Schizophrenia linked with higher rates of violence, suicide, and early mortality

1. Within the first five years of diagnosis with schizophrenia or a related psychotic disorder, patients were at a much higher likelihood of experiencing an adverse outcome such as an episode of violence, suicide, or death.

2. Pre-diagnosis drug use disorders, criminality, and self-harm were three factors predictive of an adverse outcome in patients. 

Evidence Rating Level: 3 (Average)

Study Rundown: Individuals with schizophrenia or other psychotic disorders are at an increased risk for violence, suicide, and early mortality. The risk factors associated with these increased likelihoods have not been clearly elucidated. The authors of this study set out to define the rates of adverse outcomes in patients with schizophrenia and related disorders and compared these rates with the general population and unaffected siblings. Additionally, they attempted to define risk factors, such as pre-diagnosis drug use, criminality, and self-harm, with an association to adverse outcomes in schizophrenia in order to help design clinically relevant protocols for identifying at-risk patients. Strengths of this study include the analysis of risk factors between patients and unaffected siblings and the general population, as this is the first study to date to undertake this type of comparison. Additionally, the stipulation that patients must have two episodes with a diagnosis of schizophrenia or another related psychotic disorder in order to be included in the study accommodated for the high degree of false diagnosis and change in diagnostic criteria that had occurred over the period of study. The generalizability may be limited by the fact that it was undertaken in only 1 country with a very specific racial and ethnic make-up.

The study was funded by Wellcome Trust and the Swedish Research Council.

Click to read the study, published today in the Lancet

Relevant Reading: A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?

In-Depth [case-control]: This study included 24,297 individuals from five linked Swedish population registers with a diagnosis of schizophrenia or another related disorder made between January, 1972 and December, 2009. Subjects were compared with sex and age matched individuals from either the general population or siblings without a diagnosis of schizophrenia.

Within this group the mean ages of first diagnosis were 28.8 years (standard deviation, SD 7.6) in men and 29.8 years (SD 8.3) in women. Within the first 5 years after diagnosis 13.9% of men and 4.7% of women had major adverse outcomes (violence, suicide, or death). The odds ratios of any adverse outcome were 7.5 (95% confidence interval, CI, 7.2-7.9) in men and 11.1 (95% CI, 10.2-12.1) in women for patients as compared to the general population. The adjusted odds ratio was 8.1 (95% CI, 7.6-8.6) for premature death. The adjusted odds ratio was 20.7 (95% CI 18.8-22.9) for suicide. The adjusted odds ratio was 7.4 (95% CI, 7.1-7.8) for violent offences.

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