Suicide rate for people with schizophrenia spectrum disorders 170 times higher

Summary: Suicide rates for those with schizophrenia spectrum disorders (SSD) are 170 times higher than the general population. Suicide risk is predicted by key factors including age, evidence of mood disorders and hospitalization. An increased risk of suicidal behavior in those with SSD occurs within the first five years following diagnosis.

Source: CAMH

The suicide rate for people with schizophrenia spectrum disorders (SSD) is 170 times higher than the general population according a study just published in the journal Schizophrenia Research, a figure the authors call “tragically high.”

The study of 20-years of population data, believed to be the largest of its kind ever done, examined statistics on over 75,000 patients who received a first diagnosis of SSD. On average, each patient was followed for almost ten years. The study found several key factors that were predictors of suicide including:

  • During the first five years after an individual has been diagnosed with SSD
  • If there was evidence of a mood disorder or hospitalization prior to diagnosis
  • If the individual was diagnosed with SSD at a later age

“What this study teaches is us that although people with SSD are at higher risk for suicide, we can target those at the highest risk with changes in policy and treatment,” said lead author Dr. Juveria Zaheer, Clinician Scientist at the CAMH Institute for Mental Health Policy Research.

“In the past clinicians have focused on treating the psychosis itself when it first appears,” said senior author Dr. Paul Kurdyak, Director, Health Outcomes and Performance Evaluation, CAMH Institute for Mental Health Policy Research and Clinician Scientist at ICES. “This study shows that treatment has to include suicide prevention safety planning as well from the very beginning.”

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The suicide rate for people with schizophrenia spectrum disorders (SSD) is 170 times higher than the general population. Image is in the public domain.

The authors suggest increasing the age limit for admission to first episode psychosis programs (most are closed to people over 30) and increasing the length of clinical follow-up care after a first episode of psychosis.

“Now that we know what is happening, we need to better understand why,” said Dr. Zaheer. “Our next step will be to study the lived experience of people with SSD who have had suicidal ideation.”

About this neuroscience research article

Source:
CAMH
Media Contacts:
Sean O’Malley – CAMH
Image Source:
The image is in the public domain.

Original Research: Closed access
“Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada”. by Juveria Zaheer et al.
Schizophrenia Research doi:10.1016/j.schres.2020.04.025

Abstract

Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada

Background
Suicide is a major cause of mortality for individuals with schizophrenia spectrum disorders (SSD). Understanding the risk factors for suicide at time of diagnosis can aid clinicians in identifying people at risk.

Methods
Records from linked administrative health databases in Ontario, Canada were used to identify individuals aged 16 through 45 years who received a first lifetime diagnosis of SSD (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified (NOS)) using a validated algorithm between 01/01/1993 and 12/31/2010. The main outcome was death by suicide following cohort entry until 12/31/2012.

Outcomes

75,989 individuals with a first SSD diagnosis (60.1% male, 39.9% female) were followed for an average of 9.56 years. During this period, 1.71% of the total sample (72.1% male, 27.9% female) died by suicide, after an average of 4.32 years. Predictors of suicide death included male sex (HR 2.00, 95% CI 1.76–2.27), age at diagnosis between 26 and 35 (HR 1.27, 95% CI 1.10–1.45) or 36–45 (HR 1.34, 95% CI 1.16–1.54), relative to 16–25, and suicide attempt (HR 2.23, 95% CI 1.86–2.66), drug use disorder (HR 1.21, 95% CI 1.04–1.41), mood disorder diagnosis (HR 1.32, 95% CI 1.17–1.50), or mental health hospitalization (HR 1.30 95% CI 1.13–1.49) in the 2 years prior to SSD diagnosis.

Interpretation

Death by suicide occurs in 1 out of every 58 individuals and occurred early following first diagnosis of SSD. Psychiatric hospitalizations, mood disorder diagnoses, suicide attempts prior to SSD diagnosis, as well as a later age at first diagnosis, are all predictors of suicide and should be integrated into clinical assessment of suicide risk in this population.

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