Suicide ideation, suicide attempts, their sociodemographic and clinical associates among the elderly Chinese patients with schizophrenia spectrum disorders

Suicide Probability Among Patients With Schizophrenia and Bipolar Disorder

PURPOSE

To evaluate the possibility of suicide and related factors among individuals with schizophrenia and bipolar disorder (BD).

METHOD

Data were collected for 270 individuals registered in a community mental health center using the Suicide Probability Scale (SPS). Subsequently, t test and multiple linear regression analyses were conducted on independent samples.

RESULTS

There was no statistically significant difference found between mean SPS scores of participants with schizophrenia and BD. However, hostility subscale mean scores of participants with schizophrenia were higher than those of participants with BD, and the difference was statistically significant. Sex, family history of mental illness, need for help with medication, suicidal ideation in the past 10 days, and number of suicide attempts were important predictors of suicide probability.

CONCLUSION

Individuals with schizophrenia and BD and in remission should be evaluated periodically for the possibility of suicide. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 37-45.].

Prevalence and risk factors of suicide attempts among Chinese elderly patients over 50 years with schizophrenia

BACKGROUND

Several research efforts have found that older schizophrenia patients are at higher risk for suicide. Related risk factors for suicide attempts in the elderly with schizophrenia are poorly understood. This study sought to assess the prevalence of suicide attempts and related risk variables in schizophrenia patients over the age of 50.

METHODS

We recruited 591 elderly patients over the age of 50. Demographic, clinical and blood parameters of all patients were collected. Patients with schizophrenia were evaluated for psychopathological symptoms using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

The rate of suicide attempts among elderly Chinese schizophrenia patients was 15.2%. In these elderly schizophrenia patients, those who with suicide attempts had significantly higher scores for insomnia, depression and smoking addiction, and higher levels of red blood cells, Hc1 glycosylated hemoglobin and free T3, but significantly lower levels of hypersensitive C-reactive protein and -globulin. Binary logistic regression analysis showed that higher depression scores and smoking addiction were risk factors for suicide attempts in these patients. Additionally, multiple regression analyses showed that higher BMI and insomnia scores were associated with suicide risk scores in elderly schizophrenia patients.

CONCLUSIONS

Our research shows that there is a high incidence of suicide attempts in people over 50 years of age with schizophrenia. A number of clinically relevant factors and metabolic markers are associated with suicide attempts among elderly patients with schizophrenia.

Gender differences and clinical correlates in the age of the first hospitalization in patients with drug-naïve schizophrenia in China: a cross-sectional study

Gender differences in the onset age of schizophrenia have been reported in many studies, but differences in the age of the first hospitalization and associated factors have not been explored. The present study investigated gender differences and clinical correlates in the age of the first hospitalization in drug-naïve schizophrenia (DNS). A total of 144 DNS patients and 67 health controls were included. Demographic information, duration of untreated psychosis (DUP), Positive and Negative Symptom Scale (PANSS) scores, the Brief Psychiatric Rating Scale (BPRS) scores, Global Assessment of Functioning (GAF) scores, and MATRICS Consensus Cognitive Battery (MCCB) scores were collected and analyzed. The age of the first hospitalization was significantly earlier in males than in females (P < 0.01). In addition, there were significant differences in the age of the first hospitalization in terms of marital status, occupation, family ranking, suicide attempt, and place of residence (all P < 0.05). After Bonferroni correction, only DUP had a positive correlation with the age of the first hospitalization (PBonferroni < 0.05/6 = 0.0083). Multivariate linear regression analysis showed that gender (β = 0.141, t = 2.434, P = 0.016), marital status (β = 0.219, t = 3.463, P = 0.001), family ranking (β = 0.300, t = 4.918, P < 0.001), suicide attempt (β = 0.348, t = 5.549, P < 0.001), and DUP (β = 0.190, t = 2.969, P < 0.004) positively predicted the age of the first hospitalization. The age of the first hospitalization in male DNS was earlier than in females. In addition, gender, marital status, suicide attempt, DUP, and family rank were independent risk factors for the age of the first hospitalization.

