Suicide completion in secondary mental healthcare: a comparison study between schizophrenia spectrum disorders and all other diagnoses
Tóm tắt
Suicide completion is a tragic outcome in secondary mental healthcare. However, the extent to which demographic and clinical characteristics, suicide method and service use-related factors vary across psychiatric diagnoses remains poorly understood, particularly regarding differences between ‘schizophrenia spectrum disorders (SSD)’ and ‘all other diagnoses’, which may have implications for suicide prevention in high risk groups. 308 patients who died by suicide over 2007–2011 were identified from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register. Demographic, clinical, services use-related factors, ‘full risk assessment’ ratings and the Health of the Nation Outcome Scale (HONOS) scores were compared across psychiatric diagnoses. Specifically, differences between patients with and without SSD were investigated. Patients with SSD ended their lives at a younger age, were more frequently of Black ethnicity and had higher levels of social deprivation than other diagnoses. Also, these patients were more likely to have HONOS and ‘risk assessment’ completed. However, patients who had no SSD scored significantly higher on ‘self-injury’ and ‘depression’ HONOS items and they were more likely to have the following ‘risk assessment’ items: ‘suicidal ideation’, ‘hopelessness’, ‘feeling no control of life’, ‘impulsivity’ and ‘significant loss’. Of note, ‘disengagement’ was more common in patients with SSD, although they had been seen by the staff closer to the time of suicide than in all-other diagnoses. Whilst ‘hanging’ was the most common suicide method amongst patients with non-SSD, most service users with a SSD diagnosis used ‘jumping’ (from heights or in front of a vehicle). Suicide completion characteristics varied between SSD and other diagnoses in patients receiving secondary mental healthcare. In particular, although clinicians tend to more frequently recognize suicide risk as a focus of concern in patients who have SSD, who are therefore more likely to have a detailed risk assessment documented; ‘known’ suicide risk factors appear to be more relevant in patients with non-SSD. Hence, the classic suicide prevention model might be of little use for SSD.
Tài liệu tham khảo
Public Health Action for the prevention of suicide. 2013, WHO, Geneva
Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD: Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009, 374: 881-892.
Suicide Prevention. 2008, WHO, Geneva
Hawton K, van Heeringen K: Suicide. Lancet. 2009, 373: 1372-1381.
Bebbington PE, Minot S, Cooper C, Dennis M, Meltzer H, Jenkins R, Brugha T: Suicidal ideation, self-harm and attempted suicide: results from the British psychiatric morbidity survey 2000. Eur Psychiatry. 2010, 25: 427-431.
Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM: Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003, 33 (3): 395-405.
Hawton K, Harris L, Hall S, Smikin S, Bale E, Bond A: Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics. Psychol Med. 2003, 33 (6): 987-995.
Arsenault-Lapierre G, Kim C, Turecki G: Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry. 2004, 4: 37-
Kreitman N: The coal gas story. United Kingdom suicide rates 1960–71. Brit J Prev Soc Med. 1976, 30: 86-93.
Bennewith O, Nowers M, Gunnell D: Effect of barriers on the Clifton suspension bridge, England, on local patterns of suicide: implications for prevention. Br J Psychiatry. 2007, 190: 266-267.
Nielssen O, Glozier N, Babidge N, Reutens S, Andrews D, Gerard A, Malhi GS, Large MM: Suicide attempts by jumping and psychotic illness. Aust N Z J Psychiatry. 2010, 44: 568-573.
Brown S: Excess mortality of schizophrenia: A meta-analysis. Br J Psychiatry. 1997, 171: 502-508.
Saha S, Chant D, McGrath J: A systematic review of mortality in schizophrenia: Is the differential mortality gap worsening over time?. Arch Gen Psychiatry. 2007, 64 (10): 1123-1131.
Dutta R, Murray RM, Allardyce J, Jones PB, Boydell JE: Mortality in first-contact psychosis patients in the UK: a cohort study. Psychol Med. 2012, 42 (8): 1649-1661.
Palmer BA, Pankratz VS, Bostwick JM: The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005, 62 (3): 247-253.
Miles CP: Conditions predisposing to suicide. J Nerv Ment Dis. 1977, 164 (4): 231-246.
Caldwell CB, Gottesman II: Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophr Bull. 1990, 16 (4): 571-589.
Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ: Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry. 2005, 187: 9-20.
Bakst S, Rabinowitz J, Bromet EJ: Antecedents and patterns of suicide behavior in first-admission psychosis. Schizophr Bull. 2009, 36 (4): 880-889.
Pedersen CG, Jensen SO, Gradus J, Johnsen SP, Mainz J: Systematic suicide risk assessment for patients with schizophrenia: a national population-based study. Psychiatr Serv. 2014, 65 (2): 226-231.
The Management of Deliberate Self-Harm. 1984, HMSO, London
Wing J, Curtis R, Beevor A: ‘Health of the Nation’: measuring mental health outcomes. Psychiatric Bull. 1994, 18 (11): 690-691.
National Institute for Health and Clinical Excellence (NICE): Clinical guidance 16 self-harm. 2004, []., [http://www.nice.org.uk/Guidance/CG16]
Stewart R, Soremekun M, Pereira G, Broadbent M, Callard F, Denis M, Hotopf M, Thornicroft G, Lovestone S: The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry. 2009, 9: 51-
Office for National Statistics (ONS): Suicide statistics: deaths registered in England and Wales. [] Accessed 23 March 2012., [http://www.ons.gov.uk/ons/datasets-and-tables/index.html?pageSize=50&sortBy=none&sortDirection=none&newquery=suicide&content-type=Reference+table&content-type=Dataset]
Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. 1993, WHO, Geneva
Linsley KR, Schapira K, Kelly TP: Open verdict v. suicide – importance to research. Br J Psychiatry. 2001, 178: 465-468.
