McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX.
Schizophr Bull. 2018 Jun 6;44(4):787-797. doi: 10.1093/schbul/sbx131.
The lifetime risk of suicide and suicide attempt in patients with schizophrenia are 5% and 25%-50%, respectively. The current meta-analysis aims to determine risk factors associated with suicidality in subjects with schizophrenia. We searched Pubmed, Web of Science, EMBASE, and the reference lists of included studies. Inclusion criteria were met if an article reported a dichotomous sample of patients with schizophrenia with suicidal ideation, attempted suicide, or suicide compared to patients without. We also performed a cohort study meta-analysis as a supplemental analysis. A total of 96 studies with 80488 participants were included in our analysis. Depressive symptoms (P < .0001), Positive and Negative Symptom Scale (PANSS) general score (P < .0001) and number of psychiatric hospitalizations (P < .0001) were higher in patients with suicide ideation. History of alcohol use (P = .0001), family history of psychiatric illness (P < .0001), physical comorbidity (P < .0001), history of depression (P < .0001), family history of suicide (P < .0001), history of drug use (P = .0024), history of tobacco use (P = .0034), being white (P = .0022), and depressive symptoms (P < .0001) were the most consistent variables associated with suicide attempts. The first two were also significant in the cohort meta-analysis. Being male (P = .0005), history of attempted suicide (P < .0001), younger age (P = .0266), higher intelligence quotient (P < .0001), poor adherence to treatment (P < .0001), and hopelessness (P < .0001) were the most consistently associated with suicide. The first three were also significant in the cohort meta-analysis. Our findings may help with future development of preventive strategies to combat suicide. Future studies may combine the above-mentioned variables by using multivariate predictive analysis techniques to objectively stratify suicidality in schizophrenia.
精神分裂症患者的终生自杀和自杀未遂风险分别为 5%和 25%-50%。本荟萃分析旨在确定与精神分裂症患者自杀意念相关的危险因素。我们检索了 Pubmed、Web of Science、EMBASE 和纳入研究的参考文献列表。如果文章报告了精神分裂症患者有自杀意念、自杀未遂或自杀的二分样本与无自杀意念的患者相比，即符合纳入标准。我们还进行了队列研究荟萃分析作为补充分析。我们的分析共纳入了 96 项研究，共 80488 名参与者。有自杀意念的患者抑郁症状（P <.0001）、阳性和阴性症状量表（PANSS）一般评分（P <.0001）和精神科住院次数（P <.0001）较高。有酒精使用史（P =.0001）、精神病史（P <.0001）、躯体合并症（P <.0001）、有抑郁病史（P <.0001）、有自杀家族史（P <.0001）、药物使用史（P =.0024）、有吸烟史（P =.0034）、白种人（P =.0022）和抑郁症状（P <.0001）是与自杀未遂最一致的相关变量。前两个变量在队列荟萃分析中也有意义。男性（P =.0005）、自杀未遂史（P <.0001）、年龄较小（P =.0266）、智商较高（P <.0001）、治疗依从性差（P <.0001）和绝望（P <.0001）是与自杀最一致的相关因素。前三个变量在队列荟萃分析中也有意义。我们的研究结果可能有助于未来制定预防自杀的策略。未来的研究可以通过使用多元预测分析技术，结合上述变量，客观地对精神分裂症的自杀倾向进行分层。
