Risk Factors for Suicidality Among Clients With Schizophrenia

Among clients with schizophrenia, suicidality is associated with extreme personal distress, an increased number of inpatient hospitalizations, increased health care expenditures, and early mortality. This study attempted to identify risk factors for current suicidality in clients diagnosed with schizophrenia (N = 223). Results indicated that severity of depressive symptoms most strongly correlated with degree of suicidality. Younger age and recent traumatic stress each significantly predicted suicidality independent of depressive symptoms. Stepwise regression procedures showed that the combination of depression, younger age, and traumatic stress might provide a general prediction model for suicidality among clients diagnosed with schizophrenia. Counseling implications of these findings are outlined.     

Psychosis and functioning as risk factors for later suicidal activity among schizophrenia and schizoaffective patients: a disease-based interactive model.

The present research explores the relationship of positive symptoms, negative symptoms, and posthospital functioning to subsequent suicidal behavior over a 7 1/2-year period, and examines whether these patterns vary with diagnosis. The results support a multifactor model of suicide risk. Both psychosis and poor functioning show some relationship to later suicidal activity for both schizophrenic and schizoaffective patients. Psychosis may remain a risk factor for suicidal activity for schizoaffective patients, even when functioning is partialed out. This is in contrast to the schizophrenia patients, for whom funtioning seems to mediate the effects of psychosis on later suicidality. In general, adequacy of overall posthospital functioning mediates the effects of some risk factors on suicidal activity within different diagnostic groups.     

Depression, suicide, and suicide prevention in schizophrenia

Suicide is the single largest cause of premature death among individuals with schizophrenia. Furthermore, epidemiological data indicate that nearly 80% of patients with the diagnosis of schizophrenia will experience a major depressive episode at some time during their lifetime. This report reviews recent findings relative to the risk of suicide in schizophrenia, including data from the Chestnut Lodge longitudinal study of schizophrenia subtypes and symptom domains. Paradoxically, those patients with schizophrenia who are most likely to recover or experience a good outcome are also those at greatest risk for suicide. The reduction of morbidity and mortality in schizophrenia should include depression and suicidality as targets for both psychopharmacological and psychosocial treatment.     

Memory specificity as a risk factor for suicidality in non-affective psychosis: The ability to recall specific autobiographical memories is related to greater suicidality

A difficulty in recalling specific autobiographical memories has been noted as a risk factor for suicidal behaviour. However, the relationship between memory specificity and suicide has not previously been investigated in those with non-affective psychosis. It was predicted that in this group, more specific memory recall would be associated with an increased risk of suicide. This is because such specific memories are likely to be associated with greater levels of distress and negative affect than less specific memories. This prediction contradicts the prevailing belief that lower memory specificity is associated with greater suicidality. Sixty participants with schizophrenia spectrum disorders were recruited, 40 of whom reported past suicide attempts. Analyses showed suicide attempters recalled a greater proportion of specific memories, whilst controlling for trait anxiety and depressive symptoms. These results supported the main hypothesis, and suggest non-specific memory may have adaptive qualities in individuals with psychosis.     

Violent obsessions are associated with suicidality in an OCD analog sample of college students

The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Likelihood of suicidality at varying levels of depression severity: a re-analysis of NESARC data

Although it is clear that increasing depression severity is associated with more risk for suicidality, less is known about at what levels of depression severity the risk for different suicide symptoms increases. We used item response theory to estimate the likelihood of endorsing suicide symptoms across levels of depression severity in an epidemiological data set. Regardless of depression severity, suicide attempts were less frequently endorsed than ideation, which was less frequently endorsed than feeling like one wanted to die. All suicide symptoms were generally less likely to be endorsed than other depression symptoms. There was a low probability of suicidality at depression levels that likely would not merit a diagnosis of major depression.     

