms. Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, although they continue to be at elevated suicide risk during their lives with times of worsening or improvement. Having awareness of symptoms, especially, awareness of delusions, anhedonia, asociality, and blunted affect, having a negative feeling about, or non-adherence with, treatment are associated with greater suicide risk in patients with schizophrenia. Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia. The only reliable protective factor for suicide in patients with schizophrenia is provision of and compliance with comprehensive treatment. Prevention of suicidal behavior in schizophrenia should include recognizing patients at risk, delivering the best possible therapy for psychotic symptoms, and managing comorbid depression and substance misuse.
Highlights
Suicide is an important public health problem
Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, they continue to be at elevated suicide risk during their lives with times of worsening or improvement
A 5-year follow-up study of 1065 patients with psychotic disorders conducted by the World Health Organization (WHO) found that “the risk for suicide in schizophrenia is as great, if not greater, than the risk of suicide associated with affective disorders” [11]
Summary
Suicide is an important public health problem [1,2]. According to the World health Organization (WHO), each year, about one million people die by suicide across the world [1]. A 5-year follow-up study of 1065 patients with psychotic disorders conducted by the World Health Organization (WHO) found that “the risk for suicide in schizophrenia is as great, if not greater, than the risk of suicide associated with affective disorders” [11]. Illnesses associated with chronic pain, significantly increase suicide risk [16,17,18,19,20]. While many deaths due to opioid overdoses are accidental, an increasing amount of data indicates that the presence of pain plays a role in the decision to end life via opioid overdoses [19] Neurological conditions such as stroke, epilepsy, head injury, or Huntington’s disease confer greater suicide risk [20,21].
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