Abstract
BackgroundThe incidence of suicide is high among patients with schizophrenia spectrum disorders and psychosis. A systematic review was performed to investigate the effectiveness of psychosocial interventions in reducing suicidal behaviour among patients with schizophrenia spectrum disorders and psychosis.MethodsCochrane, PubMed and PsycINFO databases were searched to January 2012. Additional materials were obtained from reference lists. Randomised Controlled Trials describing psychosocial interventions for psychotic disorders with attention placebo, treatment as usual (TAU), no intervention or waitlist control groups were included.ResultsIn total, 11,521 abstracts were identified. Of those, 10 papers describing 11 trials targeting psychosocial interventions for reducing suicidal behaviour in patients with schizophrenia spectrum disorders and psychosic symptoms or disorders met the inclusion criteria. Odds Ratios describing the likelihood of a reduction in suicidal behaviour or ideation ranged from 0.09 to 1.72 at post-test and 0.13 to 1.48 at follow-up.ConclusionsPsychosocial interventions may be effective in reducing suicidal behaviour in patients with schizophrenia spectrum disorders and psychosis, although the additional benefit of these interventions above that contributed by a control condition or treatment-as-usual is not clear.
Highlights
The incidence of suicide is high among patients with schizophrenia spectrum disorders and psychosis
Tiihonen et al (2006) have confirmed, in a nationwide follow-up of individuals discharged from hospital after a first episode of schizophrenia, that not taking any regular antipsychotic medication was associated with a 12-fold increase in the relative risk of all-cause death and a worrying 37-fold increase in death by suicide (Hor & Taylor 2010)
The present study aims to conduct a systematic review of preventative psychosocial interventions for suicide in individuals with schizophrenia spectrum disorders and psychosis, as well as examining specific features of the psychosocial intervention that contributes to its effectiveness
Summary
The incidence of suicide is high among patients with schizophrenia spectrum disorders and psychosis. Suicide risk is greatly increased in schizophrenia (Hawton et al 2005) and is, in particular amongst males, the leading cause of premature death (Ösby et al 2000; De Leo & Spathonis 2003). It is associated with personal and family tragedy. Risk factors for suicide in this population group include previous attempts, being male, experiencing co-morbid Post Traumatic Stress Disorder (PTSD), and recent hospital discharge without treatment planning (Carlborg et al.2010; Kasckow et al 2011; Meltzer 2006; Tarrier & Picken 2011; Palmer et al 2005). The risk of suicide in patients with schizophrenia is considered to be higher in the early course of the illness, especially within the first year (De Leo & Spathonis 2003; Kuo et al 2005). Hawton et al (2005) found that many of the important risk factors for suicide in schizophrenia were similar to those in the general population (e.g., mood disorder, recent loss, previous suicide attempts, drug misuse), but other risk-factors may be more specific to this population, such as fear of mental disintegration, agitation or restlessness, and poor adherence with treatment. Tiihonen et al (2006) have confirmed, in a nationwide follow-up of individuals discharged from hospital after a first episode of schizophrenia, that not taking any regular antipsychotic medication was associated with a 12-fold increase in the relative risk of all-cause death and a worrying 37-fold increase in death by suicide (Hor & Taylor 2010)
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