Symptoms of Depression, Positive Symptoms of Psychosis, and Suicidal Ideation Among Adults Diagnosed With Schizophrenia Within the Clinical Antipsychotic Trials of Intervention Effectiveness (original) (raw)
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Assessing suicidal ideation in individuals at clinical high risk for psychosis
Schizophrenia Research, 2015
Background-The majority of individuals with schizophrenia and other psychotic illnesses have had suicidal ideation at some point during the illness. However, little is known about the variation in level and intensity of suicidal ideation and symptoms in the attenuated stage of psychotic illness. Our aims were to assess prevalence of suicidal ideation in this at risk group, and to examine the severity and intensity of suicidal ideation, and their relation to symptoms. Methods-Suicidal ideation was assessed in 42 clinical high-risk participants using the Columbia Suicide Severity Rating Scale (C-SSRS). We hypothesized prevalence rates would be similar to what was found in previous studies, and individuals with suicidal ideation would have higher positive and negative symptoms, with poorer functioning. We assessed levels of severity and intensity of suicidal ideation related to these symptoms, and examined how depressive symptoms affected these relationships. Results-Nearly half (42.9%) of participants reported having current suicidal ideation. We found no relationship to positive symptoms. However, severity and intensity of suicidal ideation was found to be related to negative symptoms and level of functioning. When controlling for depressive symptoms during exploratory analysis, this relationship still emerged. Conclusions-This study adds to the literature demonstrating the complex nature of suicidal ideation in psychotic illness. The C-SSRS has shown to be helpful in determining relationships
Suicidal Ideation in Patients with Schizophrenia
Objective: To evaluate the factors affecting suicidal ideas in patients with schizophrenia in terms of some socio-demographic and clinical properties. Method: The sample of the study consisted of 120 patients with schizophrenia selected from among patients receiving treatment at Trabzon Atakoy Psychiatry Hospital. All patients were evaluated using a Socio-demographic Data Collection Form, Reasons for Living Inventory (RLI), Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndromes Scale (PANSS), and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Results: Of the patients, 31.6% had suicide ideation. Negative symptoms are found to be significantly higher. The group with suicidal ideation had fewer reasons for living than the group without. Conclusion: Evaluations of the history of suicide attempts, depression and hopelessness in patients with schizophrenia are thought to be important in the prevention of suicidal behavior in these patients.
Suicidal ideation in inpatients with acute schizophrenia
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2004
Schizophrenia has been associated with a high rate of suicide. This study investigates the prevalence of suicidal ideation in a population of inpatients with acute schizophrenia, together with the clinical parameters associated with suicidal thoughts. We assessed 93 schizophrenia patients. We matched subjects for age and sex and compared subjects with and without suicidal thoughts. We performed stepwise multiple regression analysis to assess the association between specific clinical symptoms and suicidal ideation. Of the patients, 20.4% reported suicidal thoughts during the last 15 days. Severity of depressive symptoms, motor retardation, guilt feelings, pathological guilt, and self-depreciation predicted the patients' suicidal ideation. Suicidal thoughts are frequent among inpatients with acute schizophrenia. Prevention of suicidal behaviour should include helping patients improve their self-esteem and reducing depression and guilt feelings.
An 18-month longitudinal study of suicidality in patients diagnosed with schizophrenia
Schizophrenia Research, 2020
Background: Suicide kills over 30,000 people annually in the US. Schizophrenia increases the risk, even in psychiatric populations. Identifying high-risk groups within this patient population is central to suicide prevention. We tested the effects of known and putative risk factors for suicide in a clinically recognizable population with symptoms of schizophrenia and unstable illness. Methods: We studied 1439 subjects with schizophrenia participating in the NIMH-funded Clinical Antipsychotic Treatment for Intervention Effectiveness (CATIE) trial and followed for 18 months. The dependent variable was moderate to severe self-reported suicidal thinking and self-reported suicide attempts. The independent variables comprised potential risk factors for suicidality including measures of clinical change during follow-up. Proportional hazards models of time to first suicidality generated bivariate and multivariate hazard ratios (HRs). Results: Altogether 96 patients (7.6%) experienced moderate to severe suicidality in the course of 18 months. Multivariate analyses showed that baseline moderate or severe suicidality was the strongest correlate of subsequent moderate or severe suicidality (HR 5.1). An increase in a subject's depression score during follow-up was also independently and strongly associated with suicidality (HR 3.5). A change in psychotic symptoms was not. Conclusions: Depression and despair may be more important risk factors for suicidality among people with schizophrenia than psychotic decompensation. Strategies for prevention that seek to identify groups at high risk of suicide should focus on these variables, as well as the effect of prior suicidality.
