Life satisfaction and suicidal attempts among persons with schizophrenia (original) (raw)
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International Journal of Geriatric Psychiatry, 2007
Background-Suicidality is a health concern in patients with schizophrenia. We examined the hypotheses: (1) Middle aged and older patients with schizophrenia, depressive symptoms and suicidality would exhibit worse quality of life and worse everyday functioning, social skills and medication management relative to those without suicidality; (2) higher levels of suicidality would be significantly associated with worse functioning, worse quality of life and older age. Methods-We examined 146 outpatients with schizophrenia and depression. Patients were at least 40 years old and were diagnosed with schizophrenia or schizoaffective disorder and had two or more depressive symptoms based on DSM-IV criteria for major depression. We assessed suicidality with the Intersept Suicide Scale (ISS) and functioning with the UCSD Performancebased Skills Assessment (UPSA), Social Skills Performance Assessment (SSPA), and Medication Management Ability Assessment (MMAA). Quality of life was assessed with the Heinrichs Quality of Life Scale (QLS). Results-The mean age of patients was 52.4 ± 6.9 years. Subjects with suicidality (ISS scores > 0) had lower QLS scores compared to those without suicidality. However, there were no differences in UPSA, SSPA nor MMAA scores between the two groups. In addition, based on Spearman's rho correlational analysis, there were significant associations of QLS scores with ISS scores (r = −0.236) and with MMAA "total errors" scores (r = 0.174). Logistic regression demonstrated that only QLS scores predicted suicidality. Conclusion-Thirty-six percent of our sample had at least mild degrees of suicidality. Lower quality of life appears to be an important predictor of suicidality.
Completed suicide in schizophrenia: Evidence from a case-control study
Psychiatry Research, 2009
Suicide is the single major cause of death among patients with schizophrenia. Despite great efforts in the prevention of such deaths, suicide rates have remained alarming, pointing to the need for a better understanding of the phenomenon. The present sample comprised 20 male patients with schizophrenia who committed suicide and who were investigated retrospectively for a large number of characteristics. Controls were 20 living patients with schizophrenia. The results suggest that suicide attempts, hopelessness and self-devaluation were the three variables most strongly associated with completed suicide. However, a number of variables were identified which may constitute risk factors, some of which have not been identified in the past: agitation and motor restlessness (OR = 3.66; 95%CI = 0.95/14.02), self-devaluation (OR = 28.49; 95%CI = 3.15/257.40), hopelessness (OR = 51.00; 95% CI = 7.56-343.72), insomnia (OR = 12.66; 95%CI = 0.95/14.02), mental disintegration (OR = 3.66; 95%CI = 0.95/14.02), and suicide attempt (OR = 3.66; 95%CI = 1.40/114.41). Poor adherence to medications was also predictive of completed suicide in our sample of schizophrenia patients, primarily because the suicide victims showed very low adherence.
Quality of Life Research, 2005
We sought to identify a core subset of Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) items that maintains the validity and psychometric properties of the basic version. A parsimonious subset of items from the Q-LES-Q that can accurately predict the basic Q-LES-Q domain mean scores was sought and evaluated in 339 inpatients meeting DSM-IV criteria for schizophrenia, schizoaffective, and mood disorders. Three additional data sets were used for validation. Assessments included Q-LES-Q, Quality of Life Scale, Lancashire Quality of Life Profile, rating scales for psychopathology, medication side effects, and self-reported emotional distress, self-esteem, self-efficacy, and social support. We found that 18-items predicted basic Q-LES-Q domains (physical health, subjective feelings, leisure time activities, social relationships) and general index scores with high accuracy. Q-LES-Q-18 showed high reliability, validity, and stability of test-retest ratings. Thus, Q-LES-Q-18, a brief, self-administered questionnaire may aid in monitoring quality of life outcomes of schizophrenia, schizoaffective, and mood disorder patients.
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.
