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Cited by 190Suicide and Self-Harm StudiesSchizophrenia research and treatmentPsychiatric care and mental health services

Reassessing the long-term risk of suicide after a first episode of psychosis

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Dutta, Rina, Murray, Robin M., Hotopf, Matthew, Allardyce, Judith, Jones, Peter B., Boydell, Jane·2010·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2010.157
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Abstract

CONTEXT: The long-term risk of suicide after a first episode of psychosis is unknown because previous studies often have been based on prevalence cohorts, been biased to more severely ill hospitalized patients, extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses. OBJECTIVE: To determine the epidemiology of suicide in a clinically representative cohort of patients experiencing their first episode of psychosis. DESIGN: Retrospective inception cohort. SETTING: Geographic catchment areas in London, England (between January 1, 1965, and December 31, 2004; n = 2056); Nottingham, England (between September 1, 1997, and August 31, 1999; n = 203); and Dumfries and Galloway, Scotland (between January 1, 1979, and December 31, 1998; n = 464). PARTICIPANTS: All 2723 patients who presented for the first time to secondary care services with psychosis in the 3 defined catchment areas were traced after a mean follow-up period of 11.5 years. MAIN OUTCOME MEASURE: Deaths by suicide and open verdicts according to the International Classification of Diseases (seventh through tenth editions). RESULTS: The case fatality from suicide was considerably lower than expected from previous studies (1.9% [53/2723]); the proportionate mortality was 11.9% (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with a median time to suicide of 5.6 years. Suicide occurred approximately 12 times more than expected from the general population of England and Wales (standardized mortality ratio, 11.65; 95% confidence interval, 8.73-15.24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation-a time when there may be less intense clinical monitoring of risk-suicide risk remained almost 4 times higher than in the general population (standardized mortality ratio, 3.92; 95% confidence interval, 2.22-6.89). CONCLUSIONS: The highest risk of suicide after a psychotic episode occurs soon after presentation, yet physicians should still be vigilant in assessing risk a decade or longer after first contact. The widely held view that 10% to 15% die of suicide is misleading because it refers to proportionate mortality, not lifetime risk. Nevertheless, there is a substantial increase in risk of suicide compared with the general population.

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  • Dutta et al. (2010) estimated a lifetime risk of suicide of 3.23% for patients 20 years after the first psychotic diagnosis.

    “Recently, Dutta et al. (2010) estimated a lifetime risk of suicide of 3.23% for patients 20 years after the first psychotic diagnosis.”

    From Excess early mortality in schizophrenia. (2014) · cites this paper as Dutta et al. 2010

    Table 4 reports a 3.23% cumulative suicide risk for the entire cohort at 20 years after the first psychotic episode. It does not establish 3.23% as a lifetime risk: the paper cautions about that term, and its Results report suicides after 20 years of follow-up. The study measures time from first presentation or episode, rather than first diagnosis. (LLM, conf=0.86)

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  • Unnatural-cause mortality rates remained high across the follow-up period.

    “unnatural-cause mortality rates remained high across the follow-up period”

    From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [40]

  • The reduced risk of unnatural-cause mortality observed in women compared with men is consistent with most earlier studies.

    “The reduced risk of unnatural-cause mortality that we observed in women compared with men is consistent with most earlier studies investigating this issue to date.40,52”

    From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [40]

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Cites

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2 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 10

  1. Miles CP. Conditions predisposing to suicide. J Nerv Ment Dis. 1977;164(4):231-246.
  2. Angst J, Angst F, Gerber-Werder R, Gamma A. Suicide in 406 mood-disorder patients with and without long-term medication. Arch Suicide Res. 2005;9 (3):279-300.
  3. Høyer EH, Olesen AV, Mortensen PB. Suicide risk in patients hospitalised because of an affective disorder. J Affect Disord. 2004;78(3):209-217.
  4. McGuffin P, Farmer A, Harvey I. A polydiagnostic application of operational criteria in studies of psychotic illness. Arch Gen Psychiatry. 1991;48(8):764-770.
  5. Castle DJ, Wessely S, Van Os J, Murray RM. Psychosis in the Inner City. Maudsley monographs No. 40. London, England: Psychology Press; 1998.
  6. Boydell J, Van Os J, Lambri M, Castle D, Allardyce J, McCreadie RG, Murray RM. Incidenceofschizophreniainsouth-eastLondonbetween1965and1997.BrJPsychiatry. 2003;182:45-49.
  7. Dutta R, Boydell J, Kennedy N, Van Os J, Fearon P, Murray RM. Suicide and other causes of mortality in bipolar disorder. Psychol Med. 2007;37(6):839-847.
  8. Wiersma D, Nienhuis FJ, Slooff CJ, Giel R. Natural course of schizophrenic disor- ders. Schizophr Bull. 1998;24(1):75-85.
  9. Neeleman J. A continuum of premature death. Int J Epidemiol. 2001;30(1):154-162.
  10. Neeleman J, Wessely S. Changes in classification of suicide in England and Wales. Psychol Med. 1997;27(2):467-472.

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Authors
Dutta, R., Murray, R. M., Hotopf, M., Allardyce, J., Jones, P. B., & Boydell, J.
Affiliations
  • King's College London (GB)
  • Maastricht University (NL)
  • University of Cambridge (GB)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2010-12-06
Volume
67
Issue
12
Pages
1230
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2010.157
OpenAlex
W2125577364
Cited by
190
References
66
Citations by year
2026: 7 · 2025: 5 · 2024: 9 · 2023: 7 · 2022: 7 · 2021: 21 · 2020: 15 · 2019: 20 · 2018: 11 · 2017: 12 · 2016: 10 · 2015: 21 · 2014: 14 · 2013: 11 · 2012: 10
FWCI
10.88
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Research Portal (King's College London) (publishedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
  • Psychiatry Research Trust
  • National Institute for Health and Care Research (NF-SI-0507-10088)
  • British Medical Association
  • Medical Research Council
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
suicide, first-episode psychosis, schizophrenia, long-term risk, standardized mortality ratio, excess mortality, suicide risk assessment, psychiatric hospitalization, follow-up cohort, mental health services, community mental health services, primary care mental health services
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, England, Female, Follow-Up Studies, Humans, London, Male, Middle Aged, Psychiatric Status Rating Scales, Psychotic Disorders, Retrospective Studies, Risk Factors, Schizophrenia, Schizophrenic Psychology, Scotland, Suicide, Time Factors, Prevalence, Confidence Intervals, International Classification of Diseases, Young Adult, Health Records, Personal

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