Suicidal behavior in patients with schizophrenia (narrative review)
https://doi.org/10.31363/2313-7053-2025-4-2-1137
Abstract
The article is a narrative review of the literature that comprehensively examines the problem of suicidal behavior in patients with schizophrenia. This article describes the risk factors, methods of prevention and treatment of suicidal behavior in patients with schizophrenia. Suicide is one of the leading causes of premature death among patients with schizophrenia, significantly reducing the average life expectancy in this category of patients. The risk of suicide in schizophrenia is significantly higher than in the general population. The highest risk of suicidal behavior occurs in the first years after the onset of the disease, but it persists throughout life. The key factors of suicide risk are male gender, young age, depression, substance abuse, somatic comorbid pathology and social isolation, etc. Adequate assessment of suicide risk requires careful verification of risk factors. Modern approaches to this problem are focused on a comprehensive assessment of risk factors, using a personalized approach that takes into account subjectively significant aspects for the patient. The main goals of therapy include identifying patients at risk, reducing modifiable factors, and preventing events that increase suicidality with active use of protective factors. The high prevalence of suicidal behavior among this group of patients makes the problem relevant for clinical practice and the health care system. Psychosocial interventions play an important role, including measures to increase adherence to therapy, psychoeducational programs for patients, staff, and relatives of patients, as well as family therapy. For effective treatment and prevention of this group of patients, a comprehensive approach is needed, including psychosocial interventions and the use of modern drug methods.
About the Authors
A. O. Munin
Psychiatric Clinical Hospital 4 named after P.B. Gannushkin; Mental Health Research Center
Russian Federation
Russian Federation
Andrei O. Munin
Moscow
S. A. Golubev
Psychiatric Clinical Hospital 4 named after P.B. Gannushkin; Mental Health Research Center
Russian Federation
Russian Federation
Sergey A. Golubev
Moscow
References
1. Ajrapetyan A.A., Burak E.S., Umarov A.H., Kolesnikova Yu.A. Samoubijstvo pri shizofrenii. Nauchnye issledovaniya vysshej shkoly: Sbornik statej VII Mezhdunarodnoj nauchno-prakticheskoj konferencii, Penza, 27 yanvarya 2022 goda. – Penza: Nauka i Prosveshchenie, 2022. (In Russ.).
2. Ambrumova A.G., Tihonenko V.A. Diagnostika suicidal'nogo povedeniya: Metodicheskie rekomendacii. – M., 1980. (In Russ.).
3. Lyubov EB. Risk factors of suicidal behavior in patients with schizophrenia. Rossiyskiy Psikhiatricheskiy Zhurnal. 2018;4:24-30. (In Russ.). http://dx.doi.org/10.24411/1560-957X-2018-1%25x
4. Mosolov SN. Diagnosis and therapy of depression in schizophrenia. Consortium Psychiatricum. 2020;1(2):29-42. (In Russ.). https://doi.org/10.17650/2712-7672-2020-1-2-29-42.
5. Petrova NN. Risk factors and prevention of suicide in schizophrenia: focus on the role of modern long-acting injectable antipsychotics. Sovremennaya Terapiya Psikhicheskikh Rasstroystv. 2021;3:31-37. (In Russ.). https://doi.org/10.21265/PSYPH.2021.15.71.003
6. Polozhy BS. Integrative model of suicidal behavior. Rossiyskiy Psikhiatricheskiy Zhurnal. 2010;4:55-62. (In Russ.).
7. Simak OYa. The problem of suicide in schizophrenia: the family of the patient is in focus (literature review). Suitsidologiya. 2018;9(4):17-28. (In Russ.). https://doi.org/10.32878/suiciderus.18-09-04(33)-17-28
8. Altamura AC, Bassetti R, Bignotti S, et al. Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res. 2003;60:47–55. https://doi.org/10.1016/s0920-9964(02)00164-0.
9. Berardelli I, Rogante E, Sarubbi S, Erbuto D, Lester D, Pompili M. The Importance of Suicide Risk Formulation in Schizophrenia. Front. Psychiatry. 2021;12:779684. https://doi.org/10.3389/fpsyt.2021.779684
10. Bornheimer LA, Zhang A, Li J, Hiller M, Tarrier N. Effectiveness of Suicide-Focused Psychosocial Interventions in Psychosis: A Systematic Review and Meta-Analysis. Psychiatr Serv. 2020;71(8):829-838. https://doi.org/10.1176/appi.ps.201900487
11. Cipriani A, Pretty H, Hawton K, et al. Lithium in the prevention of suicidal behaviour and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry. 2005;162:1805–1819. https://doi.org/10.1176/appi.ajp.162.10.1805.
12. Correll CU, Solmi M, Croatto G, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J. Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry. 2022;21:248-271. https://doi.org/10.1002/wps.20994
13. De Berardis D, Rapini G, Olivieri L, et al. Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine. Ther Adv Drug Saf. 2018;9(5):237-256. https://doi.org/10.1177/2042098618756261
14. Demir S. The relationship between expressed emotion and the probability of suicide among Turkish psychiatric outpatients: A descriptive cross-sectional survey. Fam. Community Health. 2018;41:111–116. https://doi.org/10.1097/FCH.0000000000000178.
15. Díaz-Fernández S, Frías-Ortiz DF, Fernández-Miranda JJ. Suicide attempts in people with schizophrenia before and after participating in an intensive case managed community program: A 20-year follow-up. Psychiatry Res. 2020;287:112479. https://doi.org/10.1016/j.psychres.2019.112479
16. Gentile A, Bonfitto I, Stella E, Mari M, Steardo L, Bellomo A, Ventriglio A. Cуицидальное поведение в дебюте шизофрении. Суицидология. 2017;8-2(27):20-27. (In Russ.).