Suicidal Ideation and Suicide Attempts in Recent-Onset Schizophrenia
Schizophrenia Bulletin, 1998
The objective of this study was to predict suicidality in people with schizophrenia. Ninety-six patients with recent-onset schizophrenia were rated every 2 weeks for 1 year to examine (1) the temporal course of suicidal ideation and suicide attempts and (2) the extent to which anxiety, depression, and mild suicidal ideation were followed by significant suicidal ideation or a suicide attempt. The severity of suicidality changed rapidly. Low levels of suicidal ideation increased the risk for significant suicidal ideation or a suicide attempt during the subsequent 3 months. Depression was moderately correlated with concurrent suicidality, but not independently associated with future suicidality. Therefore, low levels of suicidal ideation may predict future suicidal ideation or behavior better than depressed mood in individuals with schizophrenia.
Psychiatric Services, 2018
Objective-People with psychotic disorders are at high risk for suicidal behavior. We evaluated whether response to item 9 of the Patient Health Questionnaire or PHQ9 (regarding thoughts of death or self-harm) predicts subsequent suicidal behavior in outpatients with diagnoses of psychotic disorders. Methods-Electronic health records from seven large integrated health systems were used to identify all outpatient visits by adults with a diagnosis of schizophrenia-spectrum psychosis or unspecified psychosis between 1/1/2009 and 6/30/2015 during which a PHQ9 depression questionnaire was completed (n=32,982 visits by 5947 patients). Suicide attempts over the 90 days following each visit were ascertained from EHRs and insurance claims. Suicide deaths were ascertained by linkage to state death certificate files. Results-Risk of suicide attempt within 90 days of an outpatient visit increased from 0.8% among those reporting thoughts of death or self-harm "not at all" to 3.5% among those reporting such thoughts "nearly every day". Over 90 days of follow-up, 47% of suicide attempts occurred among those reporting any recent thoughts of death or self-harm at the sampled visit. 59% of suicide attempts occurred among those reporting thoughts of death or self-harm at the index visit or any visit in the prior year. The number of suicide deaths within 90 days (n=10) was too small to accurately assess the relationship between response to PHQ9 item 9 and subsequent suicide death.
Suicidal Behavior in Patients With Schizophrenia and Other Psychotic Disorders
American Journal of Psychiatry, 1999
Objective: Patients with schizophrenia are known to be at high risk for suicide attempts and dying by suicide. However, little research has been conducted to determine whether the risk for suicidal behavior is elevated among patients with psychosis in general. Method: This study evaluated 1-month and lifetime rates of suicidal behavior among 1,048 consecutively admitted psychiatric inpatients (ages 18 to 55 years) with DSM-III-R psychotic disorders. Demographic, clinical, and diagnostic correlates of suicidal behavior were examined. Results: A high rate of suicidal behavior was found in the group: 30.2% reported a lifetime history of suicide attempts, and 7.2% reported a suicide attempt in the month before admission. The highest 1-month and lifetime rates were found in patients with schizoaffective disorder and major depression with psychotic features. Ratings of the medical dangerousness of the most recent suicide attempt on the basis of the extent of physical injury were higher in patients with schizophrenia spectrum psychoses. Agreement was high between emergency room assessments and semistructured interview assessments of suicidal behavior. Conclusions: Rates of suicidal behavior were high across a broad spectrum of patients with psychotic disorders; patients with a history of a current or past major depressive episode (as a part of major depressive disorder or schizoaffective disorder) were at a greater risk for suicide attempts, but patients with schizophrenia, on average, made more medically dangerous attempts. Risk factors for suicidal behavior in patients with psychosis appear to vary compared to those for the general population.