Skip to main content

Advertisement

SpringerLink
Log in

Incidence and method of suicide mortality in patients with schizophrenia: a Nationwide Cohort Study

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Suicide is a leading cause of death in patients with schizophrenia. This nationwide cohort study investigated the incidence of each suicide method in patients with schizophrenia compared with the general population.

Methods

In total, records of 174,039 patients with schizophrenia were obtained from the National Health Insurance Research Database in Taiwan from 2001 to 2016. This schizophrenia cohort was linked with the national mortality database, and 26,926 patients died during this follow-up period. Of the deceased, 3033 had died by suicide. Univariate Cox regression was used to estimate the demographic variables associated with suicide. We estimated the difference in the proportion of each suicide method used in patients with schizophrenia compared with the general population. The incidence and standardized mortality ratio (SMR) of each suicide method were calculated and stratified based on sex.

Results

Patients aged 25–34 years exhibited the highest suicide risk. Compared with the general population, patients with schizophrenia were more likely to commit suicide by jumping and drowning and less likely to use charcoal-burning and hanging. Women showed a higher incidence of suicide by drowning and jumping than did men. Comorbidity with substance use disorders (SUDs) was associated with a high suicide SMR (26.9, 95% confidence interval [CI] = 23.4–28.9), particularly for suicide by jumping (61.2, 95% CI = 48.3–76.3).

Conclusions

Patients with schizophrenia had higher suicide rates for all methods than did the general population. Suicide method differed based on sex. Patients with SUDs exhibit a high SMR for each suicide method and warrant intensive clinical attention.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1 

Similar content being viewed by others

References

  1. McGrath J, Saha S, Chant D, Welham J (2008) Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 30:67–76

    Article  Google Scholar 

  2. Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, Rossler W (2008) Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ 86(9):726–732

    Article  Google Scholar 

  3. Nordentoft M, Wahlbeck K, Hallgren J, Westman J, Osby U, Alinaghizadeh H, Gissler M, Laursen TM (2013) Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS ONE 8(1):e55176

    Article  CAS  Google Scholar 

  4. Abdeen MS, Shaker NM, Elrassas HH, Hashim MA, Abo Zeid MY (2019) Characteristics of the schizophrenia suicide attempts in comparison with the suicide attempts with other diagnosed psychiatric disorders: an Egyptian study. Int J Soc Psychiatry 65(5):368–377

    Article  Google Scholar 

  5. Nordentoft M, Mortensen PB, Pedersen CB (2011) Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry 68(10):1058–1064

    Article  Google Scholar 

  6. Palmer BA, Pankratz VS, Bostwick JM (2005) The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry 62(3):247–253

    Article  Google Scholar 

  7. Dutta R, Murray RM, Hotopf M, Allardyce J, Jones PB, Boydell J (2010) Reassessing the long-term risk of suicide after a first episode of psychosis. Arch Gen Psychiatry 67(12):1230–1237

    Article  Google Scholar 

  8. Plana-Ripoll O, Pedersen CB, Agerbo E, Holtz Y, Erlangsen A, Canudas-Romo V, Andersen PK, Charlson FJ, Christensen MK, Erskine HE, Ferrari AJ, Iburg KM, Momen N, Mortensen PB, Nordentoft M, Santomauro DF, Scott JG, Whiteford HA, Weye N, McGrath JJ, Laursen TM (2019) A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet 394(10211):1827–1835

    Article  Google Scholar 

  9. Nordentoft M, Laursen TM, Agerbo E, Qin P, Hoyer EH, Mortensen PB (2004) Change in suicide rates for patients with schizophrenia in Denmark, 1981–97: nested case–control study. BMJ 329(7460):261

    Article  Google Scholar 

  10. Ventriglio A, Gentile A, Bonfitto I, Stella E, Mari M, Steardo L, Bellomo A (2016) Suicide in the early stage of schizophrenia. Front Psychiatry 7:116

    Article  Google Scholar 

  11. Mork E, Walby FA, Harkavy-Friedman JM, Barrett EA, Steen NE, Lorentzen S, Andreassen OA, Melle I, Mehlum L (2013) Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm—a cross-sectional study. BMC Psychiatry 13:255

    Article  Google Scholar 

  12. Popovic D, Benabarre A, Crespo JM, Goikolea JM, Gonzalez-Pinto A, Gutierrez-Rojas L, Montes JM, Vieta E (2014) Risk factors for suicide in schizophrenia: systematic review and clinical recommendations. Acta Psychiatr Scand 130(6):418–426

    Article  CAS  Google Scholar 

  13. Kreyenbuhl JA, Kelly DL, Conley RR (2002) Circumstances of suicide among individuals with schizophrenia. Schizophr Res 58(2–3):253–261

