Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 757-770
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.757
Prevalence and associated factors of suicide among hospitalized schizophrenic patients
Pakapan Woottiluk, Benchalak Maneeton, Natthanan Jaiyen, Wajana Khemawichanurat, Suttipong Kawilapat, Narong Maneeton
Pakapan Woottiluk, Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
Benchalak Maneeton, Suttipong Kawilapat, Narong Maneeton, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Natthanan Jaiyen, Graduate School, Chiang Mai University, Chiang Mai 50200, Thailand
Wajana Khemawichanurat, Suan Prung Psychiatric Hospital, Chiang Mai 50100, Thailand
Author contributions: All authors contributed to the study conception and design; data acquisition, data analysis and interpretation; and article writing, editing, review and final approval.
Supported by the Faculty of Medicine, Chiang Mai University, No. 046/2557; Chiang Mai University, No. 04/2562.
Institutional review board statement: The study was reviewed and approved by the Ethics Committees of Chiang Mai University and Suan Prung Psychiatric Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: This study had no commercial or financial relationships with any third party. BM received honoraria and/or travel reimbursement from Lundbeck, Pfizer, Servier and Thai-Otsuka. NM received travel reimbursement from Lundbeck, Pfizer and Thai-Otsuka. The other authors report no conflicts of interest related to this work.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Benchalak Maneeton, MD, Professor, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Amphur Muang, Chiang Mai 50200, Thailand. benchalak.maneeton@cmu.ac.th
Received: October 18, 2019
Peer-review started: October 18, 2019
First decision: November 11, 2019
Revised: November 15, 2019
Accepted: January 15, 2020
Article in press: January 15, 2020
Published online: February 26, 2020
Abstract
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.

Keywords: Hospitalization, Schizophrenia, Prevalence, Suicide attempts, Suicide risk, Charlson comorbidity index

Core tip: The results of the present study suggest that the prevalence of suicidality in schizophrenic patients is high (19.6%). Females appear to have a slightly higher suicide risk than males, with borderline significance. Additionally, the factors related to higher levels of suicide risk were younger age, a current major depressive episode, receiving fluoxetine or lithium carbonate in the previous month, and a relatively higher score on the Charlson comorbidity index. Based on such findings, routine identification of suicidality, including suicidal ideation, suicide plans, suicide attempts, and monitoring and reducing the related factors should be beneficial in the management of inpatient schizophrenic patients.