Schizophrenia Suicide Rate: How To Address Risk

Suicide prevention in schizophrenia

Many people with schizophrenia spectrum disorders experience comorbid depression. Mood disorders and psychotic disorders also tend to be associated with increased suicide attempts. Many risk factors can cause someone to want to end their life, but a key factor may be overwhelming psychological pain. Around 700,000 people die by suicide each year, making suicide prevention a global priority. Suicide prevention for people with schizophrenia usually involves a thorough understanding of risk factors, as well as therapy and other forms of treatment for addressing psychotic symptoms and depression.

Help available for mental health and suicide prevention

If you or a loved one are experiencing thoughts of suicide, please know that help is available. You can call the National Suicide Prevention Lifeline anytime, 24/7, at 988.

Schizophrenia suicide rate and risk in people with schizophrenia

Common suicide risk factors and schizophrenia suicide rate

Other figures suggest that between 25% and 50% of those with schizophrenia may attempt suicide at some point in their lives. Risk factors can include the following:

• Being a younger adult*
• Being unmarried
• Living alone
• Unemployment
• Higher intelligence
• High functioning in premorbid state
• High expectations and hopes
• Believing that expectations and hopes are unlikely to be met
• Recent, stressful life events 
• Poor work functioning
• Substance misuse
• Attainability of a firearm(s)
• Awareness of psychotic symptoms, such as delusions
• Awareness of asociality, anhedonia, blunted affect, and other symptoms of schizophrenia
• Negative feelings about treatment
• Non-adherence to treatment
• A previous suicide attempt 
• First psychotic break occurrence
• Adverse childhood experiences

Long-term risks in people with schizophrenia

The first decade of living with the disorder usually presents the highest risk, but this risk may continue throughout the lives of schizophrenia patients. Moreover, people with schizophrenia who have comorbid depression and a history of suicidal behavior can also present a significant risk for suicidality. Researchers have noted that being single and unemployed can apply to many people with schizophrenia, potentially complicating the analysis of these risk findings. 

*The World Health Organization (WHO) lists suicide as the fourth leading cause of death among those who are 15 to 29 years old. 

Other early risk factors in schizophrenia

Other risk factors in the early course of schizophrenia can include those listed below:

• Early onset of psychotic symptoms
• Being female
• Depressive symptoms
• Suicidal ideation and plans
• Having a history of suicide attempts
• Severity of symptoms
• Emotional trauma
• Insight into one's condition
• Having several psychiatric admissions
• Recurrent relapses
• Experiencing delusions
• Lack of adherence to antipsychotic medication
• Having what was previously referred to as the paranoid subtype of schizophrenia*
• Aversion to hospital admissions
• A sense of demoralization

*The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) no longer lists paranoid schizophrenia as a subtype. 

Depression symptoms

According to the Schizophrenia Bulletin, the prevalence of depressive disorders in schizophrenia patients is around 40%. Acute episodes and early-phase schizophrenia are generally linked with a higher prevalence of depression. Depression can be considered the most significant factor for suicide, with implications for quality of life and poorer outcomes in schizophrenia. 

Mood symptoms in schizophrenia

The Bulletin contends that effective treatment of schizophrenia should include attention to mood symptoms. The Calgary Depression Scale for Schizophrenia (CDSS) assesses depression as being separate from negative symptoms, using self-reported measures of hopelessness, guilt, and suicidal ideation. However, researchers note that there can be common features in both depression and negative symptoms, such as social withdrawal, low motivation, and reduced ability to experience pleasure. 

Suicidal ideation and suicide risk

Suicidal ideation may be described as thoughts, plans, contemplations, wishes, and preoccupation around death and suicide. Suicidal ideation can greatly vary in duration, nature, and intensity, potentially complicating its risk assessment.

Suicidal ideation: Active vs. passive

Some researchers contend that "suicidality should be regarded as a distinct psychiatric diagnosis.” Ideation may be passive or active. Active suicidal ideation usually relates to concrete plans to end one's life, whereas passive ideation typically refers to a general wish to die without a concrete plan to do so. 

Suicide risk in early psychosis

Research findings suggest that those with schizophrenia spectrum psychosis who expressed suicidal ideations "had over a six-fold increase of suicide." Moreover, studies suggest that suicide risk tends to be significantly greater during a person's first psychotic break. At this time, suicidal ideation may quickly escalate to a suicide attempt. A delay in receiving treatment can be a contributing factor in increasing that risk. 

The International Suicide Prevention Trial

The International Suicide Prevention Trial (InterSePT) was a two-year study designed to assess the potential use of antipsychotic medications to reduce the risk of suicidal behaviors in individuals with schizophrenia or schizoaffective disorder. Noting that approximately 50% of people with these mental health disorders could attempt suicide at some point, the study included 980 participants, 26.8% of whom were considered high-risk due to a previous suicide attempt or suicidal ideation. The study's findings suggest that treatment with antipsychotic medications "significantly reduces suicidal behavior in these patients." However, updated research may be needed to confirm these findings. Always speak to your doctor or psychiatrist before starting, stopping, or changing the way you take any form of medication.

Attempted suicide findings 

According to the WHO, "for every suicide there are many more people who attempt suicide." Researchers have noted that suicide attempts can greatly affect communities, families, and societies. Some estimate that for every death by suicide, there may be 10 to 15 attempts. Studies also suggest that the vast majority of people who attempt or die by suicide have a mental health condition, with mood and psychiatric disorders being the main associated conditions. 

Mental health and suicide prevention

Navigating feelings of hopelessness and deep sadness can be distressing and isolating, but help is available. Speaking with a licensed therapist can foster improved mental health and help individuals manage symptoms of depression.

Online therapy options for schizophrenia and mental health

If in-person therapy is not convenient, you may want to consider online therapy. A platform like BetterHelp can enable you to connect with a therapist by phone, video, or online chat, depending on your preferences and comfort level. 

A study of 58 individuals with schizophrenia who participated in an online depression intervention indicated that "participants in the treatment group showed a significant decline of depressive symptoms at a medium-to-large effect size." Please note that individuals currently experiencing acute psychotic symptoms may need to seek in-person care.