Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Subjective quality of life and suicidal behavior among Taiwanese schizophrenia patients

  • 316 Accesses

  • 19 Citations

Abstract

Purpose

Research of suicidal behavior in individuals with schizophrenia has often suggested that clinical characteristics and symptoms likely influence a patient’s suicidal risk. However, there is a lack of research describing the link between patients’ subjective quality of life (SQOL) and suicidal behavior in non-Western countries. Therefore, the current study attempts to explore how schizophrenia patients’ SQOL and their suicidal behavior are related in a Taiwanese sample.

Methods

In this study, 102 schizophrenia outpatients were investigated using the Taiwanese World Health Organization Quality of Life Schedule-Brief Version (WHO-QOL-BREF-TW), several Beck-Related symptom rating scales, and the Positive and Negative Syndrome Scale (PANSS) for psychopathology. These patients were also evaluated for suicidal risk using the critical items of the Scale for Suicide Ideation (SSI) and lifetime suicide attempts.

Results

Statistical analyses, including independent sample t tests, analysis of covariance (ANCOVA) and logistic stepwise regression models were completed. Compared with the non-suicidal group, suicidal patients had significantly lower scores in SQOL domains. The differences in social domain remained significant after adjusting for depressive symptoms. In multiple logistic regression analyses, level of depressive and psychotic symptoms increased and poor social and psychological SQOL were significant contributors to suicidal behavior. Having removed depressive symptoms from the model, only dissatisfaction with social SQOL was associated with heightened suicidal risk.

Conclusions

Schizophrenia is associated with a high suicidal risk, of which depressive and psychotic symptoms are the major correlates. Again, the present study confirms and extends previous research showing that dissatisfied SQOL, particularly dissatisfaction with social relationships, should be considered in the assessment of suicidal risk in outpatients with schizophrenia, even when accounting other possible confounding factor such as depression.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Ran MS, Xiang MZ, Mao WJ et al (2005) Characteristics of suicide attempters and nonattempters with schizophrenia in a rural community. Suicide Life Threat Behav 35:694–701

  2. 2.

    Palmer BA, Pankratz VS, Bostwick JM (2005) The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry 62:247–253

  3. 3.

    Healy D, Harris M, Tranter R et al (2006) Lifetime suicide rates in treated schizophrenia: 1875–1924 and 1994–1998 cohorts compared. Br J Psychiatry 188:223–228

  4. 4.

    Harkavy-Friedman JM, Restifo K, Malaspina D et al (1999) Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry 156:1276–1278

  5. 5.

    Hewitt J (2010) Rational suicide: philosophical perspectives on schizophrenia. Med Health Care Philos 13:25–31

  6. 6.

    Cohen S, Lavelle J, Rich CL, Bromet E (1994) Rates and correlations of suicide attempts in first-admission psychotic patients. Acta Psychiatr Scand 90:167–171

  7. 7.

    Kaplan KJ, Harrow M (1996) Psychosis and functioning as risk factors for late suicidal activity in schizophrenics versus depressives. Suicide Life Threat Behav 26:105–121

  8. 8.

    Haw C, Hawton K, Sutton L et al (2005) Schizophrenia and deliberate self-harm: a systematic review of risk factors. Suicide Life Threat Behav 35:50–62

  9. 9.

    Schwartz RC, Cohen BN (2001) Psychosocial correlates of suicidal intent among patients with schizophrenia. Compr Psychiatry 42:118–123

  10. 10.

    Isabella B, David G (2006) Suicide rates, life satisfaction and happiness as markers for population mental health. Soc Psychiatry Psychiatr Epidemiol 41:333–337

  11. 11.

    Koivumaa-Honkanen H, Honkanen R, Koskenvuo M, Kaprio J (2003) Self-reported happiness in life and suicide in ensuing 20 years. Soc Psychiatry Psychiatr Epidemiol 38:244–248

  12. 12.

    Koivumaa-Honkanen H, Honkanen R, Viinamaki H, Heikkila K, Kaprio J, Koskenvuo M (2001) Life satisfaction and suicide: a 20-year follow-up study. Am J Psychiatry 158:433–439

  13. 13.

    Koivumaa-Honkanen H, Honkanen R, Viinamaki H, Heikkila K, Kaprio J, Koskenvuo M (2000) Self-reported life satisfaction and 20-year mortality in healthy Finnish adults. Am J Epidemiol 152:983–991

  14. 14.

