March 10, 2005

Suicide in schizophrenia

The lifetime risk of suicide in schizophrenia: a reexamination.

Palmer BA, Pankratz VS, Bostwick JM.
Arch Gen Psychiatry. 2005 Mar;62(3):247-53.

In 1977, Miles conducted a major meta-analysis (ie. which looks at results from many published studies) where he reviewed 34 studies looking at people with schizophrenia. This original study found an estimated 10% lifetime risk of suicide. The authors in the current study thought that this might be an overestimation of suicide risk and wanted to conduct another meta-analysis including more factors. They were interested in issues such as the difference between proportionate mortality (PM) which is the percentage the percentage of the dead who died by suicide and case fatality (CF) which the percentage of the original sample who died by suicide. They also wanted to see if there was a difference between groups who were followed from the beginning of their illness vs those who were studied after they were chronically ill. They hoped to come up with what they call “the most accurate estimation of suicide risk in schizophrenia to date.”

For their methods, they carefully included studies that looked at people with schizophrenia for at least 2 years, with at least 90% follow-up. They also included other data such as sample size, number of deaths, number of suicides, percentage of follow-up, and diagnostic system used.

The authors found that first-admission and new-onset studies more accurately estimates of suicide risk because they included the initial years of the illness when death by suicide is most likely in schizophrenia. Overall they found that 4.9% of those with schizophrenia commit suicide during their lifetimes, usually near illness onset. They also suggest that CF rates more accurate at approximating suicide prevalence than PM rates, and an even more accurate prevalence estimate may be approximated with statistical reconciliation of these 2 statistics. However, there are limitations to this study such as the use of composite data from collections of studies to estimate lifetime risk of suicide and the extrapolation of data beyond that which was observed. Nevertheless, this study highlights that fact that intervention and prevention efforts are best directed toward the early stages of schizophrenia.

Support: This study was supported by a grant from the American Foundation for Suicide Prevention, New York, NY.

Click here to find this article on PubMed


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