Bravve Lidia, Kaydan Maria, Kostyuk Georgy
Scientific and Clinical Research Centre for Neuropsychiatry of "Psychiatric Hospital no. 1 Named after N.A. Alexeev of the Department of Health of Moscow, Moscow, Russia.
Department of Mental Health and Clinical Psychiatry, Faculty of Psychology, Lomonosov Moscow State University, Moscow, Russia.
Front Psychiatry. 2025 Apr 24;16:1560699. doi: 10.3389/fpsyt.2025.1560699. eCollection 2025.
Suicide represents the primary risk factor for mortality among individuals diagnosed with schizophrenia, with a mortality rate that is 10 times higher than that observed in the general population. In the study of individuals who have committed suicide, some exhibited a high risk of aggression and impulsivity, which permitted the consideration of these indicators as predictors of suicide risk. The extant literature contains a number of debates concerning diverse conceptualizations of aggression and impulsivity in the context of suicidal behavior. The present study examined the levels of verbal and physical aggression in individuals diagnosed with schizophrenia, finding that 43% exhibited verbal aggression and 24% physical aggression, levels that are significantly higher than those observed in the general population. Concurrently, an analysis of the psycho-emotional state of patients with suicidal behavior in the anamnesis reveals an indication that the suppression of emotions (including aggression) and the avoidance of harm may result in suicide. This finding is at odds with the previously mentioned results, and consequently, the present review sought to assess the impact of aggressive behavior on suicide risk in patients diagnosed with schizophrenia.
The search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was conducted in PubMed, Cochrane Library, PsychINFO and Mendeley Data. The search terms used were "aggress*" and "suicid*" or "autoaggress*" and "schizophrenia*". The search was limited to papers published between 2009 and 2024 (the last 15 years), and the search was continued until November 2024. This systematic review has been registered in PROSPERO (CRD42024628033).
A total of 1,364 articles were identified, 295 of which were duplicates. Following a thorough review, 1,046 articles that did not align with the title and abstract were excluded from the analysis. During the literature search, 23 articles were read in full, of which eight studies met the inclusion criteria. A total of eight studies provided information on the effect of aggressive behavior on suicide in patients with schizophrenia. Of these, six studies demonstrated a positive association between aggression and suicidal behavior or employed a logistic regression model in which the risk of aggression increased the risk of suicide and vice versa. Conversely, two studies revealed no association between suicide risk and aggression.
Patients with a documented history of suicide attempts and aggressive behavior are considered to be at risk of suicide, thus emphasizing the necessity for preventive measures to be implemented for this cohort of patients. However, the conclusion regarding the influence of aggressive behavior on increased suicide risk may not be entirely accurate and may not reflect the true extent of the problem, due to the significant number of methodological inaccuracies and discrepancies in the design of the studies included in the review.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628033, identifier CRD42024628033.
自杀是精神分裂症患者死亡的主要风险因素，其死亡率比普通人群高出10倍。在对自杀者的研究中，一些人表现出高攻击性和冲动性风险，这使得这些指标可被视为自杀风险的预测因素。现有文献围绕自杀行为背景下攻击性和冲动性的不同概念存在诸多争论。本研究调查了精神分裂症患者的言语和身体攻击水平，发现43%的患者表现出言语攻击，24%表现出身体攻击，这些水平显著高于普通人群。同时，对有自杀行为患者既往心理情绪状态的分析表明，情绪（包括攻击性）的抑制和伤害回避可能导致自杀。这一发现与上述结果相矛盾，因此，本综述旨在评估攻击行为对精神分裂症患者自杀风险的影响。
检索按照系统评价和Meta分析的首选报告项目（PRISMA）声明进行。文献检索在PubMed、Cochrane图书馆、PsychINFO和Mendeley数据中进行。使用的检索词为“aggress*”和“suicid*”或“autoaggress*”和“schizophrenia*”。检索限于2009年至2024年（过去15年）发表的论文，检索持续至2024年11月。本系统综述已在PROSPERO（CRD42024628033）注册。
共识别出1364篇文章，其中295篇为重复文章。经过全面审查，1046篇与标题和摘要不符的文章被排除在分析之外。在文献检索过程中，全文阅读了23篇文章，其中八项研究符合纳入标准。共有八项研究提供了攻击行为对精神分裂症患者自杀影响的信息。其中，六项研究表明攻击与自杀行为之间存在正相关，或采用逻辑回归模型，其中攻击风险增加自杀风险，反之亦然。相反，两项研究表明自杀风险与攻击之间无关联。
有自杀未遂和攻击行为记录的患者被认为有自杀风险，因此强调有必要对这一患者群体采取预防措施。然而，由于综述中纳入的研究在设计上存在大量方法学不准确和差异，关于攻击行为对自杀风险增加影响的结论可能并不完全准确，可能无法反映问题的真实程度。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628033，标识符CRD42024628033