Acta Psychiatrica Scandinavica, 2007
Self-reported life satisfaction and treatment factors in patients with schizophrenia, major depression and anxiety disorder Koivumaa-I-tonkancn HT, tionkanen R, Antikainen R , Hintikka J , Viinamaki H. Self-reported life satisfaction and treatment factors in patients w i t h sch izo p h rcn i a , in aj o I' dc pressi o n and ;I 11 xi e t y d i soid er . Acta Psychiatr Scand 1999: YY: 377-384. ( Munksgaard 1999. Our aim was to study the associations between life satisfaction and treatment factors and how depression affects schizophrenia (n =403), major dep (n = 139) from a defined area. Treatment satisfaction and compliance were high, but life satisfaction was low regardless o f diagnostic group. Patients with schizophrenia recorded better life satisfaction than patients with the other disorders. There were few independent associations between life satisfaction and treatment factors. Fortunately, factors amenable to treatment intervention, such as depression, problem-solving ability and social support. were independently related to life satisfaction in every diagnostic group. Dcprcssion decreased thesc associations significantly only in patients with schizophrenia. Life satisfaction and treatment satisfaction should be included as separate variables in treatment outcome studies. associations among patients with n ( n =349) and anxiety disorder
Assessment of suicide in schizophrenia: Development of the interview for suicide in schizophrenia
Cognitive and Behavioral Practice, 1998
Persons diagnosed with schlzophrema are at increased risk for suicide and selfharmful behavior. It is currently estimated that between 20% and 40% of individuals diagnosed with schizophrenia will attempt suicide during their lifetime Despite the prevalence of suicide m this population, no research to date has focused on the development of standardized methods for assessing suicide vulnerability an this high-risk population This amcle describes the development of the Interview for Suicide in Schizophrenia (ISIS), a semlstructured interview for the assessment of suicide in indwlduals diagnosed with schizophrenia. Preliminary data describing the instrument's psychometric properties are presented. Transcripts from an administration of the ISIS are then presented to illustrate the administration of this interview. Appendix A includes a copy of the ISIS-Lifetime. Persons diagnosed with schizophrenic illness have been identified as being at increased risk for suicide. The incidence of suicide for these patients has remained relatively stable over the last 20 years, despite dramatic improvements in the pharmacological treatment and psychosocial management. Between 20 % to 40% of schizophrenic patients will attempt suicide during their lifetime, and approximately 3,800 die each year because of the attempt (Haas, 1997; Mehzer & Okayli, 1995). At present, suicide is the leading cause of premature death in this populauon (Caldwell & Gottesman, 1990; Haas).
The Journal of Clinical Psychiatry, 2014
Objective: To characterize subgroups of subjects with schizophrenia from the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC) trial who either completed or attempted suicide and those who did not. Method: The ZODIAC, conducted between February 2002 and March 2007, was an open-label, randomized, large simple trial of patients with schizophrenia (N = 18,154) followed up for 1 year by unblinded investigators providing usual care in 18 countries; the primary outcome measure was nonsuicide mortality. Every report on a completed or attempted suicide was independently adjudicated using a predefined algorithm. Primary analysis for the current report examined the association between completed or attempted suicides and the baseline variables using descriptive statistics and multivariate logistic regression models. Usage of "hard" or "soft" methods for attempted or completed suicide and distribution of suicide-related events by geographical region were also summarized. Results: Overall incidences of subjects who either completed (35/18,154) or attempted (108/18,154) suicide were low, as were rates per person-time on assigned treatment analysis (0.24 for completed and 0.74 for attempted suicides per 100 person-years of exposure). The highest suicide-related mortality was seen among subjects recently diagnosed with schizophrenia. Among all potential baseline risk factors for completed suicide examined, the variables most associated with completed suicide were history of suicide attempts (OR = 2.6; 95% CI, 1.33-5.12) and usage of antidepressant medication (OR = 3.5; 95% CI, 0.84-14.85). History of > 5 hospitalizations in the past (OR = 2.1; 95% CI, 1.35-3.31) and history of suicide attempts (OR = 5.0; 95% CI, 3.21-7.76) were the variables most associated with attempted suicide among potential baseline risk factors for suicide attempts. Conclusions: Our results, obtained in a large prospective randomized study, confirm current clinical understanding regarding completed or attempted suicide in schizophrenia and the associated risk factors.
2013
Background: To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. Methods: Using a cross-sectional design, 251 patients (18-61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm. Results: Suicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only. Conclusions: Patients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay.