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Schizophrenia and Suicide

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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 linked to 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 complete the act of suicide. Compared to the general population, people with schizophrenia have a more than eight-fold 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 sometimes 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 happen.

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 alcohol or other 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 linked to:

  • 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 so-called "negative" or "deficit" symptoms, such as:

  • Hopelessness
  • Negative outlook on life
  • Sense of worthlessness
  • Awareness that schizophrenia is negatively 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 always be a clear risk factor for suicide in schizophrenia. Drug abuse, however, has been widely linked to suicide risk in people with schizophrenia. People with schizophrenia are twice as likely to abuse drugs as people in the general population.

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