Factors Influencing Suicide Deaths in Patients With Schizophrenia Based on Cohort Data: An Empirical Study of a Sample of 170006 Patients in Western China

  Objective   To prospectively explore the risk factors of suicide in patients with schizophrenia.

  Methods   Data on schizophrenia patients in a certain province between 2006 and 2018 were obtained from the National Severe Mental Disorders Information System, and the Cox proportional hazards regression model was used to explore for risk factors for suicide in schizophrenia patients.

  Result  A total of 170006 patients with schizophrenia were included in the study. At the end of the follow-up period, 160570 patients were alive and 9436 died from various causes, 929 of which being suicide deaths, resulting in a suicide rate of 223.61/100, 000 person-years. The Cox proportional hazards regression model suggested that risk factors for suicide in patients with schizophrenia included poverty (HR=1.20, 95% CI: 1.02-1.41), higher education level (primary school HR=1.32, 95% CI: 1.09-1.60, middle school HR=1.40, 95% CI: 1.14-1.73, high school and above HR=1.93, 95% CI: 1.49-2.52) in comparison with illiteracy and semi-literacy, suicide attempts (HR=2.70, 95% CI: 1.70-4.29), strict medication compliance (HR=1.91, 95% CI: 1.66-2.20), history of antipsychotic drug therapy (HR=1.42, 95% CI: 1.06-1.90), younger age group of patients of 46-60 (HR=1.95, 95% CI: 1.60-2.39), 31-45 (HR=3.61, 95% CI: 2.92-4.47), and 15-30 (HR=12.37, 95% CI: 9.69-15.78) compared with the 61-90 age group, and doing agriculture jobs (HR=1.36, 95% CI: 1.13-1.65).

  Conclusion  Young and middle-aged schizophrenia patients with higher education levels, especially those with a history of suicide attempts, are at high risk for suicide. Focused interventions should be directed at high-risk groups to reduce suicide deaths in patients with schizophrenia.