    Article  Google Scholar 

  14. Lyu J, Zhang J (2014) Characteristics of schizophrenia suicides compared with suicides by other diagnosed psychiatric disorders and those without a psychiatric disorder. Schizophr Res 155(1–3):59–65

    Article  Google Scholar 

  15. Kuo CJ, Tsai SY, Lo CH, Wang YP, Chen CC (2005) Risk factors for completed suicide in schizophrenia. J Clin Psychiatry 66(5):579–585

    Article  Google Scholar 

  16. Hunt IM, Kapur N, Windfuhr K, Robinson J, Bickley H, Flynn S, Parsons R, Burns J, Shaw J, Appleby L (2006) Suicide in schizophrenia: findings from a national clinical survey. J Psychiatr Pract 12(3):139–147

    Article  Google Scholar 

  17. Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Langstrom N (2010) Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ 341:c3222

    Article  Google Scholar 

  18. Chen YY, Lee MB, Chang CM, Liao SC (2009) Methods of suicide in different psychiatric diagnostic groups. J Affect Disord 118(1–3):196–200

    Article  Google Scholar 

  19. Chang SS, Chen YY, Yip PS, Lee WJ, Hagihara A, Gunnell D (2014) Regional changes in charcoal-burning suicide rates in East/Southeast Asia from 1995 to 2011: a time trend analysis. PLoS Med 11(4):e1001622

    Article  Google Scholar 

  20. Chen YY, Tsai CW, Biddle L, Niederkrotenthaler T, Wu KC, Gunnell D (2016) Newspaper reporting and the emergence of charcoal burning suicide in Taiwan: a mixed methods approach. J Affect Disord 193:355–361

    Article  Google Scholar 

  21. Liu KY, Beautrais A, Caine E, Chan K, Chao A, Conwell Y, Law C, Lee D, Li P, Yip P (2007) Charcoal burning suicides in Hong Kong and urban Taiwan: an illustration of the impact of a novel suicide method on overall regional rates. J Epidemiol Community Health 61(3):248–253

    Article  Google Scholar 

  22. Chang YH, Hsu CY, Cheng Q, Chang SS, Yip P (2019) The evolution of the characteristics of charcoal-burning suicide in Hong Kong, 2002–2013. J Affect Disord 257:390–395

    Article  Google Scholar 

  23. Yoshioka E, Saijo Y, Kawachi I (2016) Spatial and temporal evolution of the epidemic of charcoal-burning suicide in Japan. Soc Psychiatry Psychiatr Epidemiol 51(6):857–868

    Article  Google Scholar 

  24. Choi YR, Cha ES, Chang SS, Khang YH, Lee WJ (2014) Suicide from carbon monoxide poisoning in South Korea: 2006–2012. J Affect Disord 167:322–325

    Article  Google Scholar 

  25. Chen YL, Pan CH, Chang CK, Chen PH, Chang HM, Tai MH, Su SS, Tsai SY, Chen CC, Kuo CJ (2020) Physical illnesses before diagnosed as schizophrenia: a nationwide case–control study. Schizophr Bull 46:785–794

    Article  Google Scholar 

  26. Chen PH, Tsai SY, Pan CH, Chang HM, Chen YL, Su SS, Chen CC, Kuo CJ (2020) Incidence and risk factors of sudden cardiac death in bipolar disorder across the lifespan. J Affect Disord 274:210–217

    Article  Google Scholar 

  27. Chen PH, Tsai SY, Pan CH, Chang CK, Su SS, Chen CC, Kuo CJ (2019) Mood stabilisers and risk of stroke in bipolar disorder. Br J Psychiatry 215(1):409–414

    Article  Google Scholar 

  28. Lee ET (1992) Statistical methods for survival data analysis. Wiley, New York

    Google Scholar 

  29. Chan SKW, Chan SWY, Pang HH, Yan KK, Hui CLM, Chang WC, Lee EHM, Chen EYH (2018) Association of an early intervention service for psychosis with suicide rate among patients with first-episode schizophrenia-spectrum disorders. JAMA Psychiatry 75(5):458–464

    Article  Google Scholar 

  30. Osby U, Correia N, Brandt L, Ekbom A, Sparen P (2000) Mortality and causes of death in schizophrenia in Stockholm county. Sweden Schizophr Res 45(1–2):21–28

    Article  CAS  Google Scholar 

  31. Ko YS, Tsai HC, Chi MH, Su CC, Lee IH, Chen PS, Chen KC, Yang YK (2018) Higher mortality and years of potential life lost of suicide in patients with schizophrenia. Psychiatry Res 270:531–537

    Article  Google Scholar 

  32. Todorov L, Vulser H, Pirracchio R, Thauvin I, Radtchenko A, Vidal J, Guigui P, Limosin F, Lemogne C (2019) Suicide attempts by jumping and length of stay in general hospital: a retrospective study of 225 patients. J Psychosom Res 119:34–41