Association of loneliness with suicide risk and depression in individuals with schizophrenia: moderating effects of self-esteem and perceived support from families and friends

Loneliness is prevalent among individuals with mental illnesses. This cross-sectional survey study examined the moderating effects of self-esteem and perceived support from families and friends on the association of loneliness with suicide risk and depression in individuals with schizophrenia. In total, 300 participants (267 with schizophrenia and 33 with schizoaffective disorder) completed the University of California, Los Angeles, Loneliness Scale (Version 3); suicide module of the Mini International Neuropsychiatric Interview; Center for Epidemiologic Studies Depression Scale; Family and Friend Adaptability, Partnership, Growth, Affection, and Resolve Index; and Rosenberg Self-Esteem Scale. Moderation analysis was performed to examine the moderating effects of self-esteem and perceived support from families and friends on the association of loneliness with suicide risk and depression. The results found that self-esteem was significantly associated with a reduced magnitude of depression in participants with loneliness. In addition, perceived support from friends was significantly associated with a reduced magnitude of suicide risk in participants with loneliness. Our findings indicate the importance of intervention programs that strengthen support from friends and self-esteem in reducing suicide risk and depression among lonely individuals with schizophrenia.

Prevalence and Associated Factors of Suicidal Behaviors Among Community-Dwelling Individuals with Serious Mental Disorders - Shandong Province, China, 2022

What is already known about this topic?

Serious mental disorders (SMD) are significant risk factors for suicide, and individuals with SMD are crucial target populations for suicide prevention efforts. While numerous studies have examined the prevalence of suicidal behaviors among psychiatric inpatients, fewer reports have addressed the occurrence of such behaviors in community-based patients.

What is added by this report?

The prevalence of suicidal ideation, planning, and attempts among community-dwelling individuals with SMD was found to be 36.8%, 17.9%, and 15.0%, respectively. A significant association was observed between the severity of psychiatric symptoms and the presence of suicidal behaviors. Notably, patients within the 55-59 age range demonstrated the highest rates of both suicidal planning and attempts.

What are the implications for public health practice?

Particular attention to the risk of suicide is crucial, especially for community-dwelling individuals with SMD of middle age, those with religious beliefs, living alone, and exhibiting more severe depressive and psychiatric symptoms.

Suicidal ideation in Chinese patients with chronic schizophrenia: prevalence, clinical correlates, and relationship with alexithymia

Suicidal ideation (SI) is common among people with schizophrenia. However, it has received less attention than suicide attempts (SA), especially in the Chinese population. Alexithymia is a well-established risk factor for SI across different populations. Nevertheless, very few studies evaluated their relationship in schizophrenia patients. We aimed to determine the prevalence and clinical correlates of SI and its relationship with alexithymia in 812 Chinese chronic schizophrenia inpatients. We assessed SI, clinical symptoms, and alexithymia by the Beck Scale for Suicidal Ideation, the Positive and Negative Syndrome Scale (PANSS), and the Toronto Alexithymia Scale, respectively. A multiple logistic regression model was conducted to identify independent correlates of SI. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were performed to determine the ability of our model to distinguish between patients with and without SI. 10% (n = 84) reported current SI. Lifetime SA (OR, 4.68; 95% CI 2.76-7.94, p < 0.001), PANSS depressive factor (OR, 1.24; 95% CI 1.12-1.38, p < 0.001), PANSS positive subscale (OR, 1.055; 95% CI 1.004-1.108, p = 0.035), and difficulty identifying emotions (OR, 1.07; 95% CI 1.03-1.12, p = 0.002) were associated with SI. The AUC value was 0.80, indicating excellent distinguishing capabilities. Timely assessments of these factors may help identify schizophrenia patients who are at risk for SI.

Sex differences in the association between suicidal ideation and neurocognitive function in Chinese patients with schizophrenia

There is increasing evidence that sex differences exist in many clinical manifestations of patients with schizophrenia, including suicidal ideation (SI) and neurocognitive function. The present study was performed to explore the sex differences in the association between SI and neurocognitive function in Chinese patients with schizophrenia. A total of 1188 inpatients with schizophrenia were recruited from multicenter psychiatric hospitals. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was utilized to evaluate the neurocognitive function of all patients. The Positive and Negative Syndrome Scale (PANSS) was utilized to assess the psychopathology of patients. The Beck Scale for Suicide Ideation (BSSI) was used to assess the severity of SI. In male patients, the suicide risk score was significantly associated with PANSS negative symptoms (r = 0.167, p = 0.043), visuospatial subscale (r = - 0.261, p = 0.001), and RBANS total scores (r = - 0.172, p = 0.037). Furthermore, multivariate linear regression analysis showed that the visuospatial subscale (β = - 0.490, t = - 3.273, p = 0.001) was independently associated with the suicide risk score in male patients. In female patients, the suicide risk score was significantly correlated with PANSS positive symptoms (r = 0.249, p = 0.021), negative symptoms (r = 0.394, p < 0.001), general psychopathology (r = 0.276, p = 0.01) and PANSS total score (r = 0.365, p = 0.001). Multivariate linear regression analysis showed that PANSS negative symptoms (β = 1.849, t = 3.933, p = 0.001) were significantly associated with suicide risk scores in female patients. Our findings indicate that there are sex differences in the association between SI and neurocognitive function in patients with schizophrenia. Based on the findings of our study, gender-specific prevention and intervention strategies may make a difference in reducing SI in Chinese schizophrenia patients.

