Evaluation of Suicidal Behavior and Depression, Insight and Disease Characteristics in Schizophrenia

Year 2024, Volume: 10 Issue: 3, 399 - 407, 19.09.2024

Fatma Gül Helvacı Çelik , Meltem Puşuroğlu , Mehmet Baltacıoğlu , Bulent Bahceci , Cicek Hocaoglu

https://doi.org/10.53394/akd.1286393

Abstract

Introduction: Suicide is a severe public health issue with high rates of morbidity and mortality. Schizophrenia also has a high suicide incidence, which is one of the main factors contributing to rising morbidity and mortality. For strategies to lower suicide rates, it is essential to understand the risk factors for suicide in people with schizophrenia. By evaluating the relationship between the risk of suicidal behavior and demographic factors, disease characteristics, depression, and insight in schizophrenia patients, in the light of literature information, this study aimed at preventing suicide in schizophrenia and set an example for future studies.
Method: This study included 103 schizophrenia patients who underwent follow-up for at least 4 years in a community mental health center (CMHC). The study included patients who had the mental capacity to understand and complete the questionnaires, were not experiencing an acute psychotic attack, and gave their consent to participate. The patients were given the Three Components of Insight Scale (TCIS), Scale for Evaluation of Positive Symptoms in Schizophrenia (SAPS), Scale for Evaluation of Negative Symptoms in Schizophrenia (SANS), Calgary Depression Inventory in Schizophrenia (CDIS), and Suicide Behavior Scale (SBS).
Results: 47% of patients demonstrated suicidal behavior, and 69% of patients were men. 46% of the group demonstrating suicidal behavior had severe or very severe suicidal ideation. Age and disease duration were revealed to be significant risk factors for suicidal behavior (p=0.033 and p=0.004, respectively), but gender, SBS, CDIS, SANS, SAPS, and TCIS scores had no significant effect. Age and suicidal behavior risk were found to be inversely correlated, with each unit of age increase reducing the risk of suicidal behavior by 0.929 times. The risk of suicidal behavior rises along with the duration of disease. With every one unit increase in the duration of disease, the risk of suicidal behavior increases by 1.133 times. Additionally, the group with severe-very severe suicidal ideation had significantly more severe depression scores than the group with mild-moderate (p=0.01).
Discussion: More than half of the patients with schizophrenia who were followed up showed suicidal behavior, and approximately half of the group who had suicidal ideation showed severe suicidal ideation. Suicidal behavior was found to be correlated with age and duration of illness. While suicidal behavior increases age decreases and duration of illness increases.There was no significant correlation between insight, depression, gender, symptom severity and suicidal behavior in this population. In addition, depression scores were found to be statistically significantly higher in the group with severe-very severe suicidal ideation. According to the research, in individuals with schizophrenia who were being monitored, the frequency of suicidal behavior increased along with the severity of depression.
Conclusion: It is crucial to identify the risk factors and protective factors for suicide in schizophrenia patients in order to develop interventions for them. Because suicidal behavior is a significant morbidity and mortality factor in schizophrenia.

Keywords

schizophrenia, suicide, suicidal behavior, depression

Şizofrenide İntihar Davranışı ile Depresyon, İçgörü ve Hastalık Özelliklerinin Değerlendirilmesi

