Self-harm and suicide attempts in Schizophrenia

Abstract

Background The risk of suicide among persons with schizophrenia (SZ) is higher than in general population, with multiple contributory factors. We assessed the prevalence of risk of deliberate self-harm and suicide attempts, along with associated socio-demographic and clinical factors in a group of SZ outpatients (n=61) as part of a larger study on overall schizophrenia-associated risks. Aims To investigate factors associated with risk of deliberate self-harm and suicide among persons with schizophrenia. Method Out of 270 SZ participants evaluated for various risks using Ram Manohar Lohia Risk Assessment Interview (RML-RAI), 61 reported risk of self-harm including suicide attempt/s. The factors associated with this risk were further evaluated on clinical details and Diagnostic Interview for Genetic Studies. Results Risk of reported self-harm was 22.59%. Among them, 10% had attempted suicide at least once. Current age and past month Global Assessment of Functioning score from DIGS (GAF) were significantly correlated with suicide attempt. Attempters had significantly lower current GAF score, indicating poorer functioning. Among 27 attempters, 9 attempted at the onset of illness while 6 others attempted suicide within one year. Most common method of attempt was ingestion of insecticides or overdose of medication, followed by hanging or jumping from height. Conclusion In our hospital-based sample of suicide attempters, 10% had attempted suicide, among them over 55% within first year of illness. Attempters were significantly older than non-attempters and suffered from significantly more severe illness than non-attempters. Positive symptoms were significantly associated with attempt, irrespective of time at which suicide was attempted.

Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients

“…One-fourth of schizophrenia patients in acute wards showed self-harm and suicidal behaviors. ( 20 ) In the present study participants who underwent milieu therapy showed significantly decreased self-harm behavior compared to patients who underwent only routine therapy. In the present study milieu therapy ensured safe and secure environment by removing sharp objects from the patient environment, encouraged patient to express his negative emotions, taught safe and unsafe behavior, reinforced adaptive behavior.…”

Comparison of Long-Acting Injectable Antipsychotics With Oral Antipsychotics and Suicide and All-Cause Mortality in Patients With Newly Diagnosed Schizophrenia

“… 6 , 30 The risk is highest among patients during the early stage of their illness or their first episode. 5 Most suicide attempts occur within 2 years after the first episode of psychosis, 31 , 32 and suicide-related mortality is higher among individuals recently diagnosed as having schizophrenia (ie, ≤5 years from diagnosis). 33 The higher risk of suicide compared with later stages of schizophrenia might be explained by the critical period hypothesis, which states that the primary clinical and psychosocial deterioration associated with schizophrenia occurs within the first 5 years, the critical period.…”

Prevalence of suicide attempts in individuals with schizophrenia: a meta-analysis of observational studies

“…This may bias the validity of the pooled prevalence of suicide attempts across studies with different timeframes and sampling. Other than the confounding effects caused by potential recall bias and small number of studies, various factors such as more severe psychotic symptoms, impaired global functioning from onset and stigma could increase the risk of suicidal behaviours in individuals with schizophrenia (Kaplan and Harrow, 1996 ; Radomsky et al ., 1999 ; Assefa et al ., 2012 ; Jakhar et al ., 2017 ). Patients with a younger age of illness onset had a higher risk of suicide attempts, which is consistent with some (Panariello et al ., 2010 ; Vinokur et al ., 2014 ; Niehaus et al ., 2004 ), but not all studies (Popovic et al ., 2014 ).…”