Factors linked to self-harm in schizophrenia identified

By Mark Cowen, Senior medwireNews Reporter

Polysubstance abuse and a high premorbid IQ are significantly associated with self-harm in patients with schizophrenia, UK researchers report.

The team also found that depression was associated with a significantly increased risk for future self-harm in patients with the mental health disorder.

As previous studies have shown that self-harm is associated with an increased risk for suicide in schizophrenia patients, "clinicians treating individuals with schizophrenia should be aware of the signs that are significantly associated with risk of self-harm," say G Pluck (University of Sheffield) and team.

The findings come from a study of 87 patients (78 men) with schizophrenia who had a mean duration of illness of 16.9 years, and who were followed up for 3 months.

All of the participants underwent a variety of tests to assess for depression, disease insight, impulsiveness, hopelessness, symptom severity, premorbid IQ, and cognitive ability.

In total, 59 (68%) patients had a history of self-harm (including attempted suicide), as assessed using the Deliberate Self-harm Inventory and self report.

The team found that patients with a history of self-harm were more likely than those without to be depressed (46 vs 11%) and report a family history of self-harm (36 vs 11%) at baseline.

Patients with a self-harm history also had higher levels of hopelessness, polysubstance abuse, and trait impulsivity, and had a significantly higher estimated premorbid IQ (99.5 vs 90.0) than those without such a history.

Logistic regression analyses revealed that current depression, estimated premorbid IQ, and lifetime polysubstance abuse were significantly associated with previous self-harm at baseline.

Over the follow-up period, five participants engaged in self-harm. The only significant predictor for self-harm during follow up was the presence of depression at baseline.

Pluck and team conclude in European Psychiatry: "This study indicates the clinical importance of three factors identified as being independently linked to self-harm: lifetime polysubstance abuse, high premorbid IQ, and current depression."

They add: "It would be advisable therefore that those professionals who assess risk and treat patients with schizophrenia concentrate on the factors that we have identified, in particular the mood state of patients."

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