Service utilization and suicide among people with schizophrenia spectrum disorders
Introduction
People with schizophrenia spectrum disorders (SSD) have significantly higher rates of death by suicide compared with the general population (Bjorkenstam et al., 2014; Brugnoli et al., 2012; Fazel et al., 2014; Nordentoft et al., 2011, Nordentoft et al., 2004). Studies report a lifetime risk of 4–5% with evidence that risk of suicide is highest early in the course of illness (Bakst et al., 2010; Dutta et al., 2012; Fleischhacker et al., 2014; Palmer et al., 2005). Suicide is the leading cause of premature death in SSD, and identifying individuals with SSD who are at high risk for death by suicide is an important clinical, research and public health priority (Fleischhacker et al., 2014).
Epidemiological studies have identified population-based risk factors that are routinely incorporated into clinical assessments to identify, and intervene with, individuals at high risk of suicide. However, individuals with SSD may differ from the general population with respect to suicide risk factors and may require different types of suicide interventions. There are few studies that systematically compare those who die by suicide in SSD vs. other psychiatric diagnoses. Furthermore, the generalizability of existing studies is limited by small sample sizes, the use of clinical samples, and diagnoses made retrospectively through psychological autopsy (Banwari et al., 2013; Cavanagh et al., 2003; Lopez-Morinigo et al., 2014). Suicide is a rare outcome and a retrospective, population-based study and validated algorithm for diagnosis ascertainment allows for a rigorous analysis of the percentage of suicide victims with SSD and the differences in demographics, clinical features and mental health service utilization in those with and without a diagnosis of SSD.
The objective of this study was to examine the characteristics of those who die by suicide with and without SSD. Our hypothesis was that individuals with SSD would have a much larger suicide prevalence relative to best estimate of a population-based one-year prevalence rate of 0.6 (95% CI 0.38–0.91) and will have uniquely different suicide risk factors compared to individuals who die by suicide without SSD (Goldner et al., 2002).
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Data sources
Ontario is Canada's most populous province, with approximately 13 million people (Open Minds, Healthy Minds: Ontario's Comprehensive Mental Health and Addictions Strategy, 2011). The Ontario Ministry of Health and Long-Term Care provides coverage for all medically necessary services to residents and captures administrative data reflecting health care utilization. The Institute for Clinical Evaluative Sciences (ICES) holds these health administrative data sources which are linked via an
Cohort development
5697 suicides were identified from the ORG-D database and a further 219 were identified from other data sources in Ontario between January 1, 2008 and December 31, 2012 (Table 1). After excluding 1 case with a missing death date and 265 cases because they were not eligible for coverage under the OHIP in the 5 years prior to suicide death, there were 5650 suicide deaths included in this study, among whom 663 (11.7%) were associated with a diagnosis of schizophrenia, schizoaffective disorder or
Discussion
Over 1 in every 10 suicide deaths in Ontario over a five-year period are associated with a diagnosis of SSD. This estimate is likely the most accurate to date due to the large number of suicides over a large geographic area and duration, as well as the use of a validated algorithm designed to identify cases of SSD diagnosed both in hospital and in the community. SSD diagnoses are strongly overrepresented in those who die by suicide, as the prevalence of schizophrenia spectrum disorder in the
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On the relation of gyrification and cortical thickness alterations to the suicidal risk and mental pain in chronic schizophrenia outpatients
2021, Psychiatry Research - NeuroimagingPredictors of suicide at time of diagnosis in schizophrenia spectrum disorder: A 20-year total population study in Ontario, Canada
2020, Schizophrenia ResearchCitation Excerpt :People with schizophrenia spectrum disorders (SSD), including schizophrenia, schizoaffective disorder and psychotic disorder not otherwise specified (NOS), have significantly higher rates of death by suicide compared with the general population (Fazel et al., 2014; Kredentser et al., 2014; Nordentoft et al., 2015; Palmer et al., 2005; Popovic et al., 2014; Saha et al., 2007). Studies have reported a lifetime suicide risk in SSD of approximately 4–5%, with the highest risk occurring early in the illness (Bakst et al., 2010; Dutta et al., 2012; Fleischhacker et al., 2014; Zaheer et al., 2018). Identifying individuals at high risk for death by suicide to help prevent suicide is an important clinical, research and public health priority (Fleischhacker et al., 2014; Zaheer et al., 2018).