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Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case-control study

Lopez-Morinigo, J-D; Ayesa-Arriola, R; Torres-Romano, B; Fernandes, AC; Shetty, H; Broadbent, M; Dominguez-Ballesteros, M-E; ... Dutta, R; + view all (2016) Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case-control study. BMJ Open , 6 (9) , Article e011929. 10.1136/bmjopen-2016-011929. Green open access

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Abstract

OBJECTIVES: To investigate the role of risk assessment in predicting suicide in patients with schizophrenia spectrum disorders (SSDs) receiving secondary mental healthcare. We postulated that risk assessment plays a limited role in predicting suicide in these patients. DESIGN: Retrospective case-control study. SETTING: Anonymised electronic mental health record data from the South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM) (London, UK) linked with national mortality data. PARTICIPANTS: In 242 227 SLaM service users up to 31 December 2013, 635 suicides were identified. 96 (15.1%) had a SSD diagnosis. Those who died before 1 January 2007 (n=25) were removed from the analyses. Thus, 71 participants with SSD who died from suicide over the study period (cases) were compared with 355 controls. MAIN OUTCOME MEASURE: Risk of suicide in relation to risk assessment ratings. RESULTS: Cases were younger at first contact with services (mean±SD 34.5±12.6 vs 39.2±15.2) and with a higher preponderance of males (OR=2.07, 95% CI 1.18 to 3.65, p=0.01) than controls. Also, suicide occurred within 10 days after last contact with services in half of cases, with the most common suicide methods being hanging (14) and jumping (13). Cases were more likely to have the following 'risk assessment' items previously recorded: suicidal history (OR=4.42, 95% CI 2.01 to 9.65, p<0.001), use of violent method (OR=3.37, 95% CI 1.47 to 7.74, p=0.01), suicidal ideation (OR=3.57, 95% CI 1.40 to 9.07, p=0.01) and recent hospital discharge (OR=2.71, 95% CI 1.17 to 6.28, p=0.04). Multiple regression models predicted only 21.5% of the suicide outcome variance. CONCLUSIONS: Predicting suicide in schizophrenia is highly challenging due to the high prevalence of risk factors within this diagnostic group irrespective of outcome, including suicide. Nevertheless, older age at first contact with mental health services and lack of suicidal history and suicidal ideation are useful protective markers indicative of those less likely to end their own lives.

Type: Article
Title: Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case-control study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2016-011929
Publisher version: http://dx.doi.org/10.1136/bmjopen-2016-011929
Language: English
Additional information: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Keywords: Risk assessment, Schizophrenia, Secondary mental healthcare, Suicide, Adult, Aged, Case-Control Studies, Female, Humans, Male, Mental Health Services, Middle Aged, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Risk Factors, Schizophrenia, Suicide, Young Adult
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10063337
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