Skip to main content

Advertisement

SpringerLink
Log in

Co-morbid PTSD and suicidality in individuals with schizophrenia and substance and alcohol abuse

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

Abstract

Background

Suicide risk is high in schizophrenic patients and is further elevated in dual diagnosis patients. Suicide behaviour is a continuum from ideation, plans to attempts. Exposure to traumatic stress and co-morbid PTSD is elevated in schizophrenic patients. Suicide behaviour is also common in non-psychotic PTSD patients. This study aimed to investigate the effect of trauma and co-morbid PTSD on suicide behaviour in dual diagnosis patients and whether co-morbid PTSD would further elevate suicide risk.

Method

This was a cross-sectional study in which suicide behaviour was compared in those with and without co-morbid PTSD in 110 patients suffering schizophrenia and alcohol and/or substance abuse.

Results

100 (91%) reported at least one traumatic event with an average of 4.3 events. 31 (28%) patients met criteria for full PTSD. Current suicidal ideation was reported by 39 (35%) and 23 (21%) reported plans and ideation, 69 (63%) reported at least one previous suicide attempt. Suicide behaviour was significantly associated with an increasing number of traumatic events. Suicidality was significantly associated and elevated with co-morbid PTSD. Analysis indicated that the effect of trauma on suicide behaviour appeared to be mediated by hopelessness.

Conclusions

Suicide behaviour was not associated with exposure to trauma per se but was associated with incremental exposure to traumatic experiences. Consistent with the study hypotheses, co-morbid PTSD further adds to the risk of suicide behaviour in an already vulnerable group.

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

Similar content being viewed by others

References

  1. Addington D, Addington J, Maticka-Tyndale E (1992) Reliability and validity of a depression rating scale for schizophrenics. Schizophr Res 6:201–208

    Article  PubMed  CAS  Google Scholar 

  2. Addington D, Addington J, Maticka-Tyndale E (1994) Specificity of the Calgary Depression Scale. Schizophr Res 11:239–244

    Article  PubMed  CAS  Google Scholar 

  3. Addington D, Addington J, Atkinson M (1996) A psychometric comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale. Schizophr Res 19:205–212

    Article  PubMed  CAS  Google Scholar 

  4. Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. J Pers Soc Psychol 51:1173–1182

    Article  PubMed  CAS  Google Scholar 

  5. Barrowclough C, Haddock G, Beardmore R, Conrod P, Craig T, Davies L, Dunn G, Lewis S, Moring J, Tarrier N, Wykes T (2009) Evaluating integrated MI and CBT for people with psychosis and substance misuse: recruitment, retention and sample characteristics of the MIDAS trial. Addictive Behav (in press)

  6. Beck AT, Steer RA (1993) Beck Scale for Suicide Ideation. Harcourt Brace, San Antonio

  7. Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA (1990) Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry 147:190–195

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Beck AT, Weissman A, Lester D, Trexler L (1974) The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 42:861–865

    Article  PubMed  CAS  Google Scholar 

  10. Bertelsen M, Jeppesen P, Petersen L, Thorup A, Ohlenschlaeger J, Le Quach P, Christensen TO, Jorgensen P, Nordentoft M (2007) Suicidal behaviour and mortality in first episode psychosis: the OPUS trial. Br J Psychiatry 191(Suppl 51):140–146

    Article  Google Scholar 

  11. Blanchard J, Brown SA, Horan WP, Sherwood AR (2000) Substance use disorders in schizophrenia: review, integration, and a proposed model. Clin Psychol Rev 20(2):207–234

    Article  PubMed  CAS  Google Scholar 

  12. Bolton C, Gooding P, Kapur N, Barrowclough C, Tarrier N (2007) Developing psychological perspectives of suicidal behaviour and risk in people with a diagnosis of schizophrenia: we know they kill themselves but do we understand why? Clin Psychol Rev 27:511–536

    Article  PubMed  Google Scholar 

  13. Brown S (1997) Excessive mortality of schizophrenia. A meta-analysis. Br J Psychiatry 171(12):502–508

    Article  PubMed  CAS  Google Scholar 

  14. Caldwell C, Gottesman I (1990) Schizophrenics kill themselves too: a review of risk factors. Schizophr Bull 16(4):571–589

    PubMed  CAS  Google Scholar 

  15. Cleary M, Hunt GE, Matheson SL, Siegfried N, Walter G (2008) Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev (1). Art. No.: CD001088. doi:10.1002/14651858.CD001088.pub2

  16. Conner KR, Duberstein PR, Conwell Y, Seidlitz L, Caine ED (2001) Psychological vulnerability to completed suicide: a review of empirical studies. Suicide Life Threat Behav 31(4):367–385