Abstract

Giriş: İntihar önemli morbidite ve mortalite oranlarına sahip ciddi bir halk sağlığı sorunudur. Şizofrenide de intihar oranları yüksek olup, morbidite ve mortaliteyi artıran en önemli sebeplerden biridir. Şizofrenide intihar risk faktörlerinin anlaşılması, intihar insidansını azaltmaya yönelik yaklaşımları geliştirmek için hayati önem taşımaktadır. Bu çalışmada şizofreni hastalarında intihar davranışı riski ile demografik değişkenler ve hastalık özellikleri, depresyon ve içgörü ilişkisinin literatür bilgileri eşliğinde değerlendirilerek, şizofrenide intiharın azaltılmasına katkı sağlamak ve ileriki çalışmalara örnek oluşturmak amaçlanmıştır.
Yöntem: Araştırmaya toplum ruh sağlığı merkezinde (TRSM) şizofreni tanısı ile en az 4 yıldır takipli 103 hasta dahil edilmiştir. Çalışmaya akut psikotik atak döneminde olmayan, ölçekleri anlayabilecek ve doldurabilecek zihinsel kapasiteye sahip olan ve çalışmaya katılmayı onaylayan hastalar dahil edilmiştir. Hastalara sosyodemografik veri formu, Şizofrenide Pozitif Belirtileri Değerlendirme Ölçeği (SAPS), Şizofrenide Negatif Belirtileri Değerlendirme Ölçeği (SANS) Calgary Şizofrenide Depresyon Ölçeği (CŞDÖ), İçgörünün Üç Bileşenini Değerlendirme Ölçeği (İÜBDÖ) ve İntihar Davranış Ölçeği (İDÖ) uygulanmıştır.
Bulgular: Hastaların % 69’ u erkek olup, %47’ sinde intihar düşüncesi saptanmış; intihar düşüncesi bulunan grubun ise %46’ sında ciddi düzeyde intihar düşüncesi (şiddetli ve çok şiddetli) tespit edilmiştir. Şizofrenide intihar düşüncesinin üzerine cinsiyet, İDÖ, CŞDÖ, SANS ve SAPS puanlarının anlamlı bir etkisi bulunmazken; yaş ve hastalık süresi intihar riski üzerine etkili faktörler olarak bulunmuştur (sırasıyla p=0.033, p=0.004). Yaşla intihar riski arasında ters bir ilişkinin olduğu ve yaştaki her 1 birimlik artışın, intihar riskini 0.929 kat bir azalttığı bulunmuştur. Hastalık süresi arttıkça da intihar riski artmaktadır. Hastalık süresindeki her 1 birimlik artış ile intihar riski 1.133 kat artmaktadır. Ayrıca intihar düşüncesi şiddetli-çok şiddetli olan grubun depresyon şiddeti, hafif-orta olan gruptan anlamlı olarak yüksek çıkmıştır (p=0.01).
Tartışma: Şizofreni ile takipli hastaların yarıdan fazlasında intihar davranışı saptanmış olup intihar düşüncesi olan grubun yaklaşık yarısında ciddi intihar düşüncesi tesbit edilmiştir. İntihar düşüncesi ile sadece yaş ve hastalık süresi arasında ilişki bulunmuş olup, yaş arttıkça intihar düşüncesinin azaldığı ve hastalık süresi uzadıkça arttığı saptanmıştır. Bu örneklemde içgörü, depresyon, cinsiyet ve belirti şiddeti ile intihar düşüncesi arasında anlamlı ilişki olmadığı görülmüştür. Ayrıca intihar düşüncesi şiddetli-çok şiddetli olan grupta, depresyon puanları istatistiksel olarak anlamlı yüksek saptanmıştır. Literatürle uyumlu olarak şizofreni ile takipli hastalarda, depresyon şiddeti arttıkça intihar davranışı şiddeti de artmıştır.
Sonuç: Sonuç olarak şizofrenide intihar ve intihar girişimi önemli bir morbidite ve mortalite faktörü olup, şizofreni hastalarında intihar risk faktörleri ve koruyucu faktörlerin tesbiti yapılarak, bunlara dönük müdahelelerin oluşturulması büyük önem arz etmektedir.

Keywords

şizofreni, intihar, intihar davranışı, depresyon

Supporting Institution

yok

Thanks

makalemiz şizofreni gibi zor bir grupta intiharı değerlendirmesi nedeniyle önemli olduğunu ve literatüre katkı sağlayacağını düşünüyoruz. hocalarımız Prof. Dr. Bülent Bahçeci ve Prof. Dr. Çiçek Hocaoğlu' na teşekkür ederiz. saygılarımızla.

