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Reassessing the Long-term Risk of Suicide After a First Episode of Psychosis
Open accessAbstract
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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In the citing paper
“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
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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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Citations
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Cited by
Sorted by citations
Excess early mortality in schizophrenia.
Laursen, T. M., Nordentoft, M., & Mortensen, P. B. (2014) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032813-153657 · Cited by 913
Absolute Risk of Suicide After First Hospital Contact in Mental Disorder
Nordentoft, M. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.113 · Cited by 689
Barnes, T. R. E., Drake, R., Paton, C., Cooper, S. J., Deakin, J. F. W., Ferrier, I. N., Gregory, C. J., Haddad, P. M., Howes, O. D., Jones, I. R., et al. (2019) · Journal of Psychopharmacology · doi:10.1177/0269881119889296 · Cited by 615
Suicide risk in first episode psychosis: A selective review of the current literature
Pompili, M., Serafini, G., Innamorati, M., Lester, D., Shrivastava, A., Girardi, P., & Nordentoft, M. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.03.008 · Cited by 182
Suicide in the Early Stage of Schizophrenia
Ventriglio, A., Gentile, A., Bonfitto, I., Stella, E., Mari, M., Steardo, L., & Bellomo, A. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00116 · Cited by 199
Metadata
- 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)
- 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)
- 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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