History of suicide attempt associated with amygdala and hippocampus changes among individuals with schizophrenia

Abnormalities in subcortical brain structures may reflect higher suicide risk in mood disorders, but less is known about its associations for schizophrenia. This cross-sectional imaging study aimed to explore whether the history of suicide attempts was associated with subcortical changes among individuals with schizophrenia. We recruited 44 individuals with schizophrenia and a history of suicide attempts (SZ-SA) and 44 individuals with schizophrenia but without a history of suicide attempts (SZ-NSA) and 44 healthy controls. Linear regression showed that SZ-SA had smaller volumes of the hippocampus (Cohen's d = -0.72), the amygdala (Cohen's d = -0.69), and some nuclei of the amygdala (Cohen's d, -0.57 to -0.72) than SZ-NSA after adjusting for age, sex, illness phase, and intracranial volume. There was no difference in the volume of the subfields of the hippocampus. It suggests the history of suicide attempts is associated with subcortical volume alterations in schizophrenia.

Prevalence of suicide ideation, self-harm, and suicide among Chinese patients with schizophrenia: a systematic review and meta-analysis

Aims

Suicide ideation, self-harm, and suicide are common in patients with schizophrenia, but the reported prevalence vary largely across studies. Improved prevalence estimates and identification of moderators of the above self-directed violence are needed to enhance recognition and care, and to guide future management and research. This systematic review aims to estimate the pooled prevalence and identify moderators of suicide ideation, self-harm, and suicide among patients diagnosed with schizophrenia in China.

Methods

Relevant articles published until September 23, 2021, were searched using PubMed, EBSCO, Web of Science, Embase, Science Direct, CNKI, CBM, VIP, and Wanfang databases. Eligible studies published in English or Chinese which reported the prevalence of suicide ideation, self-harm, or suicide among Chinese patients with schizophrenia were collected. All studies passed a quality evaluation. This systematic review was registered with PROSPERO (registration number CRD42020222338). PRISMA guidelines were used in extracting and reporting data. Random-effects meta-analyses were generated using the meta package in R.

Results

A total of 40 studies were identified, 20 of which were evaluated as high-quality studies. Based on these studies, the prevalence of lifetime suicide ideation was 19.22% (95% CI: 7.57-34.50%), prevalence of suicide ideation at the time of investigation was 18.06% (95% CI: 6.49-33.67%), prevalence of lifetime self-harm was 15.77% (95% CI: 12.51-19.33%), and prevalence of suicide was 1.49% (95% CI: 0.00-7.95%). Multivariate meta-regression analysis revealed that age (β = - 0.1517, p = 0.0006) and dependency ratio (β = 0.0113, p < 0.0001) were associated with the lifetime prevalence of self-harm. Study assessment score (β = 0.2668, p < 0.0001) and dependency ratio (β = 0.0050, p = 0.0145) were associated with the lifetime prevalence of suicide ideation. Results of the spatial analysis showed that the prevalence of self-directed violence varied greatly across different provinces.

Conclusion

This systematic review provides estimates of the prevalence of self-directed violence among Chinese patients with schizophrenia and explores its moderators and spatial patterns. Findings also have important implications for allocating prevention and intervention resources to targeted high-risk populations in high prevalence areas.

Influencing factors of multiple adverse outcomes among schizophrenia patients using count regression models: a cross-sectional study

BACKGROUND

Schizophrenia patients have increased risks of adverse outcomes, including violent crime, aggressiveness, and suicide. However, studies of different adverse outcomes in schizophrenia patients are limited and the influencing factors for these outcomes need clarification by appropriate models. This study aimed to identify influencing factors of these adverse outcomes by examining and comparing different count regression models.

METHODS

This study included schizophrenia patients who had at least one follow-up record in the Guangdong Mental Health Center Network Medical System during 2020. Three types of adverse outcomes were included: a) aggressiveness with police dispatch or violent crime, b) aggressiveness without police dispatch, and c) self-harm or suicide attempts. The incidence density of these adverse outcomes was investigated using the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) models, accordingly. The best model was chosen based on goodness-of-fit tests. We further analyzed associations between the number of occurrences of adverse outcomes and sociodemographic, clinical factors with the best model.