17. Guo X, Zhai J, Liu Z, et al. Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Arch Gen Psychiatry. 2010;67(9):895-904. https://doi.org/10.1001/archgenpsychiatry.2010.105
18. Gut-Fayand A, Dervaux A, Olie JP, et al. Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity. Psychiatry Res. 2001;102:65–72. https://doi.org/10.1016/s0165-1781(01)00250-5.
19. Hodé Y, Dubreucq J, Valladier E, et al. Prévention du risque suicidaire dans la schizophrénie : importance de la psychoéducation des familles. Encephale. 2020;46(6):450-454. https://doi.org/10.1016/j.encep.2020.02.002
20. Hor K, Taylor M. Suicide and schizophrenia: A systematic review of rates and risk factors. J. Psychopharmacol. 2010;24:81–90.
21. Kasckow J, Felmet K, Zisook S. Managing suicide risk in patients with schizophrenia. CNS Drugs. 2011;25(2):129-43. https://doi.org/10.2165/11586450-000000000-00000
22. Leucht S, Kissling W, McGrath J. Lithium for schizophrenia. Cochrane Database Syst Rev. 2007;(3):CD003834. https://doi.org/10.1002/14651858.CD003834.pub2.
23. Masdrakis VG, Baldwin DS. Prevention of suicide by clozapine in mental disorders: systematic review. Eur Neuropsychopharmacol. 2023;69:4-23. https://doi.org/10.1016/j.euroneuro.2022.12.011
24. Meltzer H. Suicide in schizophrenia: clozapine, the adoption of evidence-based medicine [commentary]. J Clin Psychiatry. 2005;66:4. https://doi.org/10.4088/jcp.v66n0417.
25. Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003;60(1):82–91. https://doi.org/10.1001/archpsyc.60.1.82.
26. Napa W, Tungpunkom P, Pothimas N. Effectiveness of family interventions on psychological distress and expressed emotion in family members of individuals diagnosed with first-episode psychosis: A systematic review. JBI Database Syst. Rev. Implement. Rep. 2017;15:1057–1079. https://doi.org/10.11124/JBISRIR-2017-003361.
27. Onwumere J, Bebbington P, Kuipers E. Family interventions in early psychosis: Specificity and effectiveness. Epidemiol. Psychiatr. Sci. 2011;20:113–119. https://doi.org/10.1017/S2045796011000187.
28. Palmer DD, Henter ID, Wyatt RJ. Do antipsychotic medications decrease the risk of suicide in patients with schizophrenia? J Clin Psychiatry. 1999;60,Suppl.2:100–103;discussion 111–6.
29. Peritogiannis V, Ninou A, Samakouri M. Mortality in Schizophrenia Spectrum Disorders: Recent Advances in Understanding and Management. Healthcare (Basel). 2022;10(12):2366. https://doi.org/10.3390/healthcare10122366
30. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. 2010;(12):CD000088. https://doi.org/10.1002/14651858.CD000088.pub2
31. Pisani AR, Murrie DC, Silverman MM. Reformulating Suicide Risk Formulation: From Prediction to Prevention. Acad Psychiatry. 2016 Aug;40(4):623-9. https://doi.org/10.1007/s40596-015-0434-6
32. Pompili M, Amador XF, Girardi P, et al. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry. 2007;6:10. https://doi.org/10.1186/1744-859X-6-10
33. Pompili M, Orsolini L, Lamis D.A, Goldsmith DR, Nardella A, Falcone G, Corigliano V, Luciano M, Fiorillo A. Suicide prevention in schizophrenia: Do long-acting injectable antipsychotics (LAIs) have a role? CNS Neurol. Disord. Drug Targets. 2017;16:454–462. https://doi.org/10.2174/1871527316666170223163629.
34. Pompili M., Tatarelli C., Kotzalidis G.D., Tatarelli R. Suicide risk in substance abusers with schizophrenia. In R. Tatarelli, M. Pompili, P. Girardi (Eds.). Suicide in schizophrenia. - Nova Biomedical Books, 2007.
35. Sands JR, Harrow M. Depression During the Longitudinal Course of Schizophrenia. Schizophrenia Bulletin. 1999;25(1):157–72.
36. Schenkel LS, Spaulding WD, DiLillo D, Silverstein SM. Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophr Res. 2005;76(2-3):273-86. https://doi.org/10.1016/j.schres.2005.03.003.
37. Schooler NR. Relapse prevention and recovery in the treatment of schizophrenia. J Clin Psychiatry. 2006;67,Suppl.5:19–23.
38. Sher L, Kahn RS. Suicide in Schizophrenia: An Educational Overview. Medicina (Kaunas). 2019;55(7):361. https://doi.org/10.3390/medicina55070361
39. Tandon R, Jibson MD. Suicidal behavior in schizophrenia: diagnosis, neurobiology, and treatment implications. Curr Opin Psychiatry. 2003;16:193–197.
40. Ventriglio A, Ricci F, Magnifico G, et al. Psychosocial interventions in schizophrenia: Focus on guidelines. Int J Soc Psychiatry. 2020;66(8):735-747. https://doi.org/10.1177/0020764020934827
41. Yiu HW, Rowe S, Wood L. A systematic review and meta-analysis of psychosocial interventions aiming to reduce risks of suicide and self-harm in psychiatric inpatients. Psychiatry Res. 2021;305:114175. https://doi.org/10.1016/j.psychres.2021.114175
Review
For citations:
Munin A.O., Golubev S.A. Suicidal behavior in patients with schizophrenia (narrative review). V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY. (In Russ.) https://doi.org/10.31363/2313-7053-2025-4-2-1137
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