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
Processing time: 131 Days and 11.9 Hours
ARTICLE HIGHLIGHTS
Research background

Various factors are related to suicidality in schizophrenia, including age, sex, level of education, past history of suicide attempt, psychotic symptoms, social factors, and substance use disorders.

Research motivation

Although some factors related to suicidality in schizophrenic patients have been identified, additional factors possibly associated with suicide attempts such as medication and treatment in these patients have not been identified. In addition, the influence of culture may modify the risk of suicidality. Hence, the present study may be beneficial for clinicians seeking to identify and monitor the factors related to suicidality in schizophrenic patients.

Research objectives

Our study focused on the prevalence of suicide attempts and investigated the factors associated with suicidality in hospitalized schizophrenic patients.

Research methods

This cross-sectional study assessed all outcomes and possible suicide risk factors in inpatient schizophrenic patients. The current suicide risk was evaluated using the MINI module for suicidality and categorized as none, mild, moderate, or severe. Ordinal logistic regression was used to assess the associations of potential risk factors with the current suicide risk.

Research results

The overall prevalence of suicide risk in the evaluated schizophrenic patients was 19.6%. Our study found that a younger age, a current major depressive episode, the use of 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.

Research conclusions

The prevalence rate of suicide attempts in hospitalized schizophrenic patients is high. Being young, having a current major depressive episode, receiving fluoxetine or lithium carbonate in the previous month, or having more medical illnesses may increase the risk of suicidality.

Research prospective

Our study suggests that routine clinical assessment, environmental manipulation and adequate treatment might prevent or decrease suicide in hospitalized schizophrenic patients.