Schizophrenia And Suicide Prevention

Introduction

Suicide is a critical public health concern affecting communities, families, and societies. It has been estimated by the World Health Organization (WHO) that each year around one million people die from suicide. Suicide risk is significantly increased by mood and psychotic disorders, such as schizophrenia.²

Schizophrenia is a complex mental health disorder, characterized by a range of symptoms including delusional beliefs, hallucinations, emotional flatness,disordered thinking, behaviour, and perception.³ The life expectancy of people with schizophrenia dramatically decreases due to suicide.⁴ Studies have demonstrated that around 4-13% of individuals with schizophrenia die from suicide.⁵ Therefore, preventing suicide is a chief aspect of schizophrenia management and treatment. In this article, you will learn about the risk factors, warning signs, and prevention strategies for suicide in schizophrenia patients.

Risk factors for suicide in schizophrenia

Multiple factors increase the risk of suicide in individuals with schizophrenia, including: 

• History of suicide attempts:An important risk factor for suicide in schizophrenia is a history of previous suicide attempts. It has been suggested that almost 50% of people with schizophrenia have carried out at least one suicide attempt in their lifetime.^6,7 Suicide attempts among individuals with schizophrenia are severe and require medical attention. The majority of people who die by suicide have carried out previous suicide attempts⁵
• Social isolation: Social isolation can increase the risk of suicide in individuals with schizophrenia. Social support is critical. The symptoms of schizophrenia can be exacerbated leading to depression and hopelessness when the person finds themselves socially isolated^5,8
• Substance abuse: Substance abuse is often observed in people with schizophrenia and increases the risk of suicide. Substance abuse generally increases the risk of suicide compared to non-users and substance abuse is often comorbid with schizophrenia⁹
• Poor treatment adherence: Studies have revealed that adherence to medications can help reduce the risk of suicide in patients with schizophrenia. Therefore, failure to adhere to the treatment provided can be seen as a risk factor for suicide¹⁰
• Hopelessness: In schizophrenia patients, high levels of feelings of hopelessness have been observed. These feelings can be used as a predictor of worse outcomes.¹¹ Awareness of the illness often leads to feelings of hopelessness. Hopelessness has been found a statistically significant factor in increasing the risk of suicide in patients with schizophrenia.^12,13 Additionally, after hospital discharge, individuals with schizophrenia experience feelings of hopelessness by losing their supportsystem. Great caution is required during this period of discharge⁵
• Depression: Depression is a major risk factor for suicide and is frequently present in individuals with schizophrenia. Depressive episodes during the lifetime of a patient with schizophrenia have been associated with an increased risk of suicide.^14,15 In fact, a study found that the majority of people that have attempted suicide had suffered major depressive episodes during the course of their illness¹⁶

Warning signs of suicide in schizophrenia

It is important to look out for the presence of new behaviors in an individual with schizophrenia. Most people that are planning to attempt suicide, exhibit at least one warning sign through communication or actions.¹⁷ Some of these warning signs include:

• Talking about suicide:When an individual with schizophrenia talks about feeling hopeless, being a burden to others, feeling trapped, having no reason to live, or even killing themselves that should be alarming and should be taken seriously. It is important to ask individuals with schizophrenia whether they have suicidal ideation
• Giving away prized possessions:The act of giving away valuable possessions could be a warning sign of suicide. This behavior may indicate that the person has decided to end their life and is preparing for it.Withdrawal from family and friends:Sudden isolation and withdrawal of an individual with schizophrenia from friends and family can be seen as at risk of suicide. Social isolation is a risk factor for suicide and withdrawing from social contact may increase the risk even more
• Sudden mood changes:Mood changes such as aggression, sleep behavior, depression, loss of interest, shame, relief, hopelessness, anxiety and fatigue are all signs of suicide in a person with schizophrenia
• Increased substance abuse:Increased use of drugs or alcohol is a risk factor of suicide in patients with schizophrenia and can be considered a warning sign for suicide
• Preoccupation with death: means spending time planning for suicide or looking for a way to end their life. This can be done by searching online. This is a clear warning sign for suicide

Prevention strategies

To support and prevern a person with schizophrenia from commiting suicide, a few strategies can be considered. These include:

• Early identification and treatment of schizophrenia: The risk of suicide can be reduced by early identifying the disorder. If an individual is diagnosed early on,  a better, personalized treatment plan can be put in place^18,19 Improved access to mental health care: Barriers to care such as inadequate resources and stigma can prevent the individual from accessing the care they need.^18,19Building supportive relationships: It is critical that patients with schizophrenia receive the support they need both fromthe healthcare system and their social communities. Trusting the people around them can reduce feelings of hopelessness and isolation overall reducing the risk of suicide^18,19
• Education and training for healthcare providers: Poor relationships between patients and healthcare providers can increase the risk of suicide. Therefore, it is critical to educate medical staff about how to interact with schizophrenia patients who are suicidal. The staff should be ready to deal with and take care of any issues that arise and know what to expect^18,19
• Encouraging a healthy lifestyle: Enhancing treatment adherence and encouraging a healthy lifestyle are great ways to prevent suicide in patients with schizophrenia. Besides following a balanced diet, a healthy lifestyle refers to limiting substance use, exercise, and treatment^18,19
• Support groups and peer support: Receiving the appropriate support can help prevent suicide and offer an overall supportive environment where individuals can safely share their thoughts and feelings^18,19
• Crisis intervention: In a moment of crisis, every individual should know where to go or whom to contact
• Importance of seeking immediate help: It is fundamental for the individual or a third person to immediately contact an emergency service during a moment of crisis. Research has revealed that prompt intervention can prevent suicide in individuals with schizophrenia⁵
• Crisis hotlines and helplines: Services such as hotlines and helplines have trained staff that can provide immediate support and assistance. Crisis lines in the UK include Samaritans, Shout, CALM, SANEline, Nightline, CALL, and many others²⁰
• Emergency services: During a suicidal crisis, the ambulance or police services can provide immediate intervention. In the UK, individuals in crisis can call 999²¹
• Inpatient psychiatric hospitalization: Hospitalization may be necessary for schizophrenia patients who have serious suicidal thoughts and behaviors. In the UK, once admitted to the hospital, healthcare providers will make the appropriate referrals so that you can receive the correct support²²

Summary

Schizophrenia is a serious mental health disorder that can affect a person’s life. Individuals with schizophrenia have an increased risk of suicide due to multiple risk factors such as previous attempts, substance abuse, social isolation, depression, and others. Warning signs of suicide in schizophrenia patients include sudden mood changes, talking and preoccupying oneself with death, and withdrawal from social support. It is important to identify the disorder early and get the appropriate treatment so that you can prevent suicide. In order to get immediate help to reduce the risk of suicide during a crisis, you can use hotlines, helplines, emergency services, or go to the hospital.