Review: Suicide and schizophrenia: a systematic review of rates and risk factors
Open accessAbstract
Risk assessment is a core skill in psychiatry. Risk prediction for suicide in schizophrenia is known to be complex. We undertook a systematic review of all original studies concerning suicide in schizophrenia published since 2004. We found 51 data-containing studies (from 1281 studies screened) that met our inclusion criteria, and ranked these by standardized quality criteria. Estimates of rates of suicide and risk factors associated with later suicide were identified, and the risk factors were grouped according to type and strength of association with suicide. Consensus on the lifetime risk of suicide was a rate of approximately 5%. Risk factors with a strong association with later suicide included being young, male, and with a high level of education. Illness-related risk factors were important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide, and comorbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment. Prevention of suicide in schizophrenia will rely on identifying those individuals at risk, and treating comorbid depression and substance misuse, as well as providing best available treatment for psychotic symptoms.
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The absence of a single reported instance of suicide across the 39 studies and 2076 participants is surprising given the high rates of suicide in this population.
“The absence of a single reported instance of suicide across the 39 studies and 2076 participants is surprising, given the tragically high rates of suicide in this population (Hor & Taylor, 2010)”
From Systematic review of the safety of mindfulness-based interventions for psychosis (2024) · cites this paper as Hor & Taylor, 2010
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Dong, M., Wang, S. B., Wang, F., Zhang, L., Ungvari, G. S., Ng, C. H., Meng, X., Yuan, Z., Wang, G., & Xiang, Y. T. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796017000476 · Cited by 37 · see citing works
Epigenome-wide association study of suicide attempt in schizophrenia
Bani-Fatemi, A., Jeremian, R., Wang, K. Z., Silveira, J., Zai, C., Kolla, N. J., Graff, A., Gerretsen, P., Strauss, J., & De Luca, V. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.07.011 · Cited by 33 · see citing works
Gao, Z., Li, B., Guo, X., Bai, W., & Kou, C. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04760-6 · Cited by 22 · see citing works
Smoking, Suicidality and Psychosis: A Systematic Meta-Analysis
Sankaranarayanan, A., Mancuso, S., Wilding, H., Ghuloum, S., & Castle, D. (2015) · PLOS ONE · doi:10.1371/journal.pone.0138147 · Cited by 24 · see citing works
Psychopathy and suicide: The mediating effects of emotional and behavioral dysregulation
Fadoir, N. A., Lutz-Zois, C. J., & Goodnight, J. A. (2019) · Personality and Individual Differences · doi:10.1016/j.paid.2019.01.021 · Cited by 21 · see citing works
Bartoli, F., Cavaleri, D., Moretti, F., Bachi, B., Calabrese, A., Callovini, T., Cioni, R. M., Riboldi, I., Nacinovich, R., Crocamo, C., et al. (2020) · Medicina · doi:10.3390/medicina56110613 · Cited by 20 · see citing works
Investigating the Perceived Impact of Psychosis on Suicidal Thoughts and Behaviors
Harris, K., Gooding, P., Peters, S., & Haddock, G. (2020) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgaa038 · Cited by 15 · see citing works
Systematic review of the safety of mindfulness-based interventions for psychosis
O'Brien-Venus, B., Ellett, L., Burgess-Barr, S., & Chadwick, P. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102445 · Cited by 6 · see citing works
- Authors
- Hor, K., & Taylor, M.
- Affiliations
- National Health Service Scotland (GB)
- Corresponding author
- Taylor, Mark
- Venue
- Journal of Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2010-10-05
- Volume
- 24
- Issue
- 4_suppl
- Pages
- 81-90
- ISSN
- 0269-8811 (ISSN-L)
- 1461-7285
- PMC
- PMC2951591
- OpenAlex
- W2001157702
- Cited by
- 853
- References
- 63
- Citations by year
- 2026: 34 · 2025: 44 · 2024: 56 · 2023: 63 · 2022: 69 · 2021: 86 · 2020: 60 · 2019: 67 · 2018: 55 · 2017: 58 · 2016: 62 · 2015: 60 · 2014: 53 · 2013: 36 · 2012: 38
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychopharmacology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- suicide, schizophrenia, suicide risk factors, suicide rates, suicide attempts, depressive symptoms, delusions and hallucinations, insight, family history of suicide, substance abuse, comorbid depression, medication adherence, suicide prevention, protective factors
- MeSH terms
- Clinical Trials as Topic, Depression, Depressive Disorder, Female, Humans, Male, Risk Factors, Schizophrenia, Schizophrenic Psychology, Suicide, Suicide, Attempted, Time Factors, Comorbidity, Substance-Related Disorders
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