    Koivumaa-Honkanen H, Honkanen R, Antikainen R, Hintikka J, Laukkanen E, Honkalampi K, Viinamaki H (2001) Self-reported life satisfaction and recovery from depression in a 1-year prospective study. Acta Psychiatr Scand 103:38–44

  15. 15.

    Conley RR, Buchanan RW (1997) Evaluation of treatment-resistant schizophrenia. Schizophr Bull 23:663–674

  16. 16.

    Carin JM, Maarten WJK, Mirjam AGS, Aart HS (2009) Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 44:361–368

  17. 17.

    Sartorius N (1997) Quality of life and mental disorders: A global perspective. Wiley, Chichester

  18. 18.

    Browne S, Roe M, Lane A et al (1996) Quality of life in schizophrenia: Relationship to sociodemographic factors, symptomatology and tardive dyskinesia. Acta Psychiatr Scand 94:118–124

  19. 19.

    Law CW, Chen EY, Cheung EF et al (2005) Impact of untreated psychosis on quality of life in patients with first-episode schizophrenia. Qual Life Res 14:1803–1811

  20. 20.

    Bechdolf A, Klosterkotter J, Hambrecht M et al (2003) Determinants of subjective quality of life in post acute patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 253:228–235

  21. 21.

    Ponizovsky AM, Grinshpoon A, Levav I, Ritsner MS (2003) Life satisfaction and suicidal attempts among persons with schizophrenia. Compr Psychiatry 44:442–447

  22. 22.

    Koivumaa-Honkanen HT, Honkanen R, Antikainen R, Hintikka J, Viinamaki H (1999) Self-reported life satisfaction and treatment factors in patients with schizophrenia, major depression and anxiety disorder. Acta Psychiatr Scand 99:377–384

  23. 23.

    McGlashan TH (1988) A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophr Bull 14:515–542

  24. 24.

    Westermeyer JF, Harrow M, Marengo JT (1991) Risk for suicide in schizophrenia and other psychotic and nonpsychotic disorders. J Nerv Ment Dis 179:259–266

  25. 25.

    Qin P, Mortensen PB (2001) Specific characteristics of suicide in China. Acta Psychiatr Scand 103:117–121

  26. 26.

    Breier A, Astrachan BM (1984) Characterization of schizophrenic patients who commit suicide. Am J Psychiatry 141:206–209

  27. 27.

    Warner R, de Girolamo G, Belelli G, Bologna C, Fioritti A, Rosini G (1998) The quality of life of people with schizophrenia in Boulder, Colorado, and Bologna, Italy. Schizophr Bull 24:559–568

  28. 28.

    Heinze M, Taylor RE, Priebe S, Thornicroft G (1997) The quality of life of patients with paranoid schizophrenia in London and Berlin. Soc Psychiatry Psychiatr Epidemiol 32:292–297

  29. 29.

    Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS (2008) Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients. J Psychiatric Res 42:495–502

  30. 30.

    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th ed edn. American Psychiatric Press, Washington (DC)

  31. 31.

    Beck AT, Kovacs M, Weissman M (1979) Assessment of suicidal intention: the scale for suicidal ideation. J Consult Clin Psychol 47:343–352

  32. 32.

    Sokero PT, Melartin TK, Rytsala HJ (2003) Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry 64:1094–1100

  33. 33.

    The WHOQOL-Taiwan Group (2001) The User's Manual of the Development of the WHOQOL-BREF Taiwan Version, 1st rev ed. Taiwan WHOQOL group, Taipei

  34. 34.

    Yao G, Chung CH, Yu CF, Wang JD (2002) Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. J Formosan Med Assoc 101:342–351

  35. 35.

    Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS (2007) Quality of life of Chinese schizophrenia outpatients in Hong Kong: relationship to sociodemographic factors and symptomatology. Aust N Z J Psychiatry 41:442–449

  36. 36.

    Yen CF, Cheng CP, Huang CF, Yen JY, Ko CH, Chen CS (2008) Quality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remission. Bipolar Disord 10:617–624

  37. 37.

    Bell MD, Lysaker PH, Beam-Goulet JL, Milstein RM, Linden-mayer JP (1994) Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Res 52:295–303

  38. 38.

    Emsley R, Rabinowitz J, Torreman M (2003) The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophr Res 61:47–57

  39. 39.

