Hallucinations and/or delusions appear to be a common factor prompting patients with schizophrenia to attempt suicide, say researchers.
Hallucinations and/or delusions were the underlying suicide motive for 70.7% of the 65 schizophrenia patients in the study, who attempted suicide between 2002 and 2013.
By contrast, this was a factor for just 8.5% of 95 patients with mood disorders, among whom personal relationship difficulties and pain of illness were more common factors, at 29.8% and 22.3%, respectively.
The schizophrenia patients used more immediately lethal methods than the mood disorders group, with 40.0% and 15.4% jumping from a height or in front of a fast-moving train or car, respectively, compared with 10.6% and 1.1%. Mood disorder patients were more likely to resort to cutting/stabbing or medication overdose.
On multivariate analysis, only motive was associated with the seriousness of the attempt; specifically, patients with hallucinations/delusions were 3.46-fold more likely to use a high-lethality method than a less lethal method, eg, jumping from more than 10 metres up rather than from a lower height.
Despite the more serious methods used, schizophrenia patients were less likely than those with mood disorders to have been drinking alcohol at the time of suicide (10.8 vs 23.4%) and none of them left a suicide note, compared with 8.5% of the patients with mood disorders.
“This result suggests that suicide in schizophrenic patients may tend to be impulsive rather than planned even if they do not use alcohol at the time of the attempt”, say study author Wataru Ukai and colleagues from Sapporo Medical University in Japan.
The schizophrenia patients more often had previous or current psychiatric treatment than the mood disorder patients and were more likely to have experienced an interruption to their treatment lasting 3 months or more. They were also younger at the time of the suicide attempt, at 39.2 versus 49.8 years.
“Therefore, psychiatrists and other medical staff should keep in mind that in patients with schizophrenia, anti-suicidal measures must be taken earlier than in patients with mood disorders”, the team writes in PLoS One. “Particularly, managing the symptom of hallucination and delusion is very important to reduce the suicide risk.”
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