Suicide Risk In Schizophrenia Research Articles

Prevalence, demographic characteristics, and clinical features of suicide risk in first episode drug-naïve schizophrenia patients with comorbid severe anxiety

BackgroundBoth anxiety symptoms and suicide risk are common in schizophrenia. However, previous findings about the association between anxiety and suicide risk in schizophrenia were controversial. This study is the first to examine the prevalence of suicide risk and related demographic, clinical features in a large sample of first episode drug-naïve (FEDN) schizophrenia patients with comorbid severe anxiety. MethodsIn total, 316 patients with FEDN schizophrenia were enrolled in this study. Patients' symptoms were assessed using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS). Serum levels of glucose, insulin, uric acid, and lipids including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), were evaluated. ResultsIn the current study, 56.3% patients presented comorbid severe anxiety. The rate of suicide risk was higher in the severe anxiety group (55.6%) than in the mild-moderate anxiety group (33.3%). The interactions among severe anxiety, uric acid and HDL-C were associated with suicide risk. Compared with patients with normal uric acid, those with abnormal uric acid exhibited a stronger association between HAMA scores and HAMD-suicide item scores. This enhanced association was also observed for patients with abnormal HDL-C levels. ConclusionsIn FEDN schizophrenia patients with comorbid severe anxiety, our findings suggested a high incidence of suicide risk. Abnormal levels of uric acid and low levels of HDL-C, as well as high depression may be associated with an increased risk of suicide in FEDN schizophrenia patients with comorbid severe anxiety.

Association study of the complement component C4 gene and suicide risk in schizophrenia

Schizophrenia is a severe mental illness and a major risk factor for suicide, with approximately 50% of schizophrenia patients attempting and 10% dying from suicide. Although genetic components play a significant role in schizophrenia risk, the underlying genetic risk factors for suicide are poorly understood. The complement component C4 gene, an immune gene involved in the innate immune system and located in the major histocompatibility complex (MHC) region, has been identified to be strongly associated with schizophrenia risk. In addition, recent findings have also suggested that the MHC region has been associated with suicide risk across disorders, making C4 a potential candidate of interest for studying suicidality in schizophrenia patients. Despite growing interest in investigating the association between the C4 gene and schizophrenia, to our knowledge, no work has been done to examine the potential of C4 variants as suicide risk factors in patients with schizophrenia. In this study, we investigated the association between different C4 copy number variants and predicted C4 brain expression with suicidal outcomes (suicide attempts/suicidal ideation). We directly genotyped 434 schizophrenia patients to determine their C4A and C4B copy number variants. We found the C4AS copy number to be marginally and negatively associated with suicide risk, potentially being protective against suicide attempts (OR = 0.49; p = 0.05) and suicidal ideation (OR = 0.65; p = 0.07). Furthermore, sex-stratified analyses revealed that there are no significant differences between males and females. Our preliminary findings encourage additional studies of C4 and potential immune dysregulation in suicide.

Evaluation of the Correlation Between Peripheral Inflammatory Markers and Suicide Risk in Drug-Naive First-Episode Schizophrenia.

Patients with schizophrenia have a higher lifetime prevalence of suicidal behavior (SB) compared to the general population. Therefore, understanding the possible neurobiology of suicide and predicting the risk of suicide in schizophrenia is a solemnly critical issue. 31 drug-naïve first episode schizophrenia (FES) patients with current SB (FES-S), 69 drug-naive patients with first episode schizophrenia without SB (FES-NS), and 69 drug-naïve non-psychotic patients with current SB (NPS) who were diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) participated the study. The control group (HC) consisted of 127 individuals matched with the patients. Symptoms at the time of evaluation were assessed using The Positive and Negative Syndrome Scale (PANSS) and Columbia Suicide Severity Rating Scale (CSSRS). Blood samples were collected from all participants to determine White blood cell (WBC), neutrophil, monocyte, albumin, C-reactive protein (CRP), Lymphocyte, and Platelet levels and to measure this protein ratio. The blood levels of WBC, neutrophil, monocyte, albumin, CRP, and Neutrophil/Albumin Ratio (NAR) were higher in all patient groups compared to HC. CRP/Albumin Ratio (CAR) value was observed to be highest in the NPS group. Monocyte/Lymphocyte Ratio (MLR) value was significantly higher in patients with FES compared to HC. There were no significant differences between the FES-S group and the FES-NS and NPS groups. It can be suggested that although inflammation is not a predictor for suicide attempts in schizophrenia, it is associated with the degree of suicide risk in schizophrenia. In addition, the strong relationship between suicide and psychiatric disorders can be the main reason for high peripheral inflammation levels in suicidal patients.

