Thursday, June 5, 2014

38-Year Study Assesses Violence and Premature Mortality in People With Schizophrenia

People with schizophrenia and related disorders have increased rates of suicide, premature mortality, and convictions for violent offenses, according to a report from British and Swedish researchers published Tuesday in Lancet.

The study compared 24,297 Swedish patients with their unaffected siblings and matched controls from the general population, assessing outcomes from 1972 through 2009. Within five years of diagnosis, 13.9% of male patients and 4.7% of female patients recorded one of those three adverse outcomes. Overall, those adverse outcomes were 7.5 times more likely compared with men in the general population and 11.1 times more likely for women, wrote Seena Fazel, M.D., an honorary consultant forensic psychiatrist in the University of Oxford’s Department of Psychiatry, and colleagues.

The authors assessed adverse outcomes in all three study groups and found that three risk factors present in all three cohorts predicted the adverse outcomes: drug use disorders, criminality, and self-harm. "Schizophrenia and related disorders are associated with substantially increased rates of violent crime, suicide, and premature mortality," they concluded. "Risk factors for these three outcomes included both those specific to individuals with schizophrenia and related disorders, and those shared with the general population. Therefore, a combination of population-based and targeted strategies might be necessary to reduce the substantial rates of adverse outcomes in patients with schizophrenia and related disorders."

"[T]he authors suggest that to best manage violence and suicide risk, we should perhaps now turn our attention to those factors evident across populations," added Eric Elbogen, Ph.D., an associate professor, and Sally Johnson, M.D., a professor of psychiatry at the University of North Carolina, in a related commentary. "In this way, we might not only reduce actual risk in people with schizophrenia, but appropriately place this in the context of violence reduction for society as a whole. The potential to achieve practical, evidence-based, and potentially less stigmatising interventions is one of the most exciting implications of this study."

To read more research on violence risk in those with schizophrenia, see the Psychiatric News articles, "Antisocial Behavior Raises Violence Risk in Some Psychosis Patients" and "Untreated Schizophrenia Increases Risk for Violence By Inmates." Also see "Systematic Suicide Risk Assessment for Patients With Schizophrenia: A National Population-Based Study" in Psychiatric Services.

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