Suicide in schizophrenia: an observational study of coroner records in Toronto

Suicide is an important cause of premature mortality in people suffering from schizophrenia. This study aimed to identify demographic, personal, and suicide-specific features that distinguish suicide in people with schizophrenia from those with another severe mental illness (bipolar disorder) and those with neither illness.

We conducted a coroner's chart review for 2,886 suicide victims in Toronto from 1998 to 2010. Diagnoses were made based on coroner interviews with available informants including family members, acquaintances, the deceased's physician(s) and/or review of medical records. Of the total, 258 formed what we defined as the schizophrenia group (204 schizophrenia, 34 unspecified psychotic illness, and 20 schizoaffective disorder). Of the remainder, 169 had bipolar disorder, and 2,459 had neither illness. One-way analysis of variance (ANOVA) tests and χ² tests were conducted to examine differences between the groups.

The group with schizophrenia was the youngest (mean age for schizophrenia, 41.0 years; bipolar disorder, 43.3 years; and neither, 47.7 years; P < .001), most likely to have never been married (schizophrenia, 75.6%; bipolar disorder, 57.4%; and neither, 52.9%; P < .001), most likely to be living in temporary/assisted housing or jail (schizophrenia, 9.3%; bipolar disorder, 5.4%; and neither, 3.2%; P < .001), and least likely to have experienced a recent stressor (schizophrenia, 26.7%; bipolar disorder, 37.9%; and neither, 54.1%; P < .001). The schizophrenia group was the most likely to use a violent cause of death, specifically by fall from a height or by jumping in front of a vehicle (schizophrenia, 81.4%; bipolar disorder, 58.0%; and neither, 73.1%; P < .001).

There are important demographic and suicide-related differences between suicide victims with and without schizophrenia. Notably, suicide in schizophrenia overall appears to be more illness driven and occurs by more violent means than in the bipolar disorder group or those with neither illness.