Suicidality and Its Association with Stigma in Clinically Stable Patients with Schizophrenia in Rural China

Patients with schizophrenia not only experience more stigma than those with other mental illnesses, but they also have a higher risk of committing suicide. There are, however, few research on the connection between rural individuals with clinically stable schizophrenia and suicidality when they feel stigmatized. Therefore, the purpose of this study was to look at the suicidality in clinically stable patients with schizophrenia in rural China, including the prevalence, clinical correlates, and its relationships with stigma.

From September 2022 to October 2022, we conducted a multicenter, cross-sectional study in rural Chaohu, Anhui Province, China, and A total of 821 patients with schizophrenia completed the assessment. Three standardized questions were used to assess suicidality (including suicidal ideation, suicide plan, and suicide attempt), Patient Health Questionnaire with 9 items (PHQ-9) for determining depressive state, the first two items of the World Health Organization Quality of Life Questionnaire-Brief Version (QOL), which measures quality of life, the Social Impact Scale (SIS) to assess stigma, and some other important variables (eg employment, psychiatric medication, etc.) were measured using a homemade scale.

Of the 821 participants who completed the questionnaire, 19.2% of the patients were found to have suicidality, of which 19.2% (158/821) were suicidal ideation, 5.6% (46/821) were suicide plans and 4.5% (37/821) were suicide attempts. Binary logistic regression analysis showed that job status (OR=0.520, p=0.047), psychiatric medication (OR=2.353, p=0.020), number of hospitalizations (OR=1.047, p=0.042), quality of life (OR=0.829, p=0.027), PHQ-9 (OR=0.209, p<0.001) stigma (OR=1.060, p<0.001) and social isolation in stigma (OR=1.134, p=0.001) were associated independently with suicidality.

Among clinically stable schizophrenia patients in rural China, suicidality is frequent and associated with stigma. Since stigma and some risk factors have a negative impact on suicidality, we should conduct routine screening and take suicide prevention measures to clinically stable schizophrenia patients in rural areas of China.