    Article  Google Scholar 

  33. Muccino E, Crudele GD, Gentile G, Marchesi M, Rancati A, Zoja R (2015) Suicide drowning in the non-coastal territory of Milan. Int J Legal Med 129(4):777–784

    Article  Google Scholar 

  34. Lin C, Yen TH, Juang YY, Leong WC, Hung HM, Ku CH, Lin JL, Lee SH (2012) Comorbid psychiatric diagnoses in suicide attempt by charcoal burning: a 10-year study in a general hospital in Taiwan. Gen Hosp Psychiatry 34(5):552–556

    Article  Google Scholar 

  35. Park CHK, Yoo SH, Lee J, Cho SJ, Shin MS, Kim EY, Kim SH, Ham K, Ahn YM (2017) Impact of acute alcohol consumption on lethality of suicide methods. Compr Psychiatry 75:27–34

    Article  Google Scholar 

  36. Huang YC, Wu YW, Chen CK, Wang LJ (2014) Methods of suicide predict the risks and method-switching of subsequent suicide attempts: a community cohort study in Taiwan. Neuropsychiatr Dis Treat 10:711–718

    PubMed  PubMed Central  Google Scholar 

  37. Gonzalez-Pinto A, Aldama A, Gonzalez C, Mosquera F, Arrasate M, Vieta E (2007) Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria. Spain J Clin Psychiatry 68(2):242–247

    Article  Google Scholar 

  38. Adan A, Capella MD, Prat G, Forero DA, Lopez-Vera S, Navarro JF (2017) Executive functioning in men with schizophrenia and substance use disorders. Influence of lifetime suicide attempts. PLoS ONE 12(1):e0169943

    Article  Google Scholar 

  39. Revier CJ, Reininghaus U, Dutta R, Fearon P, Murray RM, Doody GA, Croudace T, Dazzan P, Heslin M, Onyejiaka A, Kravariti E, Lappin J, Lomas B, Kirkbride JB, Donoghue K, Morgan C, Jones PB (2015) Ten-year outcomes of first-episode psychoses in the MRC AESOP-10 study. J Nerv Ment Dis 203(5):379–386

    Article  Google Scholar 

  40. Cheng AT (1995) Mental illness and suicide. A case–control study in east Taiwan. Arch Gen Psychiatry 52(7):594–603

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Funding

This research was supported by grants from the Ministry of Science and Technology, Taiwan (MOST 105-2314-B-532-006-MY3 and MOST 108-2314-B-532-005) and Taipei City Hospital (10501-62-015 and 10601-62-002). The funding sources had no involvement in the study design, data collection, analysis, or interpretation, report writing, or decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Department of Psychology, National Chengchi University, Taipei, Taiwan

    Chun-Hung Pan

  2. Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan

    Chun-Hung Pan, Hu-Ming Chang, I-Shuan Wang, Yi-Lung Chen, Sheng-Siang Su & Chian-Jue Kuo

  3. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Pao-Huan Chen, Shang-Ying Tsai, Chiao-Chicy Chen & Chian-Jue Kuo

  4. Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan

    Pao-Huan Chen, Shang-Ying Tsai & Chian-Jue Kuo

  5. Department of Counseling Psychology, Chinese Culture University, Taipei, Taiwan

    Yi-Lung Chen

  6. Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan

    Chiao-Chicy Chen

  7. Department of Psychiatry, Mackay Medical College, Taipei, Taiwan

    Chiao-Chicy Chen

  8. Department of General Psychiatry, Taipei City Psychiatric Center, 309 Sung-Te Road, Taipei, 110, Taiwan

    Chian-Jue Kuo

Authors
  1. Chun-Hung Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pao-Huan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hu-Ming Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I-Shuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yi-Lung Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sheng-Siang Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shang-Ying Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chiao-Chicy Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chian-Jue Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drs. Pan and Kuo conceived and designed the study. Dr. Kuo acquired the data. Mr. Su performed the statistical analysis. Drs. Tsai and CC Chen provided administrative and material support. Drs. Pan and Kuo and Ms Wang drafted the manuscript. Drs. PH Chen, Chang and YL Chen made critical revisions to the manuscript for important intellectual content, and Drs. Tsai and CC Chen supervised the study.

Corresponding author

Correspondence to Chian-Jue Kuo.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 211 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pan, CH., Chen, PH., Chang, HM. et al. Incidence and method of suicide mortality in patients with schizophrenia: a Nationwide Cohort Study. Soc Psychiatry Psychiatr Epidemiol 56, 1437–1446 (2021). https://doi.org/10.1007/s00127-020-01985-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-020-01985-8

Keywords

Search

Navigation