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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 to high quality evidence finds the lifetime risk of suicide in people with schizophrenia is around 5.6%. Among first-admission and new-onset samples, who tend to be younger, 30.6% of all deaths were due to suicide while 4.9% of deaths were suicides in mixed samples of chronic and recent-onset patients. The overall rate of suicide attempts in people with schizophrenia is around 27%, with rates higher when measured from the start of illness onset (46%) and lower when measured over the previous month or year (both 3%). The overall proportion of people with first-episode psychosis who report deliberate self-harm is around 18% prior to treatment and 11% after treatment.

For suicide ideation, the risk factors include more psychiatric hospitalisations and having more severe depressive or general schizophrenia symptoms.

For suicide attempts, the risk factors include more psychiatric hospitalisations, having depressive symptoms or a history of depression, hopelessness, having a history of suicide attempts or a family history of suicide. Smaller effects were found for; younger age at illness onset, being male, being white, living alone, having a comorbid physical illness, using tobacco, alcohol or drugs, and having a family history of psychiatric illness.

For suicide completion, the risk factors include hopelessness, worthlessness, higher IQ, poor adherence to treatment, having a history of suicide attempts, having shorter illness duration, and being white. Smaller effects were found for having a history of tobacco or alcohol use, being male, and younger age.

There is a medium to large increased risk of suicide in inpatients with schizophrenia who are compulsorily detained, but decreased risk of suicide in inpatients with an affective disorder who are compulsorily detained. There were large associations between younger inpatients with schizophrenia and increased risk of suicide, and older inpatients with an affective disorder and increased risk of suicide. There were medium-sized associations between increased risk of suicide in inpatients with schizophrenia on agreed leave, but decreased risk of suicide in inpatients with an affective disorder on agreed leave.

The risk of suicide in patients recently discharged from hospital is greatest soon after discharge (<3 months) and is associated with prior suicide attempts or ideations, unplanned discharge, depression, hopelessness, current relationship problems, and male gender. Clinical risk assessments generally have good value for predicting suicide completion.

August 2020

Last updated at: 1:33 am, 18th August 2020
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