Suicidality as a function of impulsivity, callous-unemotional traits, and depressive symptoms in youth

Suicidality represents one of the most important areas of risk for adolescents, with both internalizing (e.g., depression, anxiety) and externalizing-antisocial (e.g., substance use, conduct) disorders conferring risk for suicidal ideation and attempts (e.g., Bridge, Goldstein, & Brent, 2006). However, no study has attended to gender differences in relationships between suicidality and different facets of psychopathic tendencies in youth. Further, very little research has focused on disentangling the multiple manifestations of suicide risk in the same study, including behaviors (suicide attempts with intent to die, self-injurious behavior) and general suicide risk marked by suicidal ideation and plans. To better understand these relationships, we recruited 184 adolescents from the community and in treatment. As predicted, psychopathic traits and depressive symptoms in youth showed differential associations with components of suicidality. Specifically, impulsive traits uniquely contributed to suicide attempts and self-injurious behaviors, above the influence of depression. Indeed, once psychopathic tendencies were entered in the model, depressive symptoms only explained general suicide risk marked by ideation or plans but not behaviors. Further, callous-unemotional traits conferred protection from suicide attempts selectively in girls. These findings have important implications for developing integrative models that incorporate differential relationships between (a) depressed mood and (b) personality risk factors (i.e., impulsivity and callous-unemotional traits) for suicidality in youth.     

Strain,Emotion, and Suicide Among American Indian Youth

In this article, we test the utility of Agnew's general strain theory to explain suicidal behaviors among American Indian youth. Data from 721 American Indian adolescents from the Midwest and Canada were collected in partnership with participating reservations/reserves and a research team. We investigate the effects of strains/stressors on suicide, including tests of mediating effects of negative emotions on relationships between stressors and suicidality. We found that several strains/stressors were related to suicidality, including coercive parenting, caretaker rejection, negative school attitudes, and perceived discrimination. We also found that depressive symptoms and anger mediated the effects of several key predictors of suicidality. We discuss the theoretical and policy implications of our work for the general strain theory and for American Indian suicide in general.     

Schizophrenia--a high-risk factor for suicide: clues to risk reduction.

Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and "types" of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.     

Depression and suicide in schizophrenic patients

This study supports the idea that schizophrenic patients represent a distinctive subgroup of patients who can suffer from a major depressive illness and also can commit suicide. The study showed that 22.4% of the schizophrenic population in a medium-sized psychiatric facility showed severe depressive symptoms that met the criteria for the diagnosis of a major depressive episode according to the DSM-III classification. Seven patients committed suicide during the acute phase of the illness--five during hospitalization, and two within a year of discharge. Nine patients attempted suicide during the hospitalization period, and 10 attempted suicide within a year of discharge. Nearly one-third (215) of the patients were readmitted during that year because of a recurrence of acute schizophrenic symptoms; of these, 84 were having severe depressive symptoms. The study also provides indications of the causes of suicide in these patients.     

Grateful individuals are not suicidal: Buffering risks associated with hopelessness and depressive symptoms

With suicidal behavior serving as a leading cause of injury and death around the world, researchers must expand ongoing efforts to uncover protective factors. In this study, we examined if gratitude mitigated existing risk factors for suicide. Specifically, we predicted that gratitude moderates the relationship between suicidal ideation and (a) hopelessness and (b) depressive symptoms in a sample of 369 diverse undergraduate students. Results indicate that for people who are highly grateful, both hopelessness and depressive symptoms are less likely to be associated with thoughts and intentions to kill oneself. The findings demonstrate the value of integrating protective factors against suicidality, including character strengths such as gratitude, into existing theories that tend to be limited to vulnerability factors. We offer tentative ideas for enhancing the impact of suicide prevention and intervention programs by directly addressing gratitude, which has been shown to be highly modifiable.     

Specificity of Depressive Symptoms and Suicidality in a Juvenile Delinquent Population

Research which has related scores on the Children's Depression Inventory (CDI) to suicidality have generally neglected to examine the possibility that specific depressive factors within the CDI may be more predictive of suicidality than the full scale score. Knowledge of such factors would help to explain the relationship between depression and suicidality and improve the prediction of suicidal behavior. The current study examined the relationship of depressive factors to suicidality in a sample of 200 incarcerated juvenile delinquents. The published factor structure for the CDI and one derived from the delinquent population were compared. Results revealed two factors from the derived solution, hopelessness and low self-esteem, to be more powerful predictors of suicidal ideation than the full-scale CDI score. These results suggest that symptoms such as low self-esteem and hopelessness may be responsible for the well-documented relationship between depression and suicidality. Furthermore, it appears that the prediction of suicidality may be improved by examining specific depressive factors in suicide research as opposed to full-scale scores from depression inventories such as the CDI.     

