Prevalence and associated factors of suicide among hospitalized schizophrenic patients

doi:10.12998/wjcc.v8.i4.757

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World Journal of Clinical Cases

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World J Clin Cases. Feb 26, 2020; 8(4): 757-770
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.757

Table 1 Comparison of basic characteristics and clinical outcomes of schizophrenic patients with different levels of suicide risk

Characteristics	Total (n = 214)	No risk (n = 172)	Low risk (n = 20)	Moderate/Severe risk (n = 22)	P value
Sociodemographic
Sex					0.059
Male	169 (79.0)	139 (82.2)	17 (10.1)	13 (7.7)
Female	45 (21.0)	33 (73.3)	3 (6.7)	9 (20.0)
Age (yr) (n = 213)	37.9 (32.2-47.3)	38.9 (33.4-47.4)	33.5 (31.2-47.8)	32.9 (22.7-43.7)	0.051
Educational level					0.962
Uneducated	18 (8.4)	16 (88.8)	1 (5.6)	1 (5.6)
1-6 yr	93 (43.5)	74 (79.6)	10 (10.7)	9 (9.7)
7-9 yr	53 (24.8)	43 (81.1)	4 (7.6)	6 (11.3)
10-12 yr	33 (15.4)	24 (72.7)	4 (12.1)	5 (15.2)
13 yr or more	17 (7.9)	15 (88.2)	1 (5.9)	1 (5.9)
Marital status					0.433
Single	145 (67.8)	117 (80.7)	15 (10.3)	13 (9.0)
Married	32 (14.9)	28 (87.5)	1 (3.1)	3 (9.40)
Divorced/Separated	31 (14.5)	22 (71.0)	3 (9.7)	6 (19.3)
Widowed	6 (2.8)	5 (83.3)	1 (16.7)	0 (0)
Occupation					0.396
Unemployed	81 (37.8)	61 (75.3)	9 (11.1)	11 (13.6)
Laborer	81 (37.8)	68 (83.9)	5 (6.2)	8 (9.9)
Agriculturist	32 (15.0)	27 (84.4)	3 (9.4)	2 (6.2)
Entrepreneur	11 (5.1)	10 (90.9)	0 (0)	1 (9.1)
Government officer	1 (0.5)	1 (100.0)	0 (0)	0 (0)
State enterprise/Private agency	0 (0)	0 (0)	0 (0)	0 (0)
Student	1 (0.5)	1 (100.0)	0 (0)	0 (0)
Priest	7 (3.3)	4 (57.1)	3 (42.9)	0 (0)
Personal annual income (US dollars¹) (n = 204)	1125 (563-1875)	1125 (563-1969)	750 (300-1875)	1875 (938-1875)	0.235
Household annual income (US dollars¹) (n = 203)	2438 (1125-3750)	2250 (1125-3750)	1875 (938-3750)	3188 (1875-5625)	0.263
Debt (n = 204)					0.132
No	142 (69.6)	113 (79.6)	16 (11.3)	13 (9.1)
Yes	62 (30.4)	52 (83.9)	2 (3.2)	8 (12.9)
Mental illness
Major depressive episode: Current					< 0.001^a
No	205 (95.8)	171 (83.4)	19 (9.3)	15 (7.3)
Yes	9 (4.2)	1 (11.1)	1 (11.1)	7 (77.8)
ICD10: Schizophrenia type					0.083
Paranoid	147 (68.7)	120 (81.6)	13 (8.8)	14 (9.5)
Disorganized	3 (1.4)	2 (66.7)	1 (33.3)	0 (0)
Catatonic	1 (0.5)	0 (0)	0 (0)	1 (100.0)
Undifferentiated	62 (28.9)	50 (80.6)	6 (9.7)	6 (9.68)
Postschizophrenia depression	0 (0)	0 (0)	0 (0)	0 (0)
Residual	0 (0)	0 (0)	0 (0)	0 (0)
