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.
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