    Beck AT, Steer RA (1987) Manual for the Revised Beck Depression Inventory. San Antonio, Tex, Psychological Corp

  40. 40.

    Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol 56:893–897

  41. 41.

    Beck AT, Steer RA (1988) Manual for the Beck Hopelessness Scale. San Antonio, Tex, Psychological Corp

  42. 42.

    Law CW, Chen EY, Cheung EF, Chan RC, Wong JG, Lam CL et al (2005) Impact of untreated psychosis on quality of life in patients with first-episode schizophrenia. Qual Life Res 14:1803–1811

  43. 43.

    Wegener S, Redoblado-Hodge MA, Lucas S, Fitzgerald D, Harris A, Brennan J (2005) Relative contributions of psychiatric symptoms and neuropsychological functioning to quality of life in first-episode psychosis. Aust N Z J Psychiatry 39:487–492

  44. 44.

    Motto (1992) An integrated approach to estimating suicide risk; in Maris R, Berman L, Maltzberger T, Yufit R (eds) Assessment and Prediction of Suicide. Guilford Press, New York, pp 635–639

  45. 45.

    Roy A (1986) Suicide in schizophrenia. In: Roy A (ed) Suicide. Williams & Wilkins, Baltimore, pp 97–112

  46. 46.

    Fenton WS, McGlashan TH, Victor BJ, Blyler CR (1997) Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry 154:199–204

  47. 47.

    Ran MS, Xiang MZ, Mao WJ et al (2005) Characteristics of suicide attempters and nonattempters with schizophrenia in a rural community. Suicide Life Threat Behav 35:694–701

  48. 48.

    Potkin SG, Alphs L, Hsu C et al (2003) Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial. Biol Psychiatry 54:444–452

  49. 49.

    Cohen S, Lavelle J, Rich CL, Bromet E (1994) Rates and correlates of suicide attempts in first-admission psychotic patients. Acta Psychiatr Scand 90:167–171

  50. 50.

    Drake RE, Cotton PG (1986) Depression, hopelessness and suicide in chronic schizophrenia. Br J Psychiatry 148:554–559

  51. 51.

    Kim CH, Jayathilake K, Meltzer HY (2003) Hopelessness, neurocognitive function, and insight in schizophrenia: relationship to suicidal behavior. Schizophr Res 60:71–80

  52. 52.

    Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS (2007) Impact of sociodemographic and clinical factors on subjective quality of life in schizophrenia patients in Beijing, China. J Nerv Ment Dis 195:853–856

  53. 53.

    Hewitt J (2007) Critical evaluation of the use of research tools in evaluating quality of life for people with schizophrenia. Int J Ment Health Nurs 16(1):2–14

  54. 54.

    Hasanah CI, Razali MS (2002) Quality of life: an assessment of the state of psychosocial rehabilitation of patients with schizophrenia in the community. J R Soc Health 122(4):251–255

  55. 55.

    Burns T, Patrick D (2007) Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatr Scand 116:403–418

  56. 56.

    Alptekin KY, Akvardar BB, Akdede Kivircik et al (2005) Is quality of life associatd with cognitive impairment in schizophrenia? Prog Neuro-psychopharmacol Biol Psychiatry 29(2):239–244

  57. 57.

    Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS (2008) Subjective quality of life in outpatients with schizophrenia in Hong Kong and Beijing: relationship to socio-demographic and clinical factors. Qual Life Res 17:27–36

  58. 58.

    Kuo PJ, Chen-Sea MJ, Lu RB, Chung MS, Kuo CC, Huang WC et al (2007) Validation of the Chinese version of the schizophrenia quality of life scale revision 4 (SQLS-R4) in Taiwanese patients with schizophrenia. Qual Life Res 16:1533–1538

Download references

Acknowledgments

We would like to express our deep gratitude to Professor Yao in National Taiwan University for her permission to carry out the WHOQOL-BREF the Taiwan version in this study.

Conflict of interest

The author declares that they have no competing interests.

Author information

Correspondence to Yia-Ping Liu.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kao, Y., Liu, Y., Cheng, T. et al. Subjective quality of life and suicidal behavior among Taiwanese schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol 47, 523–532 (2012). https://doi.org/10.1007/s00127-011-0361-0

Download citation

Keywords

  • Suicidal behavior
  • Subjective quality of life
  • Schizophrenia