Simple schizophrenia	1 (0.5)	0 (0)	0 (0)	1 (100.0)
Duration of schizophrenia (yr) (n = 209)	3.79 (0.04-10.39)	3.49 (0.04-10.38)	9.86 (0.04-14.22)	1.38 (0.02-8.95)	0.137
Medication in previous month
Oral antipsychotic drugs
Clozapine					0.775
Not received	140 (65.4)	114 (81.4)	13 (9.3)	13 (9.3)
Received	74 (34.6)	58 (78.4)	7 (9.4)	9 (12.2)
Dose (mg/d)	100 (50-100)	100 (50-100)	100 (50-100)	100 (50-100)
Risperidone					0.511
Not received	179 (83.6)	145 (81.0)	15 (8.4)	19 (10.6)
Received	35 (16.4)	27 (77.1)	5 (14.3)	3 (8.6)
Dose (mg/d)	4 (4-6)	4 (4-6)	6 (6-6)	4 (2-6)
Haloperidol					0.536
Not received	199 (93.0)	159 (79.9)	20 (10.0)	20 (10.0)
Received	15 (7.0)	13 (86.6)	0 (0)	2 (13.3)
Dose (mg/d)	10 (8-10)	10 (8-10)	0 (0)	9 (8-10)
Trifluoperazine					0.097
Not received	167 (78.0)	131 (78.4)	15 (9.0)	21 (12.6)
Received	47 (22.0)	41 (87.2)	5 (10.7)	1 (2.1)
Dose (mg/d)	20 (15-20)	20 (15-20)	20 (20-20)	20 (20-20)
Perphenazine					0.518
Not received	139 (65.0)	113 (81.3)	14 (10.1)	12 (8.6)
Received	75 (35.0)	59 (78.7)	6 (8.0)	10 (13.3)
Dose (mg/d)	24 (16-24)	24 (16-24)	24 (24-24)	16 (16-24)
Chlorpromazine					0.112
Not received	156 (72.9)	122 (78.2)	14 (9.0)	20 (12.8)
Received	58 (27.1)	50 (86.2)	6 (10.4)	2 (2.4)
Dose (mg/d)	50 (50-50)	50 (50-50)	50 (50-50)	50 (50-50)
Long-acting antipsychotic drugs
Fluphenazine decanoate					0.008^a
Not received	160 (74.8)	128 (80.0)	11 (6.9)	21 (13.1)
Received	54 (25.2)	44 (81.5)	9 (16.7)	1 (1.8)
Dose (mg/mo)	25 (25-25)	25 (25-25)	25 (25-25)	25 (25-25)
Haloperidol decanoate					0.337
Not received	198 (92.5)	160 (80.8)	17 (8.6)	21 (10.6)
Received	16 (7.5)	12 (75.0)	3 (18.8)	1 (6.2)
Dose (mg/mo)	50 (50-50)	50 (50-50)	50 (50-50)	50 (50-50)
Anxiolytic and hypnotic drugs
AMA²					0.605
Not received	199 (93.0)	158 (79.4)	20 (10.1)	21 (10.5)
Received	15 (7.0)	14 (93.3)	0 (0)	1 (6.7)
Clonazepam					1.000
Not received	203 (94.9)	163 (80.3)	19 (9.4)	21 (10.3)
Received	11 (5.1)	9 (81.8)	1 (9.1)	1 (9.1)
Dose (mg/d)	2 (2-2)	2 (2-2)	2 (2-2)	2 (2-2)
Lorazepam					0.161
Not received	202 (94.4)	163 (80.7)	20 (9.9)	19 (9.4)
Received	12 (5.6)	9 (75.0)	0 (0)	3 (25.0)
Dose (mg/d)	2 (1-2)	2 (1-2)	0 (0)	2 (1-2)
Diazepam					0.931
Not received	186 (86.9)	148 (79.6)	18 (9.7)	20 (10.7)
Received	28 (13.1)	24 (85.7)	2 (7.1)	2 (7.1)
Dose (mg/d)	10 (5-10)	7.5 (5-10)	10 (10-10)	10 (10-10)
Antidepressants
Fluoxetine					< 0.001^a
Not received	201 (93.9)	169 (84.1)	19 (9.4)	13 (6.5)
Received	13 (6.1)	3 (23.1)	1 (7.7)	9 (69.2)