Office for National Statistics: Indices of deprivation 2007 for super output areas. []., [http://www.neighbourhood.statistics.gov.uk/dissemination/instanceSelection.do?JSAllowed=true&Function=&%24ph=60_61&CurrentPageId=61&step=2&datasetFamilyId=1893&instanceSelection=122838&Next.x=19&Next.y=17]
McGuffin P, Farmer A, Harvey I: A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Arch Gen Psychiatry. 1991, 48 (8): 764-770.
Rucker J, Newman S, Gray J, Gunasinghe C, Broadbent M, Brittain P, Baggaley M, Denis M, Turp J, Stewart R, Lovestone S, Schumann G, Farmer A, McGuffin P: OPCRIT+: an electronic system for psychiatric diagnosis and data collection in clinical and research settings. Br J Psychiatry. 2011, 199 (2): 151-155.
Morgan C, Charalambides M, Hutchinson G, Murray RM: Migration, ethnicity and psychosis: toward a sociodevelopmental model. Schizophr Bull. 2010, 36 (4): 655-664.
Bromet EJ, Naz B, Fochtmann LJ, Carlson GA, Tanenberg-Karant M: Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia. Schizophr Bull. 2005, 31 (3): 639-649.
Wu CY, Chang CK, Hayes M, Broadbent M, Hotopf M, Stewart R: Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register. Psychol Med. 2012, 42 (8): 1581-1590.
Fearon P, Kirkbride JB, Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J, Funq WL, Holloway J, Mallet R, Harrison G, Leff J, Jones PB, Murray RM: Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychol Med. 2006, 36 (11): 1541-1550.
Kirkbride JB, Boydell J, Ploubidis GB, Morgan C, Dazzan P, McKenzie K, Murray RM, Jones PB: Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychol Med. 2008, 38 (8): 1083-1094.
Aschan L, Goodwin L, Cross S, Moran P, Hotopf M, Hatch SL: Suicidal behaviour in South East London: Prevalence, risk factors and the role of socio-economic status. J Affect Disorders. 2013, 150 (2): 441-449.
Gara MA, Vega WA, Arndt S, Escamilla M, Fleck DE, Lawson WB, Lesser I, Neighbors HW, Wilson DR, Arnold LM, Strakowski SM: Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Arch Gen Psychiatry. 2012, 69 (6): 593-600.
McKenzie K: Suicide studies in ethnic minorities: improving the science to help develop policy. Ethn Health. 2012, 17 (1–2): 7-11.
McGirr A, Tousignant M, Routhier D, Pouliot L, Chawky N, Marolese HC, Turecki G: Risk factors for completed suicide in schizophrenia and other chronic psychotic disorders: A case–control study. Schizophr Res. 2006, 84: 132-143.
McGirr A, Turecki G: What is specific to suicide in schizophrenia disorder? Demographic, clinical and behavioural dimensions. Schizophr Res. 2008, 98: 217-224.
Law CK, Yip PSF, Chan WSC, Fu K-W, Wong PWC, Law YW: Evaluating the effectiveness of barrier installation for preventing railway suicides in Hong-Kong. J Affect Disorders. 2009, 114 (1–3): 254-262.
Cox GR, Owens C, Robinson J, Nicholas A, Lockley A, Williamson M, Cheung YT, Pirkis J: Interventions to reduce suicides at suicide hotspots: a systematic review. BMC Public Health. 2013, 13: 214-
Tarrier N, Haddock G, Lewis S, Drake R, Gregg L: Suicide behaviour over 18 months in recent onset schizophrenic patients: the effects of CBT. Schizophr Res. 2006, 83 (1): 15-27.
Mann JJ, Waternaux C, Haas GL, Malone KM: Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999, 156 (2): 181-189.
Dutta R, Murray RM, Allardyce J, Jones PB, Boydell JE: Early risk factors for suicide in an epidemiological first episode psychosis cohort. Schizophr Res. 2011, 126 (1–3): 11-19.
Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA: Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990, 147 (2): 190-195.
Drake RE, Cotton PG: Depression, hopelessness and suicide in chronic schizophrenia. Br J Psychiatry. 1986, 148: 554-559.
Hor K, Taylor M: Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010, 24 (4 Suppl): 81-90.
Amador XF, David AS: Insight and Psychosis. Awareness of Illness in Schizophrenia and Related Disorders. 2004, University Press, Oxford, England
Lopez-Morinigo JD, Ramos-Rios R, David AS, Dutta R: Insight in schizophrenia and risk of suicide: a systematic update. Compr Psychiatry. 2012, 53 (4): 313-322.
Alonso J, Codony M, Kovess V, Angermeyer MC, Katz SJ, Haro JM, De Girolamo G, De Graaf R, Demyttenaere K, Vilagut G, Almansa J, Lépine JP, Brugha TS: Population level of unmet need for mental healthcare in Europe. Br J Psychiatry. 2007, 190: 299-306.
Thornicroft G, Mansella M: The balanced care model: the case for both hospital- and community-based mental healthcare. Br J Psychiatry. 2013, 202 (4): 246-248.
Baca-Garcia E, Perez-Rodrigues MM, Diaz Sastre C, Saiz-Ruiz J, de Leon J: Suicidal behaviour in schizophrenia and depression: a comparison. Schizophr Res. 2005, 75: 77-81.