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Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: a 20-year total population study in Ontario, Canada

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Background — Suicide is a major cause of mortality for individuals with schizophrenia spectrum disorders (SSD). Understanding the risk factors for suicide at time of diagnosis can aid clinicians in identifying people at risk.

Methods — Records from linked administrative health databases in Ontario, Canada were used to identify individuals aged 16 through 45 years who received a first lifetime diagnosis of SSD (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified (NOS)) using a validated algorithm between 01/01/1993 and 12/31/2010. The main outcome was death by suicide following cohort entry until 12/31/2012.

Outcomes — 75,989 individuals with a first SSD diagnosis (60.1% male, 39.9% female) were followed for an average of 9.56 years. During this period, 1.71% of the total sample (72.1% male, 27.9% female) died by suicide, after an average of 4.32 years. Predictors of suicide death included male sex (HR 2.00, 95% CI 1.76–2.27), age at diagnosis between 26 and 35 (HR 1.27, 95% CI 1.10–1.45) or 36–45 (HR 1.34, 95% CI 1.16–1.54), relative to 16–25, and suicide attempt (HR 2.23, 95% CI 1.86–2.66), drug use disorder (HR 1.21, 95% CI 1.04–1.41), mood disorder diagnosis (HR 1.32, 95% CI 1.17–1.50), or mental health hospitalization (HR 1.30 95% CI 1.13–1.49) in the 2 years prior to SSD diagnosis.

Interpretation — Death by suicide occurs in 1 out of every 58 individuals and occurred early following first diagnosis of SSD. Psychiatric hospitalizations, mood disorder diagnoses, suicide attempts prior to SSD diagnosis, as well as a later age at first diagnosis, are all predictors of suicide and should be integrated into clinical assessment of suicide risk in this population.

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Citation

Zaheer J, Olfson M, Mallia E, Lam JSH, de Oliveira C, Rudoler D, Carvalho AF, Jacob BJ, Juda A, Kurdyak P. Schizophr Res. 2020; 222:382-8. Epub 2020 June 2.

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