SUICIDAL BEHAVIOR IN SCHIZOPHRENIA

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Suicide is a leading cause of death among patients with schizophrenia, with lifetime morbid risk estimates ranging from 16 to 40 times that of the general population. Epidemiologic studies of risk for suicide in schizophrenia have focused almost exclusively on gross demographic and clinical variables with specificity for predicting suicide risk. Comprehensive assessment of clinical, psychosocial, and environmental variables is needed to adequately identify and test putative predictors of risk for suicide in schizophrenia. No study to date has concurrently examined, using prospective study methods, the influence of psychopathology, psychosocial functioning, and environmental stressors on suicidal behavior in schizophrenia. Therefore, we propose to conduct a 2- year follow-up study of a well-characterized cohort of 200 DSM-III-R Schizophrenia Disorder patients, including 100 "high-risk" attempters, 50 "ideators", and 50 "low risk" non-suicidal patients. This study will assess risk for suicidal behavior associated with (1) clinical characteristics, including affective symptomatology and hopelessness--risk factors already identified in studies of suicide in affective disorders; and (2) psychosocial factors--interpersonal problem-solving skills, stressful life events, and social/familial factors such as high Expressed Emotion and social support. By adding a follow-up component to the ongoing cross-sectional and retrospective studies now supported by our Suicide MHCRC, this study will follow this unique and well-characterized cohort through the posthospital period when they are at highest risk for suicide. By following this unique and well-characterized patient sample, we will be able to differentiate state- and trait-related psychosocial and clinical risk factors and prospectively assess their relative importance in predicting suicidal behavior. This comprehensive study of clinical and psychosocial variables will provide an empirical basis for improved clinical risk assessment and for the development of clinically effective psychosocial treatment interventions.