Awareness of disorder and suicide risk in the treatment of schizophrenia: results of the international suicide prevention trial.
OBJECTIVE
Schizophrenia is characterized by high suicide risk and low awareness of disorder. Although awareness has benefits for medication compliance and clinical outcome, it is unclear how it may relate to suicide risk in this population.


METHODS
This multicenter investigation assessed awareness and suicide-related behavior in 980 patients with schizophrenia or schizoaffective disorder. Patients were followed over 2 years and assessed by blinded raters for suicide-related events.


RESULTS
Awareness of psychiatric condition at baseline was associated with increased risk of suicide events over the follow-up. This effect was mediated by depression and hopelessness levels. By contrast, changes in awareness associated with treatment decreased the risk of suicide.


CONCLUSIONS
Although some patients may become depressed after acknowledging the clinical handicaps of their disorder, treatment-related changes in awareness are generally associated with a positive outcome relative to suicide risk. The complex interactions and mediation effects of these clinical variables require careful monitoring.
Bourgeois
Marc
M
Psychopathology Research Laboratory, University of Bordeaux, 3 ter, Place de la Victoire, 33076 Bordeaux, France.
Swendsen
Joel
J
Young
Frederick
F
Amador
Xavier
X
Pini
Stefano
S
Cassano
Giovanni B
GB
Lindenmayer
Jean-Pierre
JP
Hsu
Chuanchieh
C
Alphs
Larry
L
Meltzer
Herbert Y
HY
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001364:Awareness; D001569:Benzodiazepines / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D016016:Proportional Hazards Models; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012565:Schizophrenic Psychology; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D000092864:Suicide Prevention
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D003024:Clozapine; D000077152:Olanzapine