Suicidal Behavior and Mortality in First-Episode Psychosis

Abstract

Suicide is a serious public health problem, with more than 800,000 deaths taking place worldwide each year. Mental disorders are associated with increased risk of suicide. In schizophrenia and other psychotic disorders, the lifetime risk of suicide death is estimated to be 5.6%. The risk is particularly high during the first year of the initial contact with mental health services, being almost twice as high as in the later course of the illness. The most consistently reported risk factor for suicide among people with psychotic disorders is a history of attempted suicide and depression. Suicide risk in psychosis in Denmark decreased over time, most likely because of improved quality of inpatient and outpatient services. There is a high proportion of young people with first-episode psychosis who attempted suicide before their first contact with mental health services. This finding suggests that the mortality rates associated with psychotic disorders may be underreported because of suicide deaths taking place before first treatment contact. However, currently, no data exist to confirm or refute this hypothesis. Attempted suicide can be an early warning sign of later psychotic disorder. Data from different studies indicate that the risk of suicide attempt during the first year of treatment is as high as 10%. The most important risk factors for attempted suicide after the first contact are young age, female sex, suicidal plans, and a history of suicide attempt. Early intervention services are helpful in first-episode psychosis, and staff members should, in collaboration with the patients, monitor the risk of suicide and develop and revise crisis plans.

Risk of suicide, deliberate self‐harm and psychiatric illness after the loss of a close relative: A nationwide cohort study

“…Serious mental health conditions and suicide after loss of a close relative are potentially preventable. Early mitigation of risk may have wide‐ranging beneficial effects, especially for distinct high‐risk groups.…”

Clinical variables associated with suicide attempts in schizophrenia before and after the first episode

“…Risk factors for suicide in patients with first-episode schizophrenia (FES) are reported as longer duration of untreated psychosis (DUP), severe or variable depressive symptoms, using antipsychotic drugs, higher levels of feelings of guilt, and anxiety (Barrett et al, 2010(Barrett et al, , 2015Melle and Ann Barrett, 2012;Palmier-Claus et al, 2013;Upthegrove et al, 2014), conviction of a violent crime, and having a first-degree relative with a schizophrenia/bipolar diagnosis (Björkenstam et al, 2014), young age, female sex, and history of suicide attempt (Nordentoft et al, 2015). Melle and Ann Barret (2012) also reported that risk of suicide attempt before first admission was associated with the length of untreated illness.…”

Self-harm and suicide attempts in Schizophrenia

“…The rate of attempted suicide in psychotic patients ranged from 10 to 50% (Melle et al, 2006, Power and McGowan, 2011). Up to 40–79% of individuals affected with Schizophrenia report suicidal ideation at least once during the course of illness (Fenton et al, 1997, Skodlar et al, 2008), where the estimated suicide rate is 579/100,000 person years and the lifetime risk of suicidal death is 5.6% (Hor and Taylor, 2010, Nordentoft et al, 2015). …”