Incidence and method of suicide mortality in patients with schizophrenia: a Nationwide Cohort Study
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ORIGINAL PAPER
Incidence and method of suicide mortality in patients with schizophrenia: a Nationwide Cohort Study Chun‑Hung Pan1,2 · Pao‑Huan Chen3,4 · Hu‑Ming Chang2 · I‑Shuan Wang2 · Yi‑Lung Chen2,5 · Sheng‑Siang Su2 · Shang‑Ying Tsai3,4 · Chiao‑Chicy Chen3,6,7 · Chian‑Jue Kuo2,3,4,8 Received: 16 July 2020 / Accepted: 10 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Suicide is a leading cause of death in patients with schizophrenia. This nationwide cohort study investigated the incidence of each suicide method in patients with schizophrenia compared with the general population. Methods In total, records of 174,039 patients with schizophrenia were obtained from the National Health Insurance Research Database in Taiwan from 2001 to 2016. This schizophrenia cohort was linked with the national mortality database, and 26,926 patients died during this follow-up period. Of the deceased, 3033 had died by suicide. Univariate Cox regression was used to estimate the demographic variables associated with suicide. We estimated the difference in the proportion of each suicide method used in patients with schizophrenia compared with the general population. The incidence and standardized mortality ratio (SMR) of each suicide method were calculated and stratified based on sex. Results Patients aged 25–34 years exhibited the highest suicide risk. Compared with the general population, patients with schizophrenia were more likely to commit suicide by jumping and drowning and less likely to use charcoal-burning and hanging. Women showed a higher incidence of suicide by drowning and jumping than did men. Comorbidity with substance use disorders (SUDs) was associated with a high suicide SMR (26.9, 95% confidence interval [CI] = 23.4–28.9), particularly for suicide by jumping (61.2, 95% CI = 48.3–76.3). Conclusions Patients with schizophrenia had higher suicide rates for all methods than did the general population. Suicide method differed based on sex. Patients with SUDs exhibit a high SMR for each suicide method and warrant intensive clinical attention. Keywords Incidence · Suicide method · Mortality · Suicide · Schizophrenia
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01985-8) contains supplementary material, which is available to authorized users. * Chian‑Jue Kuo [email protected] 1
Department of Psychology, National Chengchi University, Taipei, Taiwan
2
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
3
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
4
Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
Schizophrenia is a debilitating mental illness [1], and studies have indicated that compared with healthy people, patients with mental illness have their lifespans decreased by 11–20 years and mortality rate increased by two to four 5
Department of Counseling Psychology, C
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