Suicide and Schizophrenia

-Chris Summerville, D.Min.
Executive Director, Manitoba Schizophrenia Society

Introduction

  1. Who am I?
  2. What is schizophrenia?
  3. Why be concerned?
  4. What is missing in dealing with this huge problem?

A. The Mortality Rate for People with Schizophrenia.

  1. Death from all causes is 4 to 5 times greater than the general population.
  2. Often called “Premature death”  due to:
  • accident proneness
  • substance misuse
  • smoking
  • financial/social deprivation
  • side effects of medication
  • concurrent medical problems
  • homicide
  • suicide
    (Horne & Barraclough, 97)

3. Life expectancy is 9 to 10 years shorter; 20% shorter than the general population. (Newman & Bland, 91) (Women have a higher mortality rate than men.)

B. The Suicide Rate for People with Schizophrenia.

  1. “Chief cause of death for those under 60 years of age.” (Meltzer, 99)
  2. Studies estimate that from 9% to 24% of individuals with schizophrenia will die by their own hand. (Conwell, Cholette, & Duberstein)
  3. In the U.S. that is 7,500 deaths a year by suicide. (General population is 30,000)
  4. “Suicidal drive is the most serious of symptoms” in schizophrenia. Eugene Bleuler, 1911. Swiss psychiatrist who coined the term “schizophrenia.”
  5. Suicidal ideation is part of the lived experience of schizophrenia.                              
  6. 40 to 50% will attempt suicide. (Meltzer and Fatemi, 95)
  7. 10% will complete suicide. (Caldwell & Gottesman, 90)
  8. 70% of the suicides occur before age 35 and within 10 years of diagnosis.   (Ruschena, Muller, Burgess, Cardner, Barry-Walsh, Drummer, Palmer, Browne & Wallace, 98)
  9. 1 out of 4 will commit suicide while under psychiatric care. (Conwell, Cholette & Duberstein, 98)
  10. The inability to suppress or contain suicidal thoughts leads to a suicidal act.
  11. Persons with schizophrenia have a lower suicidal threshold or inability to contain suicidal thought. (Mann, 99)
  12. Some mental disorders skew the  person’s view of the future and of their ability to help themselves.(Mann, 99)
  13. Clues in detecting possible suicidal ideation. Impulsivity in other areas: extremely directed aggression, sexuality, alcoholism and substance abuse.
  14. People with schizophrenia don’t give as much warning about their suicidal ideation as with people who are simply depressed. (Lewis, 33)

C. The Reasons Why People with Schizophrenia Commit Suicide.

1. Case Study by Linda Newton RN, MN and Robb Desrochers, Health Sciences Centre, Winnipeg, MB. “Suicidal Ideation in Individuals with Schizophrenia,” (Unpublished paper). 15 stable clients with chronic schizophrenia. Six themes pinpointed.

  • Loss of a normal life.
  • Loss of self, self-esteem, and sense of future.
  • Powerlessness over process.
  • Fear of the outcome.
  • Specific illness related factors.
  • Client/doctor relationship.

2. Major risk factors. (Roy, 86; Meltzer, 99; Mann, 99; Addington, 99) Rick factors are a complex combination of psychological, social and biological issues.

  • Previous attempts
  • Depression
  • Hopelessness & demoralization
  • Male
  • First decade of illness
  • Substance Abuse (50% blood tests of samples available showed presence of alcohol and/or drugs.)
  • Poor psychosocial functioning
  • Inadequate social supports & social recovery
  • Social isolation
  • Deterioration of health in general
  • Active paranoia
  • Akathisia
  • Young adult to middle age
  • Hospitalization
  • Within 6 months of discharge
  • Newly diagnosed
  • Unmarried
  • Unemployed
  • Side effects of medication
  • Negative symptoms
  • What is missing?   _________________________.

3. Myth: Most suicides are a responseto hallucinations and voices.

Fact:  Only 2% of people who attempt or complete suicide do so in response to voices telling them. (Cleghorn, 92) Rarely attributable to  florid psychotic symptoms. Suicide more likely to occur in periods of remission or improved functioning.(Roy, 89) “Planned action in response to depression.” (Tanney, 92)

4. 1998 Manitoba Schizophrenia Focus Groups with consumers:

      “Why would a person with schizophrenia attempt or commit suicide?”

  • 24 people. 18 males and 6 females
  • Average age: 28
  • Average length of illness: 9 years
  • All unemployed, unmarried
  • 22 were medically compliant
  • 60% living with parents
  • 40% had attempted suicide
  • 50% knew of a consumer who committed suicide
  • Psychotic symptoms were at the bottom of the list.
  • All were “classic answers”

 

D. The Psychological Analysis of Suicidal Ideation of People with Schizophrenia.

  1. Helplessness: belief that life is not controllable and that one is powerless to act.
  2. Hopelessness: belief that the future will be unchanged and unchangeable.
  3. Meaninglessness: belief that life has no purpose, rhyme, or reason.
  4. Belonginglessness: belief that interpersonal, social relationships are unreachable due to isolation, stigma  (“community,” Scott Peck)
  5. Worthlessness: belief that one has no inherent value, worth, significance or
  6.       security.  (Bach, Kovacs & Weissman, 75)

E. The Correlation of Determinants of Health to People with Schizophrenia.

  1. Personal Health Practices.
  2. Social & Economic Environment.
  3. Individual Capacity and Coping Skills.
  4. Physical Environment.
  5. Health Services.

Why are these not applied to mental health consumers?

F. The Importance of Looking at Each Person with Schizophrenia Who Suicides, Case by Case.

  1. “Before considering the suicidal response, learn to understand the individual’s perception of the situation which evoked or threatens to evoke suicide response.” (Stevens,  71)
  2. “Every person who commits suicide has his or her own path of life until the tragic death. Thus, there is no such suicide to be classified as ‘schizophrenic suicide.’ However, to provide means for such suicide prevention among people who suffer from schizophrenia, studies of antecedents for suicide and possible triggers and life circumstances just before suicide,  as well as illness characteristics are needed.

      (Heila & Isometsa, 99)

The Road to Prevention of Suicide by People with Schizophrenia.

  1. Commitment to a multidisciplinary, holistic model of care and treatment: medical management & relapse prevention, psychosocial/psychiatric rehabilitation, education, vocational, reintegration into society, recovery/ empowerment.
  2. Commitment by professional service providers to be aware and sensitive to the traumatic impact of mental illness, its treatment, stigma on the person, and losses.
  3. Commitment of resources needed to create an effective, benevolent, compassionate, healing and recovery oriented mental health care system.
  • What is recovery?
  • What are people recovering from?
  • What is the impact of what people are recovering from?
  • How can people be assured by service providers and family in their recovery?
    (Spaniol, Gagne, Koehler, 97)

Long term studies of 20 years indicate 1/2 to 1/3 significantly improve or recover. If we had the right kind of integrated and coordinated mental health system could not people recover much sooner, endure less suffering, and find hope for living?

Conclusion

  1. There are no simple answers…
  2. There are no painless solutions…
  3. There are no cheap interventions…
  4. There are no fragmented systems…
  5. There are no easy ways…

...that will give people with schizophrenia

     ...what they need for

          ...recovery and empowerment.


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