Machine Learning-Based Identification of Suicidal Risk in Patients With Schizophrenia Using Multi-Level Resting-State fMRI Features.

BackgroundSome studies suggest that as much as 40% of all causes of death in a group of patients with schizophrenia can be attributed to suicides and compared with the general population, patients with schizophrenia have an 8.5-fold greater suicide risk (SR). There is a vital need for accurate and reliable methods to predict the SR among patients with schizophrenia based on biological measures. However, it is unknown whether the suicidal risk in schizophrenia can be related to alterations in spontaneous brain activity, or if the resting-state functional magnetic resonance imaging (rsfMRI) measures can be used alongside machine learning (ML) algorithms in order to identify patients with SR.MethodsFifty-nine participants including patients with schizophrenia with and without SR as well as age and gender-matched healthy underwent 13 min resting-state functional magnetic resonance imaging. Both static and dynamic indexes of the amplitude of low-frequency fluctuation (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity as well as functional connectivity (FC) were calculated and used as an input for five machine learning algorithms: Gradient boosting (GB), LASSO, Logistic Regression (LR), Random Forest and Support Vector Machine.ResultsAll groups revealed different intra-network functional connectivity in ventral DMN and anterior SN. The best performance was reached for the LASSO applied to FC with an accuracy of 70% and AUROC of 0.76 (p < 0.05). Significant classification ability was also reached for GB and LR using fALFF and ALFF measures.ConclusionOur findings suggest that SR in schizophrenia can be seen on the level of DMN and SN functional connectivity alterations. ML algorithms were able to significantly differentiate SR patients. Our results could be useful in developing neuromarkers of SR in schizophrenia based on non-invasive rsfMRI.

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

Feasibility and correlations of smartphone meta-data toward dynamic understanding of depression and suicide risk in schizophrenia.

ObjectivesWe investigate whether meta‐data, specifically duration of responses to smartphone‐delivered surveys, is correlated to elevated scores on the depression assessment PHQ‐9 as well as the specific item around self‐harm (item 9).MethodsIn this observational study, we recruited 92 smartphone‐owning adults (≥ 18) with schizophrenia (45) and healthy controls (43). We installed an open‐source smartphone app called mindLAMP to collect survey results and latencies (response times) over a period of 3 months. Surveys were scheduled for twice a week, but participants were instructed to take the surveys naturally as much or as little as they wanted. A total of 1,218 PHQ‐9 surveys were completed across all participants over 3 months.ResultsA total of 75 participants (39 with schizophrenia and 36 healthy controls) completed both the initial visit and follow‐up, as well as provided at least one self‐reported PHQ‐9 survey through the app. We found that depression symptom severity and response latencies were correlated for both individuals with schizophrenia (Spearman's ρ = .22, p = .037) and healthy controls (Spearman's ρ = .58, p < .001). Participants with schizophrenia scored higher (more severe) and took longer for every item of the PHQ‐9 when compared to controls (p < .05 for each item). Item 9 response value and latency was slightly correlated for participants with schizophrenia (Spearman's ρ = .086, p = .035) but was not significant for controls (Spearman's ρ = .036, p = .37).ConclusionsMeta‐data revealed group differences between individuals with schizophrenia and healthy controls based on individual depression symptoms completed on a smartphone. Correlation between suicide specific question latency and severity for participants with schizophrenia but not for controls indicates the clinical potential and need for further research.

An Analysis of Five TrkB Gene Polymorphisms in Schizophrenia and the Interaction of Its Haplotype with rs6265 BDNF Gene Polymorphism.

