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Schizophrenia and suicide: systematic review of risk factors

Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford

CAMILLA HAW, MRCPsych

St Andrew's Hospital, Northampton

JULIA SINCLAIR, MRCPsych

Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford

JONATHAN J. DEEKS, MSc

Centre for Statistics in Medicine, Institute for Health Sciences, Oxford, UK

Correspondence: Professor Keith Hawton, Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. E-mail: keith.hawton{at}psychiatry.ox.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Suicide risk is greatly increased in schizophrenia. Detection of those at risk is clinically important.

Aims To identify risk factors for suicide in schizophrenia.

Method The international literature on case-control and cohort studies of patients with schizophrenia or related conditions in which suicide was reported as an outcome was systematically reviewed. Studies were identified through searching electronic databases and reference lists, and by consulting experts.

Results Twenty-nine eligible studies were identified. Factors with robust evidence of increased risk of suicide were previous depressive disorders (OR=3.03, 95% CI 2.06-4.46), previous suicide attempts (OR=4.09, 95% CI 2.79-6.01), drug misuse (OR=3.21, 95% CI 1.99-5.17), agitation or motor restlessness (OR=2.61, 95% CI 1.54-4.41), fear of mental disintegration (OR=12.1, 95% CI 1.89-81.3), poor adherence to treatment (OR=3.75, 95% CI 2.20-6.37) and recent loss (OR=4.03, 95% CI 1.37-11.8). Reduced risk was associated with hallucinations (OR=0.50, 95% CI 0.35-0.71).

Conclusions Prevention of suicide in schizophrenia is likely to result from treatment of affective symptoms, improving adherence to treatment, and maintaining special vigilance in patients with risk factors, especially after losses.

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