RESULTS

A total of 130,474 schizophrenia patients were enrolled. Adverse outcomes rates were reported to be less than 1% for schizophrenia patients in 2020, in Guangdong. The NB model performed the best in terms of goodness-of-fit and interpretation when fitting for the number of occurrences of aggressiveness without police dispatch, whereas the ZINB models performed better for the other two outcomes. Age, sex, and history of adverse outcomes were influencing factors shared across these adverse outcomes. Higher education and employment were protective factors for aggressive and violent behaviors. Disease onset aged ≥ 18 years served as a significant risk factor for aggressiveness without police dispatch, and self-harm or suicide attempts. Family history of mental diseases was a risk factor for self-harm or suicide attempts individually.

CONCLUSIONS

NB and ZINB models were selected for fitting the number of occurrences of adverse outcomes among schizophrenia patients in our studies. Influencing factors for the incidence density of adverse outcomes included both those shared across different types and those individual to specific types. Therefore, comprehensive and customized tools in risk assessment and intervention might be necessary.

Exosomes in schizophrenia: Pathophysiological mechanisms, biomarkers, and therapeutic targets

While schizophrenia (SCZ) is a devastating psychiatric disorder that detrimentally affects a significant portion of the worldwide population, its diagnosis is traditionally based on a relatively subjective assessment of current symptoms and medical history, devoid of an objective diagnostic modality. Antipsychotic medications are commonly used in the treatment of SCZ; however, some patients have low remission rates or forsake treatment due to the associated multiple side effects, resulting in recurrent episodes of the disease and poor prognosis. These situations imply that the diagnosis, treatment, and prognosis of SCZ need to be improved to increase the odds of a better outcome. Mounting studies have found that extracellular vesicles (EVs) play essential roles in the central nervous system. They are implicated in several mechanisms closely associated with SCZ such as cellular communication and synaptic plasticity. They can additionally exhibit neuroprotective and therapeutic effects. Since they possess distinct constituents, are readily available, easily detectable, and dependent on the internal environment, they can potentially serve as reliable biomarkers for disease diagnosis. Moreover, their biological configuration along with their ability to increase the bioavailability of their constituents and modulate intricate intracellular reactions in target cells, propel EVs as new targets for treatment. This review paper summarizes relevant research pertaining to the roles of EVs in SCZ, with the aim of improving insights into SCZ pathogenesis and evaluating EVs as potential biomarkers in the diagnosis and treatment of SCZ.

Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys

Schizophrenia is a severe psychiatric disorder with high premature mortality rates. This is a meta-analysis and systematic review of the prevalence of suicidal ideation (SI) and suicide plan (SP) among people with schizophrenia. PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 10, 2020. Data on prevalence of SI and/or SP were synthesized using the random effects model. Twenty-six studies covering 5079 people with schizophrenia were included for meta-analysis. The lifetime and point prevalence of SI were 34.5% (95% CI: 28.2-40.9%), and 29.9% (95% CI: 24.2-35.6%), respectively. The lifetime prevalence of SP was 44.3% and the point prevalence of SP ranged between 6.4 and 13%. Subgroup and meta-regression analyses revealed that source of patients, survey countries, and sample size were significantly associated with the point prevalence of SI, while male proportion and quality assessment scores were significantly associated with the lifetime and point prevalence of SI. Survey time and mean age were significantly associated with lifetime prevalence of SI. Both SI and SP are common in people living with schizophrenia, especially in males and inpatients. Routine screening and effective interventions for SI and SP should be implemented in this population.

Epidemiological profile of psychiatric illnesses in the province of Taza, Morocco: case of a study on a schizophrenic sub-population in the Ibn Baja Hospital

Aim

The objective of this study is to assess the prevalence of major psychiatric disorders and to plot some characteristics of the schizophrenic sub-population in the study area.

Methods

We present the results of a retrospective study on psychiatric illnesses listed at the level of the psychiatric department at the Ibn Baja Hospital in the province of Taza (Morocco), involving a sample of 3803 patients aged 18 years and over between 2006 and 2016.

Results

The results obtained show that the average age of our sample is 33 ± 10.5 years and that schizophrenia is the most pronounced psychiatric disorder with a prevalence of 69.9%, followed by bipolar disorder (8.4%), manic state (8.3%), major depression (5.8%), epilepsy (3.7%), dementia (2.5%), and drug addiction (1.5%). The predominance of the workforce for all psychiatric disorders was significantly in favor of males (P = 0 .000) with an M/F sex ratio of 4.9. Most patients were from urban areas 77.1%, compared with 22.9% from rural areas, with a predominance of males (P<0.001). Schizophrenia disease is the most predominant in the region with a prevalence of 1.6% and affects 83% of men versus 17% of women with a M/F sex ratio value of 5.6 in favor of men (P = 0.000).

