Risk Factors for Suicidality in Patients With Schizophrenia

A Systematic Review, Meta-analysis, and Meta-regression of 96 Studies

Ryan Michael Cassidy; Fang Yang; Flávio Kapczinski; Ives Cavalcante Passos


Schizophr Bull. 2018;44(4):787-797. 

In This Article


In summary, our study showed the risk factors associated with suicide ideation, suicide attempt, and suicide in patients with schizophrenia, indicating that suicidality in schizophrenia has a signature composed of several risk factors. The risk factors we identified, particularly for suicide attempts, in this population have compelling indications for clinical management. For example, effective treatment modality of substance use may be applied to reduce the risk of suicide attempts, as well as suicide in schizophrenia population. As we noted, patients with higher IQ were more vulnerable to suicide, better clinical strategies of suicide prevention may be implemented for the care of this group of patients. Further, despite the promising evidence that antipsychotic therapy may reduce suicidal risk, we found in our study a gap in the literature regarding effective reporting and cataloguing of this effect. It is likely that this is because of the relatively inconsistent use of the suicide risk-reducing antipsychotic clozapine; exposing this gap will provide impetus to use these medications as a suicide risk-reducing method when a schizophrenic patient presents with many of the risk factors detailed in our study. The difference in identified risk factors for suicide and suicide attempts necessitates further research on the biological and psychological underpinning of both processes. Future longitudinal studies examining the mechanism of how these variables are linked to suicidality might offer new insight into how to treat and prevent it. Future studies may combine these risk factors with machine learning techniques in order to objectively predict at an individual level suicide and suicide attempt in patients with schizophrenia.