Aim The BDNF dysfunction in the schizophrenia has been soundly documented. The TrkB gene is a high-affinity receptor of the BDNF that is changed in schizophrenia and mood disorders. The study had two aims: first, to identify whether the five nucleotide polymorphisms (SNPs) in TrkB gene are associated with a diagnosis of schizophrenia; and the latter, if any association exists between the TrkB SNPs and psychopathology, suicide attempts, and family history of schizophrenia in a Caucasian population. Methods Case-control study (401 patients and 657 healthy controls) was used to examine a predisposition for schizophrenia. The tests for psychopathology, suicide attempts, and family history of schizophrenia were conducted only in patient group. The severity of the schizophrenia was measured using the five-factor model of the PANSS. In addition, the haplotype analysis for both the separate for SNPs of TrkB gene and in combination with the rs6265 SNP BDNF gene was conducted. Results Our case-control study revealed that the genetic variants of rs10868235 (T/T polymorphic genotype) and rs1387923 (G/G polymorphic genotype) of the TrkB gene were associated with a higher risk of developing schizophrenia in men. However, the A/A wild genotype of rs1387923 was connected with a lower risk for both the development of and the family manifestation of schizophrenia in men. The G polymorphic allele of rs1565445 was associated with an increased risk of suicide in schizophrenia. The tested SNPs of the TrkB gene did not modulate the psychopathology of schizophrenia. The haplotype that was built with five SNPs in the TrkB gene was protective for men, but after joining the rs6265 SNP of the BDNF gene, a haplotype that was protective for women was created.

Relief of expressed suicidality in schizophrenia after electroconvulsive therapy: A naturalistic cohort study

Suicide risk in schizophrenia is a significant treatment challenge but there are few approved treatments. Electroconvulsive therapy (ECT) is a highly effective treatment for suicidality in depression but its effect on suicidality in schizophrenia is unclear. We conducted a retrospective naturalistic study of the real-world effect of ECT on expressed suicidality as assessed by item 4 of the 24-item Brief Psychiatric Rating Scale in 113 patients with treatment resistant schizophrenia receiving ECT. 19.5% of patients expressed suicidal ideation pre-ECT of which 86.4% experienced an improvement in expressed suicidality after an average of 10.2 (SD 2.7) sessions of ECT. Changes in suicide scores before and after ECT was examined using a generalized estimating equation (GEE) model which showed that the effect of ECT on suicide was significantly mediated by depression and explained 72.2% of the decreased in expressed suicidality. ECT is effective in decreasing depression and expressed suicidality in patients with schizophrenia and should be considered as a treatment option for managing suicidality and psychosis in patients with treatment resistant schizophrenia.

The Role of Demoralization and Hopelessness in Suicide Risk in Schizophrenia: A Review of the Literature.

Background and Objectives: Demoralization has been defined by hopelessness and helplessness attributable to a loss of purpose and meaning in life. Demoralization is a meaningful mental health concern, frequently associated with suicide risk in medical and psychiatric patients. The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with schizophrenia and to better understand the relationship between demoralization and suicide risk in patients with schizophrenia. Methods: A comprehensive literature search using key words and subject headings was performed following PRISMA guidelines with several bibliographic databases, resulting in the identification of 27 studies. Results: The findings suggested that demoralization is prevalent in patients with schizophrenia and supported the hypothesis that the association between depression and suicide is moderated by hopelessness. In clinical practice, it is important to recognize symptoms of demoralization using appropriate psychological tools to better understand the suffering of patients with schizophrenia and to implement suicide prevention programs.

Suicide Prevention in Schizophrenia: Do Long-Acting Injectable Antipsychotics (LAIs) have a Role?

Suicide risk is a major cause of death among patients with schizophrenia. Death by suicide has been reported in approximately 5% of schizophrenia patients although this figure appears to be an underestimate of the problem. A number of risk factors are routinely reported as associated with suicide risk among these patients, some of which are modifiable by targeted therapeutic strategies. Clozapine is the only compound that gathered evidence as an effective treatment for reducing suicide risk in schizophrenia. Long-Acting Injectable Antipsychotics (LAIs) have a range of advantages in terms of efficacy, safety and tolerability in the treatment of schizophrenia, and one area of interest is whether LAI-treatment may decrease suicidality by indirectly acting on a range of risk factors for suicide specific to schizophrenia patients. This background encouraged the present review of research pertaining to LAIs in relation to modifiable risk factors for suicide in schizophrenia. We viewed our task as gathering, speculating and critically appraising the available research relevant to the topic, with the aim of formulating a hypothesis to be tested with further research.

A biopsychosocial evaluation of the risk for suicide in schizophrenia.