Conclusion

In our region of study, as everywhere else in the world, the prevalence of psychiatric diseases on the one hand, and schizophrenia on the other hand, seems to be worrying, thus requiring more vigilance on the part of public health workers in general and mental health workers.

Ageing with schizophrenia: an update

PURPOSE OF REVIEW

The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia.

RECENT FINDINGS

The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia.

SUMMARY

Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.

Alteration of lipids and amino acids in plasma distinguish schizophrenia patients from controls: A targeted metabolomics study

BACKGROUND

Schizophrenia (SCZ) is a serious psychiatric disorder. Metabolite disturbance is an important pathogenic factor in schizophrenic patients. In this study, we aim to identify plasma lipid and amino acid biomarkers for SCZ using targeted metabolomics.

METHODS

Plasma from 76 SCZ patients and 50 matched controls were analyzed using the LC/MS-based multiple reaction monitoring (MRM) metabolomics approach. A total of 182 targeted metabolites, including 22 amino acids and 160 lipids or lipid-related metabolites were observed. We used binary logistic regression analysis to determine whether the lipid and amino acid biomarkers could discriminate SCZ patients from controls. The area under the curve (AUC) from receiver operation characteristic (ROC) curve analysis was conducted to evaluate the diagnostic performance of the biomarkers panel.

RESULTS

We identified 19 significantly differentially expressed metabolites between the SCZ patients and the controls (false discovery rate < 0.05), including one amino acid and 18 lipids or lipid-related metabolites. The binary logistic regression-selected panel showed good diagnostic performance in the drug-naïve group (AUC = 0.936) and all SCZ patients (AUC = 0.948), especially in the drug-treated group (AUC = 0.963).

CONCLUSIONS

Plasma lipids and amino acids showed significant dysregulation in SCZ, which could effectively discriminate SCZ patients from controls. The LC/MS/MS-based approach provides reliable data for the objective diagnosis of SCZ.

The Importance of Suicide Risk Formulation in Schizophrenia

Suicide is a cause of early mortality in nearly 5% of patients with schizophrenia, and 25-50% of patients with schizophrenia attempt suicide in their lifetime. Evidence points to numerous individual, clinical, social, and psychological risk factors for suicide in patients with schizophrenia. Although recognizing suicidal risk factors in schizophrenia is extremely important in suicidal risk assessment, we have recently witnessed a change in suicide risk management that shifts the focus from suicide risk assessment to suicide risk formulation. Suicide risk formulation is dependent on the data gathered in the suicide risk assessment and assigns a level of suicide risk that is indispensable for the choice of treatment and the management of patients with a high suicidal risk. In this article, we extend the suicide risk formulation model to patients with schizophrenia. Suicide risk formulation results from four different areas that help clinicians collect as much information as possible for the management of suicidal risk. The four distinct judgments comprise risk status (the risk relating to the specific group to which the patient belongs), risk state (the risk for the person compared with his baseline or another reference point in the course of his life), available resources (on whom the person can count during a crisis) and foreseeable events (which can exacerbate the crisis). In schizophrenia, the suicide risk formulation model allows the clinician to evaluate in depth the clinical context of the patient, the patient's own history and patient-specific opportunities for better choosing and applying suicide prevention strategies.

Prevalence and associated factors of suicide among hospitalized schizophrenic patients

BACKGROUND

Previous studies found several factors associated with suicide in schizophrenic patients, such as age, sex, education level, history of suicide attempts, psychotic symptoms, social factors, and substance abuse. However, there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts, such as medication and treatment.

AIM

To investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.

METHODS

This is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more. The outcomes and possible suicide risk factors in these patients were collated. The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none (0 points), mild (1-8 points), moderate (9-16 points), or severe (17 or more points). This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.

RESULTS

Of 228 hospitalized schizophrenia patients, 214 (93.9%) were included in this study. The majority (79.0%) of patients were males. Females appeared to have a slightly higher suicidality risk than males, with borderline significance. With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview, 172 (80.4%) schizophrenic patients scored zero, 20 (9.4%) had a mild risk, 8 (3.7%) had a moderate risk, and 14 (6.5%) had a severe risk. The total prevalence of current suicide risk in these schizophrenic patients was 19.6%. Based on multivariable ordinal logistic regression analysis with backward elimination, it was found that younger age, a current major depressive episode, receiving fluoxetine or lithium carbonate in the previous month, or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.

CONCLUSION

The prevalence rate of suicide attempts in schizophrenia is high. Considering risk factors in routine clinical assessments, environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.