Editorial Comment

Alpha Psychiatry 2022;23(1):26

DOI: 10.5152/alphapsychiatry.2022.2201011

Suicide Attempts in Schizophrenia and Their Relationship to Depression, Insight and Stigma

Om Prakash Singh

¹ MD, FRCPE, Distinguished Fellow American Psychiatric Association (APA), Hon. Editor, Indian Journal of Psychiatry (IJP), Consultant-AMRI group of hospitals

Corresponding author: Om Prakash Singh ✉ opsingh.nm@gmail.com

Cite this article as: Singh OP. Suicide attempts in schizophrenia and their relationship to depression, insight and stigma. Alpha Psychiatry. 2022;23(1):26.

People with schizophrenia have increased mortality and morbidity than the general population. There can be various reasons including death from non-communicable diseases, suicide, and accidents. The lifetime risk of suicide is around 5%. While some of the risk factors were similar to the general population, the disease-specific risk factors have been described as the young, male, higher levels of education, presence of insight, depressive symptoms, prior suicidal attempts, and co-morbid substance use.¹

People who got discharged from the hospital after 1st episode of schizophrenia and not on antipsychotics have 12 times increased risk of all-cause death and 37 fold increase in death rates by suicide.² The presence of insight and stigma has been implicated in this increase in mortality by suicide.

This issue article by Koçak et. al. has tried to identify some of the risk factors which has been implicated.³ Though the suicide attempts were found more in the males, interestingly suicidal ideation was found equal in both the sexes. The presence of depressive symptoms was associated with increased suicidal ideation and attempt. No significant difference was noted between people with schizophrenia having suicidal ideation and people who attempted suicide. Internalized stigma was significantly higher in persons having suicidal ideation.

The study raises some relevant points and tries to search for links between various factors leading to the suicide attempt. Identifying the risk factors for suicide is crucial for overall management. The finding of no significant relationship between insight and high correlation with internalized stigma raises important research questions like whether insight increases internalized stigma and whether this is the probable mechanism for suicidal ideation.

Insight has different levels: awareness of the course, outcome, and prognosis lead to hopelessness and helplessness resulting in an increase in suicidal ideation. Revisiting the prognostic factors of the DSM 5 or ICD 10 defined schizophrenia will be a significant step because the prognosis is much better than what is traditionally defined for schizophrenia. Furthermore, decreasing internalized stigma at the same time with an increase in insight is a major implication of this study and has significant management implications.

References

  1. Hor, K, & Taylor, M. (2010). Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol, 24, 4, suppl, 81-90, (https://doi.org/10.1177/1359786810385490).

  2. Tiihonen, J, Wahlbeck, K, & Lonnqvist, J. (2006). Effectiveness of antipsychotic treatments in a nationwide cohort of 2230 patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow up study. Br Med J, 333, (https://doi.org/10.1136/bmj.38881.382755.2F).

  3. Koçak, MB, Şahin, AR, Güz, H, Böke, Ö, Sarısoy, G, & Karabekiroğlu, A. (2022). The relationship between suicide attempts and ideation with depression, insight, and internalized stigmatization in schizophrenia. Alpha Psychiatry, 23, 1, 18-25.

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