CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 47SUICIDEMARNIN J. HEISELSuicide, a leading cause of preventable morbidity and mortality worldwide, accountsfor as many as 1 million deaths annually, exceeding the number of fatalities due to homicideand war combined. Suicide leaves in its wake tremendous confusion, pain, and sufferingfor suicidal individuals and for their families, friends, and care providers. Thus, preventionof suicide is a critical public health imperative. Suicide prevention spans universal,selected, and indicated strategies. Universal strategies include population-level initiativessuch as national strategies for suicide prevention and programs of means restriction. Selectedstrategies target groups at elevated risk for suicide with mental health promotionefforts such as public health education and community outreach. Indicated strategies targetindividuals imminently at risk for suicide with clinical assessment and interventioninitiatives. This chapter provides a brief overview of the epidemiology of suicide inschizophrenia, associated risk and resiliency factors, and mental health assessment andtreatment strategies, and concludes with key considerations for clinical care with individualsat elevated risk for suicide.EPIDEMIOLOGYOver 30,000 Americans die by suicide annually, accounting for more deaths than homicideand HIV combined. Suicide was the 11th leading cause of death in the United Statesin 2004, and accounted for more than 1.25 million years of potential life lost before age85. Mental illness has been implicated in over 90% of suicides in rigorous research studies.A review article assessing suicide risk factors covering a 40-plus-year period reported thepresence of mental illness in over 99% of psychiatric inpatients who died by suicide, andin 88% in the general population who died by suicide. Mood disorders (30.2%), substancemisuse disorders (17.6%), schizophrenia (14.1%), and personality disorders(13.0%) were the leading forms of mental illness associated with death by suicide; schizophreniawas more prevalent in psychiatric inpatient suicide (19.9%), second in prevalenceonly to mood disorders (20.8%).491