Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case-control study.
To investigate the role of risk assessment in predicting suicide in patients with schizophrenia spectrum disorders (SSDs) receiving secondary mental healthcare. We postulated that risk assessment plays a limited role in predicting suicide in these patients.



Retrospective case-control study.



Anonymised electronic mental health record data from the South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM) (London, UK) linked with national mortality data.



In 242 227 SLaM service users up to 31 December 2013, 635 suicides were identified. 96 (15.1%) had a SSD diagnosis. Those who died before 1 January 2007 (n=25) were removed from the analyses. Thus, 71 participants with SSD who died from suicide over the study period (cases) were compared with 355 controls.



Risk of suicide in relation to risk assessment ratings.



Cases were younger at first contact with services (mean±SD 34.5±12.6 vs 39.2±15.2) and with a higher preponderance of males (OR=2.07, 95% CI 1.18 to 3.65, p=0.01) than controls. Also, suicide occurred within 10 days after last contact with services in half of cases, with the most common suicide methods being hanging (14) and jumping (13). Cases were more likely to have the following 'risk assessment' items previously recorded: suicidal history (OR=4.42, 95% CI 2.01 to 9.65, p<0.001), use of violent method (OR=3.37, 95% CI 1.47 to 7.74, p=0.01), suicidal ideation (OR=3.57, 95% CI 1.40 to 9.07, p=0.01) and recent hospital discharge (OR=2.71, 95% CI 1.17 to 6.28, p=0.04). Multiple regression models predicted only 21.5% of the suicide outcome variance.



Predicting suicide in schizophrenia is highly challenging due to the high prevalence of risk factors within this diagnostic group irrespective of outcome, including suicide. Nevertheless, older age at first contact with mental health services and lack of suicidal history and suicidal ideation are useful protective markers indicative of those less likely to end their own lives.
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Javier-David
JD
Lopez-Morinigo
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain.
Rosa
R
Ayesa-Arriola
Division of Psychiatry, Virgen de Valme University Hospital, Seville, Spain.
Beatriz
B
Torres-Romano
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Andrea C
AC
Fernandes
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Hitesh
H
Shetty
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Matthew
M
Broadbent
Division of Psychiatry, Virgen de la Macarena University Hospital, Seville, Spain.
Maria-Encarnacion
ME
Dominguez-Ballesteros
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Robert
R
Stewart
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Anthony S
AS
David
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Rina
R
Dutta
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications*; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
Risk assessment; Schizophrenia; Secondary mental healthcare; Suicide
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