Suicide in schizophrenia. A review of the literature

This article reviews research from the 1960s to the present pertaining to suicide in people suffering with schizophrenia. An attempt has been made to examine suggested risk factors and generate recommendations for management, with particular attention to recent Department of Health guidelines regarding the care of the severely mentally ill. The literature was reviewed using Medline and PsychInfo, supplemented with a manual literature search. The studies reviewed were of variable quality. Many were limited by small numbers, lack of control groups and diagnostic heterogeneity. In combination with the low base-rate of suicide, and the relative homogeneity within groups of patients with schizophrenia, prediction remains problematic. Current initiatives suggest increased supervision of the at-risk population with little emphasis on attempting to reduce suicidal intent. There remains a need for continuing research into this difficult area of management. Specific areas for consideration include the management of hopelessness and depression in this group of patients, and the effect of the environment. The effect of the living environment, as well as the ongoing reductions in in-patient hospital beds and the current emphasis on increased turnover merit reappraisal.