The risk of suicide is greatly increased in individuals with schizophrenia. Previous research has identified several potential risk factors for suicidal behavior in schizophrenia, although their ability to independently predict suicide is limited. The objective of this review was to systematically analyze and identify the interaction between the proposed risk factors in the literature that may predict suicidal behavior in schizophrenia. Articles that explored suicidal behavior and suicide risk in schizophrenia that were published between 1980 and August of 2015, indexed in PubMed, MEDLINE, and Scopus were systematically reviewed. Many studies proposed a range of biopsychosocial risk factors that may independently lead to suicide in schizophrenia. These risk factors appear to be mainly related to stress, a history of suicidal behavior, and psychotic symptoms. It is clear, however, that many of these factors do not act independently and in fact require the reciprocal interaction of several of them to pose a risk for suicide in schizophrenia. Independently, the power of many risk factors to predict suicide is limited. Future studies should continue to adopt a multidimensional approach by considering the interaction of several factors in assessing the risk for suicide in schizophrenia.

English

INTRODUCTION: Schizophrenia is a chronic disease characterized by remissions and Exacerbations. It reduces the life expectancy of those afflicted by approximately 10 years, And suicide accounts for the majority of premature deaths among patients suffering from Schizophrenia. Suicide is the most devastating possible outcome of a schizophrenic Illness. In addition to the finality for the patients, suicide has an intense and long-lasting Impact on families, other patients, and professional staff (Allebeck 1989, Black et al 1985). The risk of suicide in schizophrenia exceeds that of all psychiatric disorders other Than major depression (Asnis et al). The rate of suicide in schizophrenia has been Reported to be some 20-50 times greater than suicide rate in general population (Black 1988). It has been found that 20% to 40% of patients suffering from schizophrenia make Suicide attempts. The completed suicide rate in schizophrenia ranges from 9% to 12.9% (Tsuang et al 1980). Approximately 1% to 2 % of patients suffering from schizophrenia Who attempt suicide are reported to complete suicide within a year after their initial Attempt, with an additional 1% doing so each year thereafter (Vanessa Raymont). Suicide attempts are associated with protracted, non-regressive symptomatology, The majority occurring before 30 years of age. Chronicity, incapacity and complaints of Social isolation even though they are not being abandoned, are characteristic of those who Die by suicide. Suicide attempts in individuals with schizophrenia are serious, typically requiring Medical attention. Intent is strong and the majority of those who attempt make multiple Attempts, having a higher rate of more lethal methods (Radomsky et al). Risk factors including previous attempts are however found to be having limited Value in the prediction of eventual suicide and traditional risk scales are considered Ineffective (Heila et al, 1997). There has been a paucity of Indian studies on this subject which promoted us to take Up this study. In this study, we have tried to find differences in the groups of suicide attempters And non-attempters in schizophrenia in search for a possible recognition of risk factors. The question looming large is: “IS THERE PREVENTION?”

Suicide risk and antipsychotic side effects in schizophrenia: nested case-control study.

This study explores suicide risk in schizophrenia in relation to side effects from antipsychotic medication. Among patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4000), those who died by suicide within 5 years from diagnosis were defined as cases (n = 84; 54% male). For each case, one individually matched control was identified from the same population. Information on antipsychotic side effects, including extrapyramidal symptoms (EPS) and akathisia, as well as prescriptions of anticholinergic medication, was retrieved from clinical records in a blinded fashion. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of the association between suicide and side effects as well as anticholinergic medication were estimated using conditional logistic regression. A lower suicide risk was found in patients with a history of EPS (aOR 0.33, 95% CI 0.12-0.94). There was no statistically significant association between akathisia or anticholinergic medication use and the suicide risk. A lower suicide risk identified among patients with EPS could potentially reflect higher antipsychotic adherence, exposure to higher dosage, or polypharmacy among these patients. Copyright © 2016 John Wiley & Sons, Ltd.

Assessment of suicide risk in schizophrenia with addictive comorbidity

Introduction Comorbid drug use disorders are associated with greater risk for relapse in schizophrenia and lower adherence to treatment. A comprehensive evaluation of patients with dual diagnosis should address the problem of suicide risk, which is a reputated complication of both psychotic disorders and drug use disorders. Objectives Depression and suicide risk assessment in subjects diagnosed with schizophrenia and drug related disorders. Aims To establish a protocol for early intervention in cases with depressive features that associate suicide risk. Methods All the patients ( n =37, female n =15, male n =12) with both schizophrenia and a drug related disorder, consecutively admitted in our department during a 6-month period, were evaluated using Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Inventory of Drug Taking Situations (IDTS), Clinical Global Impression- Severity (CGI-S). Subjects were evaluated at admission, discharge and after 3 months. Results A percentage of 21.6 of all patients registered CDSS score at baseline above the cutt-off score for a major depressive episode of 6, while 10.8% had CDSS score of 6 and 8.1% had a CDSS score of 5. IDTS had greater scores in all these 15 patients with high CDSS values, comparative to the other, P Conclusions Using a specific method for depression and suicide risk in patients with schizophrenia and drug related disorder is very useful for establishing a specific treatment approach and monitoring plan.

