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Suicide and self-harm

How is suicide and self-harm related to schizophrenia?

Rates of suicide and self-harm are considerably higher in people with schizophrenia compared to the general population. There has been much research dedicated to determining these rates and also the potential risk factors, which have important applications for prevention. Many of the risk factors for suicide in the general population apply to people with schizophrenia, including depression, or having a history of attempted suicide or self-harm. However, factors specific to schizophrenia may also contribute to an increased risk of suicide or self-harm.

What is the evidence relating to suicide and self harm?

Moderate quality evidence suggests the lifetime risk of suicide in people with schizophrenia is around 1.8%, with risk in the earlier stages of the illness being highest, at around 5.6%. Among first-admission and new-onset samples (who tend to be younger), 30.6% of all deaths are due to suicide. The overall proportion of patients with first-episode psychosis who report deliberate self-harm is around 18% prior to treatment and 11% after treatment. Inpatient and outpatient risk assessments generally have good value for predicting suicide.

Moderate to high quality evidence suggests large effects of recent suicidal ideation, recent depression, and having a higher level of education as risk factors for suicide in people with schizophrenia. Moderate or moderate to low quality evidence suggests medium-sized effects of a history of suicide attempts, prior psychiatric admissions, recent loss, a history of depression or familial depression (not necessarily recent), having a sense of worthlessness, being agitated, restless or anxious, relationship problems, involuntary hospital admission, longer duration of admission, longer duration of untreated psychosis, younger age at onset, misusing alcohol or drugs, living alone or not living with family, being white, and having a low adherence to treatment. Additional risk factors for suicide may include having a history of childhood trauma, having active auditory hallucinations or delusions, mental suffering, insomnia, post-traumatic stress syndrome, severe physical illness, family history of suicide, being unemployed, having greater insight into the disorder, male gender, feelings of hopelessness, and unplanned discharge from a psychiatric hospital.

Risk factors for deliberate self-harm (not necessarily suicide) include depressed mood, expressed suicide ideation, alcohol or substance use, younger age at onset or treatment, longer duration of untreated psychosis, having a history of self-harm, and having greater insight.

Also see the adjunctive treatment topic on antidepressants.

 

October 2017

Page last updated: 0:45  11 October 2018

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