Suicide is the most common cause of death in patients who have schizophrenia spectrum disorders, a study in Schizophrenia Bulletin has found.
Marie Stefanie Kejser Starzer, M.D., of Copenhagen University Hospital and colleagues analyzed data from the OPUS I study, a randomized controlled trial of 578 patients experiencing their first episode of psychosis. Patients enrolled in the study between January 1, 1998, and December 31, 2000. When the patients enrolled, they were between 18 and 45 years old; had received first-time treatment for a diagnosis of schizophrenia, schizotypal disorder, delusional disorder, acute or transient psychosis, schizoaffective disorder, or nonspecific nonorganic psychosis; and had not received antipsychotic medication for more than 12 weeks. They were randomized to receive treatment as usual or a specialized early intervention that consisted of two years of assertive community treatment (including family involvement, social skills training, and psychoeducation) by a multidisciplinary team. Patients were then assessed multiple times over a 20-year period.
By the end of 2021, 14.2% of the patients had died. Of those, 48.6% died of external causes (for example, suicide or accidents) and 51.4% died of medical conditions and diseases. The most common cause of death was suicide, accounting for 27.8% of deaths; followed by accidents at 13.9%; unspecified medical abnormalities at 11.1%; and cardiovascular disease and cancer, both at 8.3%.
Death due to external causes, mostly suicide, occurred at a steady rate throughout the study, whether the patients had received treatment as usual or the specialized early intervention. Starzer and colleagues wrote that this indicates a need for continuous suicide-prevention efforts for people with schizophrenia.
“Early intervention services alone cannot address this issue, as the risk [was] present long after [the specialized early intervention] ended,” they wrote. “Perhaps more regular screening for suicide risk in aging patients with schizophrenia could help prevent some of these late suicides.”
Patients with a history of substance use had a higher risk of both all-cause mortality and death from medical conditions and diseases.
“This underlines the importance of proper treatment of comorbid substance use at any time after patients are diagnosed,” the researchers wrote. They noted that the treatment of mental illness and the treatment of substance use are often managed by separate entities. “Lack of integrated treatment could be leading to suboptimal care for dual-diagnosis patients, and a more multidimensional and non-categorical treatment approach is needed.”
For related information, see the Psychiatric News article “COVID-19 Greatly Increases Mortality Risk for Schizophrenia Patients, Research Shows.”
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