The Prevalence of Suicide Attempts and Independent Demographic and Clinical Correlates among Chronic Schizophrenia Patients in Agricultural Areas of China
- 23 Downloads
This study investigated the lifetime prevalence of suicide attempts (SA) and independent demographic and clinical correlates in stabilized schizophrenia inpatients. A cross-sectional study was conducted in three psychiatric hospitals in Anhui province, an agricultural province located in east China. Psychopathology and depressive symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAMD), respectively. A total of 315 stable schizophrenia inpatients were interviewed prior to discharge. The lifetime prevalence of SA was 22.2%. Multiple logistic regression analysis revealed that female gender (P < 0.001, OR = 3.4, 95%CI: 1.9–6.0), being married (P = 0.02, OR = 2.2, 95%CI: 1.1–4.4) and having more severe depressive symptoms (P = 0.014, OR = 1.2, 95%CI: 1.01–1.3) were independently and significantly associated with higher risk of SA. Lifetime SA is common among hospitalized schizophrenia patients living in agricultural areas of China. For suicide prevention, regular assessments, appropriate interventions and clinical management should be integrated into a community-based psychiatric service model for this population.
KeywordsSchizophrenia Suicide Risk factors China
The study was supported by the National Natural Science Foundation of China (No. 81771449), the Anhui Province Key Scientific and Technological Projects (1804 h08020263).
Compliance with Ethical Standards
Conflict of Interest
The authors have no conflicts of interest concerning this article.
Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005;62(3):247–53.Google Scholar
- 2.Fialko L, Freeman D, Bebbington PE, Kuipers E, Garety PA, Dunn G, et al. Understanding suicidal ideation in psychosis: findings from the psychological prevention of relapse in psychosis (PRP) trial. Acta Psychiatr Scand. 2006;114(3):177–86. https://doi.org/10.1111/j.1600-0447.2006.00849.x.Google Scholar
- 4.Nordentoft M, Mortensen PB, Pedersen CB. Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry. 2011;68(10):1058–64. https://doi.org/10.1001/archgenpsychiatry.2011.113.Google Scholar
- 8.Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56(7):617–26.Google Scholar
- 10.De Leo D, Cerin E, Spathonis K, Burgis S. Lifetime risk of suicide ideation and attempts in an Australian community: prevalence, suicidal process, and help-seeking behaviour. J Affect Disord. 2005;86(2–3):215–24.Google Scholar
- 11.Drake RE, Gates C, Whitaker A, Cotton PG. Suicide among schizophrenics: a review. Compr Psychiatry. 1985;26(1):90–100.Google Scholar
- 12.Harkavy-Friedman JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, et al. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. A. J Psychiatry. 1999;156(8):1276–8.Google Scholar
- 13.Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA. 2005;293(20):2487–95.Google Scholar
- 14.Cao X-L, Zhong B-L, Xiang Y-T, Ungvari GS, Lai KY, Chiu HF, et al. Prevalence of suicidal ideation and suicide attempts in the general population of China: a meta-analysis. Int. J. Psychiatry Med. 2015;49(4):296–308.Google Scholar
- 15.Phillips MR, Zhang J, Shi Q, Song Z, Ding Z, Pang S, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey. Lancet. 2009;373(9680):2041–53.Google Scholar
- 18.Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients. J Psychiatr Res. 2008;42(6):495–502.Google Scholar
- 19.Yan F, Xiang YT, Hou YZ, Ungvari GS, Dixon LB, Chan SS, et al. Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol. 2013;48(3):447–54. https://doi.org/10.1007/s00127-012-0555-0.Google Scholar
- 21.Ran MS, Xiang MZ, Mao WJ, Hou ZJ, Tang MN, Chen EY, et al. Characteristics of suicide attempters and nonattempters with schizophrenia in a rural community. Suicide Life Threat Behav. 2005;35(6):694–701.Google Scholar
- 22.Gao Q, Fan H, Di F, Xia X, Long H, Zhu H. Suicide behaviors in adult inpatients with mental disorders in Beijing, China. Int J Environ Res Public Health. 2017;14(3). https://doi.org/10.3390/ijerph14030259.
- 23.Yang KJ, Xiao SY, Li XW, Liao CP, Lai J. Comparative study of schizophrenic patients who committed suicide or self-injurious behaviours during hospitalization. Sichuan Mental Health. 2015;28(05):430–5.Google Scholar
- 24.Dong M, Wang SB, Wang F, Zhang L, Ungvari GS, Ng CH, et al. Suicide-related behaviours in schizophrenia in China: a comprehensive meta-analysis. Epidemiol Psychiatr Sci. 2017:1–10. https://doi.org/10.1017/S2045796017000476.
- 27.World Health Organisation. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva 1992.Google Scholar
- 28.Kay SR, Opler LA, Lindenmayer JP. Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Res. 1988;23(1):99–110.Google Scholar
- 31.Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.Google Scholar
- 32.Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychol. 1979;47(2):343–52.Google Scholar
- 33.Fenton WS, McGlashan TH, Victor BJ, Blyler CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. A J Psychiatry. 1997;154(2):199–204.Google Scholar
- 34.Sorenson SB, Knight K. Suicide in schizophrenia. J Clin Psychiatry. 1986;47(11):570–1.Google Scholar
- 35.Bolton C, Gooding P, Kapur N, Barrowclough C, Tarrier N. 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. 2007;27(4):511–36. https://doi.org/10.1016/j.cpr.2006.12.001.Google Scholar
- 38.Canetto SS. Meanings of gender and suicidal behavior during adolescence. Suicide Life Threat Behav. 1997;27(4):339–51.Google Scholar
- 39.Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med. 1999;29(1):9–17.Google Scholar
- 41.Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav. 1998;28(1):1–23.Google Scholar
- 42.Phillips MR, Li X, Zhang Y. Suicide rates in China, 1995-99. Lancet. 2002;359(9309):835–40.Google Scholar
- 45.Law S, Liu P. Suicide in China: unique demographic patterns and relationship to depressive disorder. Curr Psychiatry Rep. 2008;10(1):80–6.Google Scholar
- 46.Phillips MR, Yang G, Li S, Li Y. Suicide and the unique prevalence pattern of schizophrenia in mainland China: a retrospective observational study. Lancet. 2004;364(9439):1062–8.Google Scholar
- 48.Isaac M, Chand P, Murthy P. Schizophrenia outcome measures in the wider international community. Br J Psychiatry Suppl. 2007;50:s71–7.Google Scholar
- 51.Black DW, Winokur G. Age, mortality and chronic schizophrenia. Schizophr Res. 1988;1(4):267–72.Google Scholar
- 52.Warnes H. Suicide in schizophrenics. Dis Nerv Syst. 1968;29(5):Suppl):35–40.Google Scholar
- 53.Altamura AC, Bassetti R, Bignotti S, Pioli R, Mundo E. Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res. 2003;60(1):47–55.Google Scholar