    Article  PubMed  CAS  Google Scholar 

  17. Crumlish N, Whitty P, Kamali M, Clarke M, Browne S, McTigue O, Lane A, Kinsella C, O’Callaghan E (2005) Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder. Acta Psychiatr Scand 112:449–455

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. Drake RE, Gates C, Whitaker A, Cotton PG (1985) Suicide among schizophrenics: a review. Compr Psychiatry 26:90–100

    Article  PubMed  CAS  Google Scholar 

  20. Drake RE, Mueser KT (2000) Psychosocial approaches to dual diagnosis. Schizophr Bull 26(1):105–118

    PubMed  CAS  Google Scholar 

  21. 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

    PubMed  CAS  Google Scholar 

  22. Fenton WS (2000) Depression, suicide and suicide prevention in schizophrenia. Suicide Life Threat Behav 30:34–49

    PubMed  CAS  Google Scholar 

  23. Foa EB, Cashman L, Jaycox L, Perry K (1997) The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale. Psychol Assess 9:445–451

    Article  Google Scholar 

  24. Frame L, Morrison AP (2001) Causes of posttraumatic stress disorder in psychotic patients. Arch Gen Psychiatry 58(3):305–306

    Article  PubMed  CAS  Google Scholar 

  25. Gearon JS, Bellack AS, Tenhula WN (2004) Preliminary reliability and validity of the clinician-administered PTSD scale for schizophrenia. J Consult Clin Psychol 72:121–125

    Article  PubMed  Google Scholar 

  26. Harkavy-Friedman JM, Kimhy D, Nelson EA, Venarde DF, Malaspina D, Mann JJ (2003) Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry 64(8):871–874

    Article  PubMed  Google Scholar 

  27. Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ (2005) Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry 187:9–20

    Article  PubMed  Google Scholar 

  28. Johnson J, Gooding P, Tarrier N (2008) Suicide risk in schizophrenia: explanatory models and clinical implications: the schematic appraisal model of suicide (SAMS). Psychol Psychother 81:55–77

    Article  PubMed  Google Scholar 

  29. Kavanagh DJ, Waghorn G, Jenner L, Chant DC, Carr V, Evans M, Herrman H, Jablesnsky A, McGrath J (2004) Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophr Res 66:115–124

    Article  PubMed  Google Scholar 

  30. Kay SR, Opler LA, Lindenmayer JP (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    PubMed  CAS  Google Scholar 

  31. Kay SR, Opler LA, Lindenmayer JP (1988) Reliability and validity of the positive and negative syndrome scale for schizophrenia. Psychiatry Res 23:99–110

    Article  PubMed  CAS  Google Scholar 

  32. Kilcommons AM, Morrison AP (2005) Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatr Scand 112(5):351–359

    Article  PubMed  CAS  Google Scholar 

  33. Kontaxakis V, Havaki-Kontaxaki B, Margariti M, Stamouli S, Kollias C, Christodoulou G (2004) Suicidal ideation in inpatients with acute schizophrenia. Can J Psychiatry 49:476–479

    PubMed  Google Scholar 

  34. McGorry PD, Chanen A, McCarthy E, Van Riel R, McKenzie D, Singh B (1991) Posttraumatic stress disorder following recent onset psychosis: An unrecognized postpsychotic syndrome. J Nerv Ment Dis 179:253–258

    Article  PubMed  CAS  Google Scholar 

  35. McMillan D, Gilbody S, Beresford E, Neilly L (2007)  Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale? A meta-analysis. Psychol Med 37:769–778

    Article  PubMed  Google Scholar 

  36. Margolese HC, Malchy L, Negrete JC, Tempier R, Gill K (2004) Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences. Schizophr Res 67:157–166

    Article  PubMed  Google Scholar 

  37. Meyer H, Taiminen T, Vuori T, Aijala A, Helenius H (1999) Posttraumatic stress disorder symptoms related to psychosis and acute involuntary hospitalization in schizophrenic and delusional patients. J Nerv Ment Dis 187(6):343–352

    Article  PubMed  CAS  Google Scholar 

  38. Morrison AT, Frame L, Larkin W (2003) Relationships between trauma and psychosis: a review and integration. Br J Clin Psychol 42:331–354

    Article  PubMed  Google Scholar 

  39. Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher FC, Vidaver R, Auciello P, Foy DW (1998) Trauma and posttraumatic stress disorder in severe mental illness. J Clin Consult Psychol 66:493–499

    Article  CAS  Google Scholar 

  40. Mueser KT, Slayers MP, Rosenberg SD, Ford JD, Fox L, Carty P (2001) Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness. Psychol Assess 13(1):110–117