Dose (mg/d)	20 (20-20)	20 (20-20)	20 (20-20)	20 (20-20)
Sertraline					0.483
Not received	211 (98.6)	170 (80.6)	20 (9.5)	21 (9.9)
Received	3 (1.4)	2 (66.7)	0 (0)	1 (33.3)
Dose (mg/d)	50 (50-50)	50 (50-50)	0 (0)	50 (50-50)
Mianserin					0.196
Not received	213 (99.5)	172 (80.7)	20 (9.4)	21 (9.9)
Received	1 (0.5)	0 (0)	0 (0)	1 (100.0)
Dose (mg/d)	30 (30-30)	0 (0)	0 (0)	30 (30-30)
Other drugs
Lithium carbonate					0.018^a
Not received	189 (88.3)	157 (83.1)	15 (7.9)	17 (9.0)
Received	25 (11.7)	15 (60.0)	5 (20.0)	5 (20.0)
Dose (mg/d)	600 (600-600)	600 (600-600)	600 (600-600)	600 (600-600)
Valproate					0.161
Not received	201 (93.9)	163 (81.1)	17 (8.5)	21 (10.4)
Received	13 (6.1)	9 (69.2)	3 (23.1)	1 (7.7)
Dose (mg/d)	600 (400-600)	600 (400-600)	600 (600-800)	600 (600-600)
Trihexyphenidyl HCl					0.637
Not received	18 (8.4)	14 (77.7)	1 (5.6)	3 (16.7)
Received	196 (91.6)	158 (80.6)	19 (9.7)	19 (9.7)
Dose (mg/d)	4 (4-6)	4 (4-6)	4 (4-6)	4 (4-6)
Level of medication compliance					0.413
Score less than 5	133 (62.2)	110 (82.7)	12 (9.0)	11 (8.3)
Score 5 or more	81 (37.8)	62 (76.5)	8 (9.9)	11 (13.6)
History of treatment
Electroconvulsive therapy					0.290
No	150 (70.1)	124 (82.7)	11 (7.3)	15 (10.0)
Yes	64 (29.9)	48 (75.0)	9 (14.1)	7 (10.9)
Psychotherapy					0.232
No	200 (93.5)	162 (81.0)	17 (8.5)	21 (10.5)
Yes	14 (6.5)	10 (71.5)	3 (21.4)	1 (7.1)
Family therapy					NA
No	214 (100.0)	172 (80.4)	20 (9.3)	22 (10.3)
Yes	0 (0)	0 (0)	0 (0)	0 (0)
Other treatment					1.000
No	205 (95.8)	164 (80.0)	20 (9.8)	21 (10.2)
Yes	9 (4.2)	8 (88.9)	0 (0)	1 (11.1)
Treatment satisfaction (n = 212)	8 (7-10)	8 (7-10)	9 (7-10)	8 (6-10)	0.379
Other indices
Charlson Comorbidity index score (n = 213)					0.086
None (0 score)	207 (97.2)	169 (81.6)	18 (8.7)	20 (9.7)
Low (1-2 score)	4 (1.8)	2 (50.0)	1 (25.0)	1 (25.0)
Moderate (3-4 score)	1 (0.5)	1 (100.0)	0 (0)	0 (0)
High (5 score or more)	1 (0.5)	0 (0)	1 (100.0)	0 (0)
Psychosocial score (n = 208)	21 (18-25)	21 (18-25)	19 (18-24)	20 (18-23)	0.214
Level of psychosocial score (n = 208)					0.128
Good (less than 25 score)	156 (75.0)	120 (76.9)	17 (10.9)	19 (12.2)
Poor (25 score or more)	52 (25.0)	47 (90.3)	2 (3.9)	3 (5.8)
Weapons and toxic chemicals accessibility score (n = 208)	18 (9.5-29)	18 (10-28)	19 (11-30)	15 (9-30)	0.585
Level of weapons and toxic chemicals accessibility score (n = 208)					0.791
Low (less than 25 score)	142 (68.3)	114 (80.2)	12 (8.5)	16 (11.3)
High (25 score or more)	66 (31.7)	53 (80.3)	7 (10.6)	6 (9.1)

