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Schizophrenia and Suicide

Schizophrenia is a chronic, disabling mental illness characterized by a wide range of symptoms, including:

abnormal thinking
loss of contact with reality
hallucinations

It is strongly associated with an increased risk of suicide attempts and completed suicides.

Among people diagnosed with schizophrenia, an estimated 20% to 40% attempt suicide. From 5% to 13% actually succeed and die by suicide. Compared to the general population, people with schizophrenia have a more than eightfold increased risk of suicide. They also have an increased risk of death from natural causes such as respiratory diseases.

Suicide prevention can be difficult because people with schizophrenia can act impulsively and without warning. So it is essential that health care workers, family members, and friends be aware of the risk factors for suicide and the circumstances when they are most likely to occur.

Risk Factors for Suicide in Schizophrenia Patients

People with schizophrenia are more likely to commit suicide if they are young, male, white, and never married. People are also at increased risk if they had good function before they were diagnosed with schizophrenia, developed depression after diagnosis, and have a history of substance abuse and past suicide attempts.

The classic suicidal patient with schizophrenia may:

Be a male under age 30
Have a higher IQ
Have been a high achiever as an adolescent and young adult
Be painfully aware of schizophrenia's effect on his mental state

Other risk factors for suicide include:

Hopelessness
Social isolation
Hospitalization
Deteriorating health
Recent loss or rejection
Limited external support
Family stress or instability
Fear of further mental deterioration
Excessive dependence on treatment
Loss of faith in treatment

Suicide among people with schizophrenia is also associated with:

Chronic illness
Family history of suicide
Past or present history of depression
Substance abuse
Agitation and impulsivity
Suicidal thoughts
Greater number of prescriptions for schizophrenia medications (antipsychotics) and antidepressants
Negative attitudes towards medication and reduced adherence to therapy
Dependence and incapability of working

In general, the core symptom of psychosis -- hallucinations -- appears to be less associated with suicide than other symptoms such as:

Agitation
Hopelessness
Sense of worthlessness
Awareness that schizophrenia is adversely affecting the person's mental function

Some research suggests that alcohol abuse, which is a major risk factor for suicide in the general population, may not be a significant risk factor in schizophrenia. Drug abuse, however, is strongly associated with suicide risk in people with schizophrenia. People with schizophrenia are twice as likely to abuse drugs as people in the general population.

Prevention of Suicide in Schizophrenia

Researchers have identified important risk factors for suicide in schizophrenia. It may be difficult, though, to recognize the early signs that a person is at risk.

For example, a person may be at greater risk in the period after hospital discharge. People with schizophrenia often perceive the hospital as a safe haven. And they see staffers and other patients as the central people in their life. So hospital discharge often triggers feelings of hopelessness.

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