Suicidal behavior is the leading cause of premature death among people with schizophrenia.1, 77 Ten percent to 13% of individuals with schizophrenia complete suicide, 8, 39, 53, 86, 98 and 20% to 40% make suicide attempts.41, 63, 66, 74 The World Health Organization (WHO), in a 5-year follow-up study of 1065 patients with psychosis concluded that “the risk for suicide in schizophrenia is as great, if not greater, than the risk of suicide associated with affective disorders.” 77 It has been estimated that completed and attempted suicide in schizophrenia cost as much as $190 million in 1991 as a result of medical expenses for attempted and completed suicide, investigational costs of completed suicide, and lost productivity.100 Clinicians working with individuals with schizophrenia are often aware of the persistence of suicidal behavior and the devastating consequences of suicidal behavior for the individual, the family, and the community at large.
Schizophrenia is a heterogenous disorder characterized by chronic or episodic psychosis and a chronic course of biopsychosocial dysfunction with no current cure. In schizophrenia, suicidal behavior is considered to be multidetermined and not readily predictable, although it typically persists throughout the life span with intermittent exacerbations. In light of the complexity of both schizophrenia and suicidal behavior, investigations have been hampered by methodologic obstacles. For example, most studies rely on medical records or nonstandardized data-gathering techniques, making it difficult to evaluate the risk factors for suicidal behavior in this group across studies. Many studies use univariate rather than multivariate techniques, thereby identifying isolated risk factors rather than providing an integrated model for understanding suicidal behavior in individuals with schizophrenia. Factors that distinguish suicide attempters and nonattempters with schizophrenia often have been identified inadvertently because the primary focus of the study was not suicidal behavior. Finally, no systematic research regarding the effectiveness of intervention strategies for suicidal individuals with schizophrenia has been conducted.
Despite these limitations, some consistencies regarding suggested assessment and intervention strategies for managing the suicidal patient with schizophrenia have emerged. The chronic nature of schizophrenia and suicidal behavior require continuous assessment and intervention. Although we still are unable to predict who will commit suicide, by reducing specific symptoms related to schizophrenia, carefully monitoring the individual's functioning in all spheres, and assessing the person's vulnerability to suicidal behavior, the risk for suicidal behavior can be decreased.