The Impact of Negative Stimuli on Suicidality among Adulthoods: A Mediating Effect of Depression

ABSTRACT

Suicide is the leading cause of mortality in the world. The major factors of suicidal behavior are depressive symptoms. Using data from the Korean General Social Survey conducted in 2012, this study identified the causes of suicidality using general strain theory (GST). The total sample size was 1,396. The results showed that physical punishment and mental abuse experienced in childhood increased the mediating variable, level of depression, in adulthood. This study also found that suicidality was significantly associated with depression level. Furthermore, physical punishment and mental abuse had significantly direct effects on the suicidality. As a result, this study found that negative experiences before 18 years of age have an influence on later depression, which increases the likelihood of suicide. Also, this study strongly supported GST. Therefore, reducing the causes of depression during adolescent period would be a key strategy to decrease suicide risk during adulthood.     

Reports of attempted suicide among Brazilian addicts

Both substance dependence and depressive mood seem to be associated with increased suicide risk. Clinical information on suicide attempts and depressive symptoms were obtained from a sample of 211 psychoactive substance dependents attending a university clinic program for addicts in Brazil. 49 subjects (23.4%) had attempted suicide at least once, and the frequency of reporting attempts was 4.32 times greater among women than among men. Male addicts also tended to engage in potentially more dangerous attempt methods than women. Depressive male addicts were 2.17 times more likely to have attempted suicide than nondepressive addicted men. Among women, no association could be established between having attempted suicide and the presence of depression. Substance addicts have a relatively high risk of attempting suicide and the co-occurrence of depression seems to increase prevalence of suicidal behavior among men.     

Suicidal Risk in Adolescent Residential Treatment: Being Female Is More Important Than a Depression Diagnosis

We investigated the relationship between gender and clinician diagnosis of a depressive disorder at intake on variables reflecting depression among adolescents in residential treatment. It was hypothesized that females diagnosed with a depressive disorder would have the highest scores on measures of suicide risk, the number of symptoms of a major depressive episode, suicidal behavior, and suicidal ideation. Results indicated partial support for the predicted comparisons. Females diagnosed with a depressive disorder scored significantly higher on measures of depressive symptom count and suicidal ideation. Surprisingly, females without a diagnosis of a depressive disorder had higher suicide risk scores than the remaining groups. The results of this study highlight the importance of assessment and treatment of internalizing disorders in youth entering residential programs, particularly female adolescents.     

Suicide schema in schizophrenia: the effect of emotional reactivity, negative symptoms and schema elaboration

Suicide risk is thought to increase with a greater potential for activation of suicide-related schemas. Suicide schemas are less likely to be activated with reductions of emotional range associated with certain negative symptoms of schizophrenia. The study tested whether suicide risk would increase in patients with recent onset schizophrenia with increased potential for suicide schema activation as indicated by lower levels of specific negative symptoms that reflected emotional reactivity, namely emotional withdrawal and blunted affect. A logistic regression analysis of baseline data of 278 recent onset schizophrenic patients with a measure of suicide behaviour as the dependent variable and negative symptoms, delusions, hallucinations, depression, gender, episode, ethnicity, education, age, duration of untreated psychosis and substance use as independent variables was carried out. Emotional withdrawal, but not blunted affect was significant and negatively associated, and depression positively associated with suicide behaviour. There was evidence to indicate that restricted emotions are associated with reduced suicide risk as predicted.     

Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China

This study evaluated the characteristics of suicidal behavior (suicide attempt or suicidal ideation) among 230 consecutively admitted inpatients with schizophrenia and mood disorders in a university hospital in China. The rate of lifetime suicidal behavior was found to be significantly higher in patients with mood disorders (62.4%) than in patients with schizophrenia (38.6%). The rate of suicidal behavior was significantly higher in patients with major depressive disorder (86.8%) than those with bipolar disorders (42.6%). Patients with schizophrenia attempted suicide for the first time earlier in life than the patients with mood disorders. Mood disorder patients, especially those with major depressive disorder, had more and more serious suicide attempts than the patients with schizophrenia.     

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.     

Reported childhood trauma and suicide attempts in schizophrenic patients

Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire (CTQ). It was found that schizophrenics who had attempted suicide reported significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect than schizophrenics who had never attempted suicide. Therefore, childhood trauma may be a risk factor predisposing schizophrenic patients to attempt suicide.