    Article  PubMed  CAS  Google Scholar 

  41. Mueser KT, Rosenberg SD, Jankowski MK, Hamblen J, Descamps M (2004) A cognitive-behavioural treatment program for posttraumatic stress disorder in persons with severe mental illness. Am J Psychiatr Rehabil 7:107–146

    Article  Google Scholar 

  42. Nieto E, Vieta E, Gasto C, Vallejo J, Cirera E (1992) Suicide attempts of high medical seriousness in schizophrenic patients. Compr Psychiatry 33(6):384–387

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  44. Panagioti M, Gooding P, Tarrier N (2009) Post-traumatic stress disorder and suicidal behaviour: a narrative review. Clin Psychol Rev 29:471–482

    Article  PubMed  Google Scholar 

  45. Picken A, Tarrier N (2010) Trauma and co-morbid PTSD in individuals with schizophrenia and substance abuse. (submitted for publication)

  46. Pinninti N, Steer RA, Rissmiller DJ, Nelson S, Beck AT (2002) Use of the Beck Scale for Suicide Ideation with psychiatric inpatients diagnosed with schizophrenia, schizoaffective or bipolar disorder. Behav Res Ther 40:1071–1080

    Article  PubMed  CAS  Google Scholar 

  47. Pratt D, Gooding P, Johnson J, Taylor P, Tarrier N (2010) Suicide schemas in non-affective psychosis: an empirical investigation. (submitted for publication)

  48. Preacher KJ, Hayes AF (2004) SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 36(4):717–731

    Google Scholar 

  49. Priebe S, Broker M, Gunkel S (1998) Involuntary admission and posttraumatic stress disorder symptoms in schizophrenia patients. Compr Psychiatry 39(4):220–224

    Article  PubMed  CAS  Google Scholar 

  50. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK (1990) Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. J Am Med Assoc 264:2511–2518

    Article  CAS  Google Scholar 

  51. Seedat S, Stein MB, Oosthuizen PP, Emsley RA, Stein DJ (2003) Linking posttraumatic stress disorder and psychosis. A look at epidemiology, phenomenology and treatment. J Nerv Ment Dis 191:675–681

    Article  PubMed  Google Scholar 

  52. Tarrier N (2005) Co-morbidity and associated clinical problem in schizophrenia: their nature and implications for comprehensive cognitive-behavioural treatment. Behav Change 22:125–142

    Article  Google Scholar 

  53. Tarrier N, Gregg L (2004) Suicide risk in civilian PTSD patients: predictors of suicidal ideation, planning and attempts. Soc Psychiatry Psychiatr Epidemiol 39:655–661

    PubMed  Google Scholar 

  54. Tarrier N, Barrowclough C, Andrews B, Gregg L (2004) Suicide risk in recent onset schizophrenia: the influence of clinical. Social, self-esteem and demographic factors. Soc Psychiatry Psychiatr Epidemiol 39:927–937

    Article  PubMed  Google Scholar 

  55. Tarrier N, Haddock G, Lewis S, Drake R, Gregg L, The Socrates Trial Group (2006) Suicide behaviour over 18 months in recent onset schizophrenic patients: the effects of CBT. Schizophr Res 83:15–27

    Article  PubMed  Google Scholar 

  56. Tarrier N, Khan S, Cater J, Picken A (2007) The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour. Soc Psychiatry Psychiatr Epidemiol 42:29–35

    Article  PubMed  Google Scholar 

  57. Tarrier N, Gooding P, Gregg L, Johnson J, Drake R, The Socrates Trial Group (2007) Suicide schema in schizophrenia: the effect of emotional reactivity, negative symptoms and schema elaboration. Behav Res Ther 45:2090–2092

    Article  PubMed  Google Scholar 

  58. Weaver T, Madden P, Charles V, Stimson G, Renton A, Tyrer P et al (2003) Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. Br J Psychiatry 183:304–313

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This research was funded by the Medical Research Council, UK as an ‘add on’ study to the MIDAS—Motivational Interventions for Drug and Alcohol misuse in Schizophrenia trial (Principal Investigator: Christine. Barrowclough; Co-Investigators: Tom Craig, Linda Davies, Graham Dunn, Gillian Haddock, Shon Lewis, Jan Moring, John Strang, Nicholas Tarrier and Til Wykes) and was submitted by Dr Picken in part fulfil of the requirement for a PhD in the School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester.

Author information

Authors and Affiliations

  1. Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK

    Nicholas Tarrier & Alicia Picken

Authors
  1. Nicholas Tarrier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alicia Picken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas Tarrier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tarrier, N., Picken, A. Co-morbid PTSD and suicidality in individuals with schizophrenia and substance and alcohol abuse. Soc Psychiatry Psychiatr Epidemiol 46, 1079–1086 (2011). https://doi.org/10.1007/s00127-010-0277-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-010-0277-0

Keywords

Search

Navigation