Suicide Risk Assessment in Schizophrenia Patients Improving

Megan Brooks

November 05, 2013

Rates of suicide risk assessment in patients with schizophrenia appear to be increasing, but there is still room for improvement, new research suggests.

A population-based study by Danish researchers shows that systematic suicide risk assessment prior to discharge from inpatient psychiatric wards has increased in recent years, but "additional efforts appear warranted" to ensure that all patients are screened for suicide risk.

Suicide prevention in patients with schizophrenia is a "key goal" in psychiatry because of the increased risk for suicidal behavior in this population, investigators led by Charlotte Gjørup Pedersen, PhD, from Aalborg Psychiatric Hospital in Denmark, write.

The study was published online November 1 in Psychiatric Services.

It is estimated that 80% of individuals with schizophrenia have suicidal thoughts. Further, as many as 60% make at least 1 suicide attempt, and 5% to 7% eventually die by suicide.

International and Danish clinical guidelines recommend suicide risk assessment as part of the care of schizophrenia patients, but "little is known about the implementation of suicide risk assessment in routine clinical practice," the researchers note.

To investigate, they conducted a 1-year follow-up study of 9745 patients with schizophrenia who were discharged from psychiatric wards and who were registered in a national schizophrenia registry between 2005 and 2009.

They found that the proportion of patients assessed at discharge for suicide risk increased steadily during the study period, from 72% (95% confidence interval [CI], 71% - 74%) in 2005, when Danish national monitoring started, to 89% (95% CI, 89% - 90%) in 2009.

Suicide risk assessment was less likely in men and in adults older than 30 years.

Within 12 months of discharge, 1% of all registered patients had died by suicide and 8% had attempted suicide.

"One out of three patients who died by suicide had no documented suicide risk assessment before discharge," the researchers write.

Strengths of the study include use of a national population-based schizophrenia registry, prospective data collection on suicide risk assessment from all Danish psychiatric wards, and the availability of data on a wide variety of covariates.

The dichotomous "yes-no" suicide risk assessment in the registry is a limitation, one that may not have captured whether the assessment was carefully conducted in all situations.

On the basis of these findings, the researchers believe additional efforts are needed to ensure that suicide risk is assessed in all patients with schizophrenia before discharge and that appropriate measures are taken to lower the risk for suicidal behavior in this at-risk population.

The authors have disclosed no relevant financial relationships.

Psychiatr Serv. Published online November 1, 2013. Abstract

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