Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case–control study

BMJ Open - Tập 6 Số 9 - Trang e011929 - 2016
Javier-David López-Moríñigo1, Rosa Ayesa‐Arriola1,2, Beatriz Torres-Romano3, Andrea Fernandes1, Hitesh Shetty1, Matthew Broadbent1, Maria-Encarnacion Dominguez-Ballesteros4, Robert Stewart1, Anthony S. David1, Rina Dutta1
1King’s College London, Institute of Psychiatry, Psychology and Neuroscience
2Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria
3Virgen de Valme University Hospital
4Virgen de la Macarena University Hospital

Tóm tắt

ObjectivesTo investigate the role of risk assessment in predicting suicide in patients with schizophrenia spectrum disorders (SSDs) receiving secondary mental healthcare. We postulated that risk assessment plays a limited role in predicting suicide in these patients.DesignRetrospective case–control study.SettingAnonymised electronic mental health record data from the South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM) (London, UK) linked with national mortality data.ParticipantsIn 242 227 SLaM service users up to 31 December 2013, 635 suicides were identified. 96 (15.1%) had a SSD diagnosis. Those who died before 1 January 2007 (n=25) were removed from the analyses. Thus, 71 participants with SSD who died from suicide over the study period (cases) were compared with 355 controls.Main outcome measureRisk of suicide in relation to risk assessment ratings.ResultsCases were younger at first contact with services (mean±SD 34.5±12.6 vs 39.2±15.2) and with a higher preponderance of males (OR=2.07, 95% CI 1.18 to 3.65, p=0.01) than controls. Also, suicide occurred within 10 days after last contact with services in half of cases, with the most common suicide methods being hanging (14) and jumping (13). Cases were more likely to have the following ‘risk assessment’ items previously recorded: suicidal history (OR=4.42, 95% CI 2.01 to 9.65, p<0.001), use of violent method (OR=3.37, 95% CI 1.47 to 7.74, p=0.01), suicidal ideation (OR=3.57, 95% CI 1.40 to 9.07, p=0.01) and recent hospital discharge (OR=2.71, 95% CI 1.17 to 6.28, p=0.04). Multiple regression models predicted only 21.5% of the suicide outcome variance.ConclusionsPredicting suicide in schizophrenia is highly challenging due to the high prevalence of risk factors within this diagnostic group irrespective of outcome, including suicide. Nevertheless, older age at first contact with mental health services and lack of suicidal history and suicidal ideation are useful protective markers indicative of those less likely to end their own lives.

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BMJ Open

Tập 6 Số 9

e011929

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