Frontal Motor Cortex Activity During Reactive Control Is Associated With Past Suicidal Behavior in Recent-Onset Schizophrenia.

Suicide is prevalent in schizophrenia (SZ), yet the neural system functions that confer suicide risk remain obscure. Circuits operated by the prefrontal cortex (PFC) are altered in SZ, including those that support reactive control, and PFC changes are observed in postmortem studies of heterogeneous suicide victims. We tested whether history of suicide attempt is associated with altered frontal motor cortex activity during reactive control processes. We evaluated 17 patients with recent onset of DSM-IV-TR-defined SZ using the Columbia Suicide Severity Rating Scale and functional magnetic resonance imaging during Stroop task performance. Group-level regression models relating past suicidal behavior to frontal activation controlled for depression, psychosis, and impulsivity. Past suicidal behavior was associated with relatively higher activation in the left-hemisphere supplementary motor area (SMA), pre-SMA, premotor cortex, and dorsolateral PFC, all ipsilateral to the active primary motor cortex. This study provides unique evidence that suicidal behavior in patients with recent-onset SZ directly relates to frontal motor cortex activity during reactive control, in a pattern reciprocal to the relationship with proactive control found previously. Further work should address how frontal-based control functions change with risk over time, and their potential utility as a biomarker for interventions to mitigate suicide risk in SZ.

Suicide in Patients with Schizophrenia : A Review on the Findings of Recent Studies

The suicide risk of patients with schizophrenia is about 8.5-fold greater than that of the general population. Since 4-13% of patients with schizophrenia commit suicide, and 25-50% attempt suicide at least once during their lifetime, suicide can be a main cause of their higher mortality rate as compared with that of the general population. While evidence suggests that previous depressive disorders, previous suicide attempts, drug misuse, agitation or motor restlessness, fear of mental disintegration, poor adherence to treatment, and recent loss of another person are associated with the increased risk of suicide in schizophrenia, hallucinations have been associated with decreased suicide risk. Despite there being at least modest evidence suggesting that antipsychotics protect against suicidal risk, clozapine has been shown to be the most favorable second-generation antipsychotic for preventing suicide in patients with schizophrenia. In addition, selective serotonin receptor inhibitors can ameliorate suicidal ideation in schizophrenia. Furthermore, individual psychosocial interventions and psychotherapy, and reducing stigma, can be integral strategies for the prevention of suicide in schizophrenia. Further study is needed to identify the epidemiological characteristics and clinical correlates of suicide in Korean patients with schizophrenia, and provide an effective strategy for its prevention in Korea. (Korean J Schizophr Res 2015;18:5-9)

Risk factors for suicide in schizophrenia: systematic review and clinical recommendations.

To identify risk factors associated with suicide of patients with schizophrenia and provide clinical recommendations, which integrate research findings into a consensus based on clinical experience and evidence. A task force formed of experts and clinicians iteratively developed consensus through serial revisions using the Delphi method. Initial survey items were based on systematic literature review published up to June 2013. Various risk factors were reported to be implicated in suicide in schizophrenia. Our findings indicate that suicide risk in schizophrenia is mainly related to affective symptoms, history of a suicide attempt and number of psychiatric admissions. Other risk factors identified are given by younger age, closeness to illness onset, older age at illness onset, male sex, substance abuse and period during or following psychiatric discharge. Integrating the evidence and the experience of the task force members, a consensus was reached on 14 clinical recommendations. Identification of risk factors for suicide in individuals diagnosed with schizophrenia is imperative to improve clinical management and develop strategies to reduce the incidence of suicide in this population. This study provides the critical overview of available data and clinical recommendations on recognition and management of the above-mentioned risk factors.

