Review

Suicide risk in schizophrenia: learning from the past to change the future

Maurizio Pompili^1,2 , Xavier F Amador³ , Paolo Girardi¹ , Jill Harkavy-Friedman⁴ , Martin Harrow⁵ , Kalman Kaplan⁵ , Michael Krausz⁶ , David Lester⁷ , Herbert Y Meltzer⁸ , Jiri Modestin⁹ , Lori P Montross¹⁰ , Preben Bo Mortensen¹¹ , Povl Munk-Jørgensen¹² , Jimmi Nielsen¹² , Merete Nordentoft¹³ , Pirjo Irmeli Saarinen¹⁴ , Sidney Zisook¹⁰ , Scott T Wilson³ and Roberto Tatarelli¹

¹  Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy

²  McLean Hospital – Harvard Medical School, USA

³  Department of Psychiatry, Columbia University, New York, USA

⁴  New York State Psychiatric Institute, Columbia University, New York, USA

⁵  Department of Psychology, University of Illinois College of Medicine, Chicago, USA

⁶  Psychiatric Clinic, University Hospital Eppendorf, Hamburg, Germany

⁷  Center for the Study of Suicide, Blackwood, USA

⁸  Department of Psychiatry Vanderbilt University School of Medicine, USA

⁹  Deptartment of Psychiatry (Burghölzli Hospital), University of Zurich, Switzerland

¹⁰  Department of Psychiatry, Division of Geriatric Psychiatry, University of California San Diego, USA

¹¹  National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark

¹²  Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark

¹³  Department of Psychiatry Copenhagen University, Bispebjerg Hospital, Copenhagen, Denmark

¹⁴  Department of Psychiatry Kuopio University Hospital, Kuopio, Finland

author email corresponding author email

Annals of General Psychiatry 2007, 6:10doi:10.1186/1744-859X-6-10

Published:	16 March 2007

Abstract

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures.

This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients.