Increased Risk for Death by Suicide in Young Adults With Schizophrenia

A retrospective longitudinal study found an increased risk for suicide among young people with schizophrenia, indicating a need for suicide prevention programs, according to the results of a study published in JAMA Psychiatry.

Data were sourced by researchers from Medicare beneficiaries. Between 2007 and 2016, individuals who had at least 2 outpatient visits or at least 1 inpatient visit for schizophrenia within 365 days were assessed for death by suicide.

A total of 668,836 recipients of Medicare fit the inclusion criteria. Participants were 52.5% men, 63.4% were White, 43.1% had chronic pain conditions, 41.5% had comorbid depressive disorder, and 9.7% had suicidal ideation.

The expected suicide rate was 16.31 per 100,000 person-years (py), which was lower than the observed rate of 74.00 per 100,000 py. Among all individuals, the standardized mortality rate (SMR) from suicide was 4.54 (95% CI, 4.35-4.73).

Stratified by age group, death from suicide was highest among those aged 18 to 34 years (SMR, 10.19; 95% CI, 9.26-11.18) and decreased with age to the lowest rate observed among individuals 65 years (SMR, 1.53; 95% CI, 1.32-1.77) and older.

Stratified by gender, suicide was higher among women (SMR, 8.16; 95% CI, 7.60-8.75) than men (SMR, 3.39; 95% CI, 3.22-3.57). This difference was due to the fact that women had a much lower expected rate (6.90 vs 26.26 per 100,000 py) but not observed rate (56.33 vs 88.96 per 100,000 py) compared with men, respectively.

The suicide rate was particularly high among individuals with a history of suicide attempt or self-injury (535.4 per 100,000 py), suicidal ideation (248.0 per 100,000 py), who were hospitalized for substance use (227.5 per 100,000 py), had drug use disorders (181.6 per 100,000 py), and alcohol use disorder (176.9 per 100,000 py).

Suicide risk was increased among those with a past suicide attempt (adjusted hazard ratio [aHR], 2.48; 95% CI, 2.06-2.98), drug use disorder (aHR, 1.55; 95% CI, 1.36-1.76), admission to the hospital (aHR, 1.47; 95% CI, 1.24-1.74), men (aHR, 1.44; 95% CI, 1.29-1.61), suicidal ideation (aHR, 1.41; 95% CI, 1.22-1.63), visit to the emergency department (aHR, 1.40; 95% CI, 1.20-1.62), depressive disorder (aHR, 1.32; 95% CI, 1.17-1.50), sleep disorder (aHR, 1.22; 95% CI, 1.07-1.39), and anxiety disorder (aHR, 1.15; 95% CI, 1.02-1.30).

This study may have been limited because the investigators had no means of validating the accuracy of the diagnosis of schizophrenia or the cause of death.

These data indicated that young adults with schizophrenia were associated with increased suicide rates compared with the general population.

Disclosure: One author declared affiliations with biomedical, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Olfson M, Stroup TS, Huang C, Wall MM, Crystal S, Gerhard T. Suicide risk in Medicare patients with schizophrenia across the life span. JAMA Psychiatry. Published online May 26, 2021. doi:10.1001/jamapsychiatry.2021.0841