Incidence of suicide in a research study of first episode schizophrenia

One of the most serious potential complications of schizophrenia is the increased incidence of suicide in this population. Almost 25% of patients with schizophrenia will make a suicide attempt and 10% of patients will successfully suicide. The majority of patients with schizophrenia who commit suicide do so relatively early in their illness. Previous evaluations of these data have revealed a mean of 4.8 years of illness for males and 9.8 years of illness for females prior to their death. We have studied 150 first episode patients with schizophrenia prospectively through the course of the first 5 years of their illness, beginning in 1986. There has been only one suicide by a patient in this group. This patient had dropped out of the study after 3 years. The reason for this low incidence of suicide needs to be examined. There is data that suggests that patients with schizophrenia are less likely to commit suicide during their first episode. This cohort of patients were followed for 5 years or longer. Further, patients in the study were ill for an average of 71 weeks prior to study entry. The selection bias of a research study may be involved in that patients who consent to a study may be different than a general population of schizophrenic patients. Thirdly, participation in a research study, with increased efforts of research staff, increased frequency of patient contact and improved follow up may decrease the number of patientsʹ suicide attempts. This suggests that close monitoring of patientsʹ progress may decrease the incidence of suicide in patients with schizophrenia. The incidence of suicidal ideation in this population will be examined and its correlation with treatment response, education level, insight and the deficit state will be evaluated.