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

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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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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: Dutta, Rina
Murray, Robin M.
Hotopf, Matthew
Allardyce, Judith
Jones, Peter B.
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: bronze
doi.org
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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Reassessing the Long-term Risk of Suicide After a First Episode of Psychosis

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