¹One US dollar approximately equals 32 Thai baht.

²AMA is a combined medication: amobarbital 50 mg and chlorpromazine HCl 25 mg.

^aP < 0.05. Data are n (%) or median (Interquartile range). P values were derived from the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. MINI: Mini international neuropsychiatric interview; n: Frequency.

Table 2 Univariable analysis of potential risk factors for suicide risk

Characteristics	Univariable ordinal logistic regression
Characteristics	OR (95%CI)	P value
Sociodemographic
Sex			0.116
Male	1.00
Female	1.85 (0.86-3.98)
Age (yr)	0.96 (0.93-0.99)		0.026^a
Educational level			0.609
Uneducated	1.00
1-6 yr	2.03 (0.43-9.56)
7-9 yr	1.90 (0.38-9.57)
10-12 yr	3.01 (0.58-15.70)
13 yr or more	1.07 (0.13-8.53)
Marital status			0.316
Single	1.00
Married	0.63 (0.20-1.93)
Divorced/Separated/Widowed	1.60 (0.70-3.66)
Occupation			0.272
Unemployed	1.00
Employed	0.60 (0.28-1.30)
Other	0.29 (0.04-2.42)
Personal annual income (US dollars¹)	1.00 (1.00-1.00)		0.918
Household annual income (US dollars¹)	1.00 (1.00-1.00)		0.881
Debt			0.598
No	1.00
Yes	0.81 (0.37-1.78)
Mental illness
Major depressive episode: Current			< 0.001^a
No	1.00
Yes	43.62 (8.51-223.65)
ICD10: schizophrenia type			0.638
Paranoid	1.00
Other	1.19 (0.58-2.44)
Duration of schizophrenia (years)	1.00 (0.96-1.05)		0.877
Medication in previous month
Clozapine			0.565
Not received	1.00
Received	1.23 (0.61-2.45)
Risperidone			0.683
Not received	1.00
Received	1.20 (0.51-2.84)
Fluphenazine			0.583
Not received	1.00
Received	0.80 (0.37-1.75)
Chlorpromazine			0.151
Not received	1.00
Received	0.54 (0.24-1.25)
Haloperidol			0.603
Not received	1.00
Received	0.67 (0.14-3.08)
Haloperidol decanoate			0.685
Not received	1.00
Received	1.27 (0.40-4.08)
Trifluoperazine			0.143
Not received	1.00
Received	0.50 (0.20-1.27)
Perphenazine			0.565
Not received	1.00
Received	1.23 (0.61-2.45)
AMA²			0.234
Not received	1.00
Received	0.29 (0.04-2.25)
Clonazepam			0.897
Not received	1.00
Received	0.90 (0.19-4.30)
Lorazepam			0.47
Not received	1.00
Received	1.65 (0.42-6.45)
Diazepam			0.445
Not received	1.00
Received	0.65 (0.21-1.97)
Fluoxetine			< 0.001^a
Not received	1.00
Received	26.77 (7.53-95.20)
Sertraline			0.443
Not received	1.00
Received	2.62 (0.22-30.46)
Lithium carbonate			0.01^a
Not received	1.00
Received	3.09 (1.31-7.29)
Depakine			0.4
Not received	1.00
Received	1.67 (0.51-5.51)
Artane			0.685
Not received	1.00
Received	0.79 (0.25-2.52)
Score for medication compliance			0.244
Less than 5	1.00
5 or more	1.50 (0.76-2.95)
History of treatment
Electroconvulsive therapy			0.242
No	1.00
Yes	1.52 (0.75-3.06)
Psychotherapy			0.492
No	1.00
Yes	1.51 (0.46-4.94)
Other treatment			0.66
No	1.00
Yes	0.62 (0.07-5.21)
Treatment satisfaction (score)	0.99 (0.83-1.18)		0.911
Other indices
Charlson Comorbidity index (score)	1.10 (0.95-1.26)		0.195
Psychosocial score (score)	0.93 (0.86-1.00)		0.046^a
Weapons and toxic chemicals accessibility score (score)	0.98 (0.95-1.02)		0.438

¹One US dollar approximately equals 32 Thai baht.

²AMA is a combined medication: amobarbital 50 mg and chlorpromazine HCl 25 mg.

^aP < 0.05. OR: Odds ratio; CI: Confidence interval.

Table 3 Factors associated with suicidal risk in multivariable analysis (n = 212)

Characteristics	Multivariable ordinal logistic regression¹
Characteristics	aOR (95%CI)	P value	Pseudo R²
Age (per 1 yr increase)	0.95 (0.92-0.99)	0.031^a	0.2084
Current major depressive episode	26.88 (4.05-178.59)	0.001^a
Received fluoxetine in previous month	18.59 (4.50-76.77)	< 0.001^a
Received lithium carbonate in previous month	2.97 (1.10-8.01)	0.032^a
Charlson comorbidity index (per 1 point increase)	1.20 (1.03-1.40)	0.020^a

¹Multivariable analysis with backward elimination with selected variables in univariable analysis included sex, age, schizophrenia with secondary depression, lifetime psychotic disorder, current major depressive episode, chlorpromazine, trifluoperazine, AMA, fluoxetine, lithium carbonate, level of medication compliance, electroconvulsive therapy, Charlson comorbidity index, and psychosocial score.

^aP < 0.05. aOR: Adjusted odds ratio; CI: Confidence interval.

Citation: Woottiluk P, Maneeton B, Jaiyen N, Khemawichanurat W, Kawilapat S, Maneeton N. Prevalence and associated factors of suicide among hospitalized schizophrenic patients. World J Clin Cases 2020; 8(4): 757-770
URL: https://www.wjgnet.com/2307-8960/full/v8/i4/757.htm
DOI: https://dx.doi.org/10.12998/wjcc.v8.i4.757