Suicide Risk Assessment and Risk of Suicide in Schizophrenia: In Reply

Back to table of contents Previous article Next article LettersFull AccessSuicide Risk Assessment and Risk of Suicide in Schizophrenia: In ReplyCharlotte Gjørup Pedersen, Ph.D., M.H.Sc.Charlotte Gjørup PedersenSearch for more papers by this author, Ph.D., M.H.Sc.Published Online:1 Apr 2014https://doi.org/10.1176/appi.ps.650404AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: On behalf of the author group, I thank Dr. Large for his comments on our article. Screening for suicide risk among patients with schizophrenia cannot be done accurately, and when viewed as a diagnostic test, the currently used screening tools perform rather poorly. Thus it is natural to question the role of systematic suicide risk assessment in modern psychiatry.However, systematic suicide risk assessment remains widely used across health care systems. This practice is rational if the systematic assessment is not used as a stand-alone diagnostic test with a dichotomous outcome. Instead, it should be considered a tool to supplement direct observation and interviews with the patient and his or her close relatives or friends. A systematic and structured approach is in our opinion a prerequisite for fulfilling the overall aim stated by Dr. Large—that all patients “should be offered individualized, optimized care to improve well-being and thereby reduce the likelihood of their taking their own lives.” FiguresReferencesCited byDetailsCited ByNone Volume 65Issue 4 April 2014Pages 564-564 Metrics PDF download History Published online 1 April 2014 Published in print 1 April 2014

Suicide Risk Assessment and Risk of Suicide in Schizophrenia

Back to table of contents Previous article Next article LettersFull AccessSuicide Risk Assessment and Risk of Suicide in SchizophreniaMatthew M. Large, M.B.B.S., F.R.A.N.Z.C.P., and Christopher J. Ryan, M.B.B.S., F.R.A.N.Z.C.P.Matthew M. LargeSearch for more papers by this author, M.B.B.S., F.R.A.N.Z.C.P., and Christopher J. RyanSearch for more papers by this author, M.B.B.S., F.R.A.N.Z.C.P.Published Online:1 Apr 2014https://doi.org/10.1176/appi.ps.201300545AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In the February issue, Pedersen and associates (1) reported that between 2005 and 2009, a steadily increasing proportion of patients with schizophrenia had received a suicide risk assessment at the point of discharge from Danish psychiatric hospitals. The authors also reported that 64 of 7,107 (.9%) discharged patients with schizophrenia died as a result of suicide during the following year. This second statistic suggests that patients with schizophrenia are approximately 80 times more likely to die by suicide than the general Danish population, for which the suicide rate is approximately 11.6 suicides per 100,000 per year (2). An understanding of the potential utility of risk assessment and the difference between absolute and relative risk suggests that the steady increase in risk assessment reported in Denmark represents the outcome of misguided policy.A recent meta-analysis found that the odds of suicide among high-risk patients in the year after discharge from psychiatric hospitals were four times higher than among low-risk patients (3). This figure is dwarfed by the 80-fold increase, compared with the general population, in the likelihood of suicide among patients who are discharged with a diagnosis of schizophrenia. Irrespective of the patient’s risk category, any patient discharged with schizophrenia is many times more likely than an individual in the general population to die by suicide. The low specificity of risk assessment means that few of the patients classified as high risk will actually die by suicide. Patients classified as low risk will still be at many times the risk of suicide as the general population.Unless there is an intervention to reduce suicide that is suitable for “high-risk” patients that should not also be available to “low-risk” patients there is no point in further stratifying the population of patients discharged with schizophrenia by their assessed relative risk. There is no such intervention. Risk assessment of patients discharged with schizophrenia is pointless. All discharged patients should be offered individualized, optimized care to improve well-being and thereby reduce the likelihood of their taking their own lives.Dr. Large is with the Department of Mental Health Services, Prince of Wales Hospital, and with the School of Psychiatry, University of New South Wales, Sydney, Australia. Dr. Ryan is with the Discipline of Psychiatry and the Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia.References1 Pedersen GC, Wallenstein Jensen SO, Gradus J, et al.: Systematic suicide risk assessment for patients with schizophrenia: a national population-based study. Psychiatric Services 65:226–231, 2014Link, Google Scholar2 Suicide rates (per 100,000), by gender, Denmark, 1950–2006. Geneva, World Health Organization, 2005. Available at www.who.int/mental_health/media/denm.pdf?ua=1Google Scholar3 Large M, Sharma S, Cannon E, et al.: Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. Australian and New Zealand Journal of Psychiatry 45:619–628, 2011Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 65Issue 4 April 2014Pages 564-564 Metrics PDF download History Published online 1 April 2014 Published in print 1 April 2014