The relationship between suicide and violence in schizophrenia: Analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset

Abstract

BackgroundSuicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness.AimsThe aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia.MethodData for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk.ResultsSuicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior.ConclusionsSuicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.

Schizophrenia and violence: realities and recommendations

“…Another noteworthy finding of the CATIE study involved the relationship between violence, and suicidal threats and attempts in both males and female community-dwelling patients with schizophrenia. Witt, Hawton, and Fazel (2014) reported that past suicidal threats and attempts increased the rate of violent behavior in male schizophrenia patients by 3.8%, compared to a 2.8% increase in the non-suicidal group. In female patients, past suicidal threats and attempts raised the OR for violence to 9.4%, compared to a 4.4-fold increase in the non-suicidal patient group.…”

Suicidality in Schizophrenia Spectrum Disorders: The Relationship to Hallucinations and Persecutory Delusions

“…A score of 1 will from here on be referred to and analysed as suicidal ideation, a score of 2: suicide plans and 3: suicide attempt. This method of analysing suicide-data from the CDSS was applied in a similar manner in the CATIE-trial [56]. The PANSS Excitement Component (PANSS-EC) consists of the PANSS items P4 Hyperactivity, P7 Hostility, G4 Tension, G8 Uncooperativeness and G14 Poor Impulse Control.…”

“…Boter et al from the EUFEST study group have published data comparing the subgroup with comorbidities such as suicidality or substance use with participants without these comorbidities [7]. Witt et al have investigated the relationship between suicide and violence in the CATIE trial [56]. Brugnoli et al found previous suicidality, depressive symptoms, prolactin-related adverse events, male gender and history of hospitalisation for schizophrenia as risk factors for suicide or suicidal behaviours in the SOHO-study, but analysed positive psychotic symptoms only at a general level [8].…”

Predictors of suicide attempts in 3.322 patients with affective disorders and schizophrenia spectrum disorders

“…Additional risk factors described by other authors include having a family history of suicide (Brent et al, 1996), certain genetic variations (Ben-Efraim et al, 2012), comorbid medical illnesses such as cancer or HIV (Cole et al, 2014; McManus et al, 2014); experiencing a social and/or financial crisis (Large et al, 2011) and having stressful life events (Pompili et al, 2011). Rates of suicidal behavior are significantly higher in psychiatric populations compared to the general population (Beghi et al, 2013), but most studies conducted so far have focused on specific psychiatric diagnoses such as bipolar disorder (Hauser et al, 2013), post traumatic stress disorder (PTSD) (Pompili et al, 2013), depression (Hawton et al, 2013), schizophrenia (Witt et al, 2014), borderline personality disorder (Soloff et al, 2014), anxiety disorders (Thibodeau et al, 2013), eating disorders (Suokas et al, 2014) and other diagnoses. On the other hand, relatively few studies have directly compared suicidal rates across different psychiatric disorders in a single patient sample.…”