Prevalence and clinical correlates of suicidal ideation and aggression in patients with chronic schizophrenia: large-scale, cross-sectional study

Aggression has been closely linked to suicidal ideation in schizophrenia (SCZ). However, whether its correlates differ by suicidal ideation status remains unclear.

This study aimed to assess the prevalence of aggression and compare the clinical correlates and predictive models of aggression in chronic SCZ patients with and without suicidal ideation.

A total of 659 chronic SCZ patients were recruited from 10 psychiatric hospitals in China. A brief interview assessed the presence of suicidal ideation in patients. Participants were assessed using the Insomnia Severity Index, Hamilton Depression Rating Scale, Modified Overt Aggression Scale and Positive and Negative Syndrome Scale.

SCZ patients with suicidal ideation exhibited a higher prevalence of aggression than those without (39.46 v. 22.15%, p < 0.001). Regardless of suicidal ideation status, patients with aggression were younger and presented with more severe clinical symptoms across multiple domains, except for negative symptoms which showed differential associations between groups. Among patients with suicidal ideation, those exhibiting aggression had a higher proportion of females and lower body mass index. Logistic regression analysis indicated that, in patients without suicidal ideation, male gender was an independent risk factor for aggression (odds ratio 1.856) whereas milder negative symptoms acted as a protective factor. In patients with suicidal ideation, positive and general psychopathology symptoms were positively associated with aggression whereas negative symptoms retained a protective effect.

Our findings suggest that aggression is more prevalent in patients with suicidal ideation, and its clinical correlates differ significantly based on suicidal ideation status. Stratified assessment of aggression risk considering suicidal ideation is warranted.