Prevalence of suicide ideation, self-harm, and suicide among Chinese patients with schizophrenia: a systematic review and meta-analysis

Abstract

AimsSuicide ideation, self-harm, and suicide are common in patients with schizophrenia, but the reported prevalence vary largely across studies. Improved prevalence estimates and identification of moderators of the above self-directed violence are needed to enhance recognition and care, and to guide future management and research. This systematic review aims to estimate the pooled prevalence and identify moderators of suicide ideation, self-harm, and suicide among patients diagnosed with schizophrenia in China.MethodsRelevant articles published until September 23, 2021, were searched using PubMed, EBSCO, Web of Science, Embase, Science Direct, CNKI, CBM, VIP, and Wanfang databases. Eligible studies published in English or Chinese which reported the prevalence of suicide ideation, self-harm, or suicide among Chinese patients with schizophrenia were collected. All studies passed a quality evaluation. This systematic review was registered with PROSPERO (registration number CRD42020222338). PRISMA guidelines were used in extracting and reporting data. Random-effects meta-analyses were generated using the meta package in R.ResultsA total of 40 studies were identified, 20 of which were evaluated as high-quality studies. Based on these studies, the prevalence of lifetime suicide ideation was 19.22% (95% CI: 7.57–34.50%), prevalence of suicide ideation at the time of investigation was 18.06% (95% CI: 6.49–33.67%), prevalence of lifetime self-harm was 15.77% (95% CI: 12.51–19.33%), and prevalence of suicide was 1.49% (95% CI: 0.00–7.95%). Multivariate meta-regression analysis revealed that age (β = − 0.1517, p = 0.0006) and dependency ratio (β = 0.0113, p < 0.0001) were associated with the lifetime prevalence of self-harm. Study assessment score (β = 0.2668, p < 0.0001) and dependency ratio (β = 0.0050, p = 0.0145) were associated with the lifetime prevalence of suicide ideation. Results of the spatial analysis showed that the prevalence of self-directed violence varied greatly across different provinces.ConclusionThis systematic review provides estimates of the prevalence of self-directed violence among Chinese patients with schizophrenia and explores its moderators and spatial patterns. Findings also have important implications for allocating prevention and intervention resources to targeted high-risk populations in high prevalence areas.

Self-Harm and Suicide Rates Before and After an Early Intervention Program for Patients With First-Episode Schizophrenia

“…between January 2003 and March 2021. These rates were similar to previous estimates from the Chinese population 51 but different from those reported in other countries. 6,7,[52][53][54][55][56] Several factors may be associated with these discrepancies.…”

Can neurocognition, brain neurotrophic factor, triglyceride, and total cholesterol predict suicidal ideation in first‐episode Han Chinese patients with schizophrenia?

“…In the present study, the incidence of concomitant suicidal ideation in 123 patients with schizophrenia was 26.02%, which was similar to the 25.8% (95% CI: 14.7-41.1%) reported by Dong et al (2019) through a meta-analysis. Another study on Chinese patients with schizophrenia found a lifetime prevalence of suicidal ideation of 19.22% (Liang et al, 2023), indicating a higher incidence of suicidal ideation in patients with schizophrenia.…”

“…( 2019 ) through a meta‐analysis. Another study on Chinese patients with schizophrenia found a lifetime prevalence of suicidal ideation of 19.22% (Liang et al., 2023 ), indicating a higher incidence of suicidal ideation in patients with schizophrenia.…”

Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

“…The determination of our sample size was guided by several considerations: (a) Prevalence estimates: the formula for calculating sample size is: n = [ Z 2 * p *(1− p )]/ E 2 ( n , sample size; Z , Z-score corresponding to the desired confidence level; p : expected incidence rate; E , allowable error margin). For suicide ideation, we utilised an estimated prevalence of 18% in Chinese patients with schizophrenia, 26 allowing a 5% error margin. This calculation yielded a required sample size of 252.…”