Suicide and psychosis: comparing the characteristics of patients who died by suicide following recent onset and longer duration of schizophrenia and other primary psychotic disorders, 2008-2021

Background and Hypothesis Suicide rates among people with schizophrenia and other primary psychotic disorders are high, with the steepest increase in risk in the first years following contact with mental health services. Evidence suggests Early Intervention in Psychosis (EIP) services may reduce suicide risk for people experiencing first episode psychosis. We aimed to compare the characteristics of patients with a recent (<12 month) onset of schizophrenia and other primary psychotic disorders with patients with a longer duration of illness (12 months and over) to identify key characteristics for patient suicide to aid services to effectively support patients during a particularly high-risk time.
Study Design A national clinical survey of patients with schizophrenia and other primary psychotic disorders who died by suicide in England and Wales between 1st January 2008 and 31st December 2021.
Study Results Of the 2,828 (N=18,487, 16%) patients with a diagnosis of schizophrenia and other primary psychotic disorders who died by suicide, ten percent (n=288) were ill for less than 12 months. These patients were more often under the care of crisis teams, or recently discharged from in-patient services than patients with a longer duration of illness (12 months and over), and they were more often seen by services within the week before they died. Patients with recent illness onset had fewer factors conventionally associated with suicide, such as alcohol or drug misuse, a history of violence, and self-harm. They were less likely to live alone and be unemployed.
Conclusions
Though all patients had contact with mental health services in the 12 months prior to death, patients with a recent onset of schizophrenia and other primary psychotic disorders were more commonly in recent contact with services at the time of death. They had fewer social and behavioural factors known to be common to suicide, suggesting lives recently disrupted by illness. Services should provide intensive support for patients who have been recently diagnosed, encouraging engagement and monitoring for deteriorating social factors.