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
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:
- Social isolation
- 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:
- 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.
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.
Throughout the course of schizophrenia, careful assessments of hopelessness and suicidal thoughts and behaviors are vital. This is especially true for people who have increased awareness of how serious their disease is.
It's true a person's increased awareness of the illness can lead to clinical improvements. But it also can contribute to suicidal thoughts in younger, previously high-functioning people who may recognize how much they've lost.
To assess the risk of suicide, doctors and caregivers must be attentive and sensitive to the person's sense of loss.
Many antidepressants and antipsychotics carry warnings of increased risk for suicidal thinking and behavior in young adults, adolescents, and children.
For now, evidence suggests that the most effective way to prevent suicide in schizophrenia is a combination of:
- Active treatment of depressive symptoms
- Improved treatment adherence
- Maintaining special vigilance in patients with risk factors, especially those who've had significant losses.