References

• 1. World Health Organization. World health statistics 2021: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2021.
• 2. World Health Organization. Thirteenth general programme of work 2019-2013. 2020.
• 3. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, Musacchio KM, Jaroszewski AC, Chang BP, Nock MK. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol. Bull 2017; 143(2):187–32.
• 4. Song Y, Rhee SJ, Lee H, Kim MJ, Shin D, Ahn YM. Comparison of suicide risk by mental illness: A retrospective review of 14-year electronic medical records. J. Korean Med. Sci 2020; 35:e402.
• 5. Olfson M, Stroup TS, Huang C, Wall MM, Crystal S, Gerhard T. Suicide risk in medicare patients with schizophrenia across the life span. JAMA psychiatry 2021; 78(8):876-85.
• 6. Hjorthøj C, Stürup AE, McGrath JJ, Nordentoft M. Years of potential life lost and life expectancy in schizophrenia: A systematic review and meta-analysis. The Lancet Psychiatry 2017; 4(4):295–301.
• 7. Bushe CJ, Taylor M, Haukka J. Mortality in schizophrenia: A measurable clinical endpoint. Journal of Psychopharmacology 2010; 24(4):17-25.
• 8. Bai W, Liu ZH, Jiang YY, Zhang QE, Rao WW, Cheung T, Hall BJ, Xiang YT. Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: A meta-analysis and systematic review of epidemiological surveys. Transl. Psychiatr 2021; 11(1):552.
• 9. Lu L, Dong M, Zhang L, Zhu XM, Ungvari GS, Ng CH, Wang G, Xiang YT. Prevalence of suicide attempts in individuals with schizophrenia: A meta-analysis of observational studies. Epidemiol Psychiatr Sci 2019; 29:e39.
• 10. Baldessarini RJ, Innamorati M, Erbuto D, Serafini G, Fiorillo A, Amore M, Girardi P, Pompili M. Differential associations of affective temperaments and diagnosis of major affective disorders with suicidal behavior. Journal of Affective Disorders 2017; 210:19-21.
• 11. Pompili M, Baldessarini RJ, Innamorati M, Vázquez GH, Rihmer Z, Gonda X, Forte A, Lamis DA, Erbuto D, Serafini G, Fiorillo A. Temperaments in psychotic and major affective disorders. Journal of Affective Disorders 2018; 225:195-200.
• 12. Rajalin M, Hirvikoski T, Jokinen J. Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters. Journal of Affective Disorder 2013; 148(1):92-7.
• 13. Bornheimer LA, Zhang A, Li J, Hiller M, Tarrier N. Effectiveness of suicide-focused psychosocial interventions in psychosis: A systematic review and meta-analysis. Psychiatric Services 2020; 71(8):829-38.
• 14. McGinty J, Haque MS, Upthegrove R. Depression during first episode psychosis and subsequent suicide risk: A systematic review and meta-analysis of longitudinal studies. Schizophrenia Research 2018; 195:58-66.
• 15. Bornheimer LA, Jaccard J. Symptoms of depression, positive symptoms of psychosis, and suicidal ideation among adults diagnosed with schizophrenia within the clinical antipsychotic trials of intervention effectiveness. Archives of Suicide Research 2017; 21(4):633-45.
• 16. Bromet EJ, Nock MK, Saha S, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Borges G, Bruffaerts R, Degenhardt L, de Girolamo G. Association between psychotic experiences and subsequent suicidal thoughts and behaviors: A cross-national analysis from the World Health Organization world mental health surveys. JAMA Psychiatry 2017; 74(11):1136-44.
• 17. Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry 1993; 150(6):873-9.
• 18. Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry 2018; 17(1):12-23.
• 19. Vohs JL, George S, Leonhardt BL, Lysaker PH. An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Rev Neurother 2016; 16(10):1193-204.
• 20. Lysaker PH, Vohs J, Hillis JD, Kukla M, Popolo R, Salvatore G, Dimaggio G. Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Rev Neurother 2013; 13(7):785-93.
• 21. Palmer EC, Gilleen J, David AS. The relationship between cognitive insight and depression in psychosis and schizophrenia: a review and meta-analysis. Schizophr Res 2015; 166(1–3):261-8.
• 22. Villa J, Choi J, Kangas JL, Kaufmann CN, Harvey PD, Depp CA. Associations of suicidality with cognitive ability and cognitive insight in outpatients with schizophrenia. Schizophr Res 2018; 192:340-4.
• 23. Ayesa-Arriola R, Terán JMP, Moríñigo JDL, Rivero MC, Setién-Suero E, Al-Halabi S, Cuesta MJ, David AS, Crespo-Facorro B. The dynamic relationship between insight and suicidal behavior in first episode psychosis patients over 3-year follow-up. Eur Neuropsychopharmacol 2018; 28(10):1161-72.
• 24. Lopez-Morinigo JD, Di Forti M, Ajnakina O, Wiffen BD, Morgan K, Doody GA, Jones PB, Ayesa-Arriola R, Canal-Rivero M, Crespo-Facorro B, Murray RM, Dazzan P, Morgan C, Dutta Rina, David AS. Insight and risk of suicidal behaviour in two first-episode psychosis cohorts: effects of previous suicide attempts and depression. Schizophr Res 2019; 204:80-9.
• 25. Belvederi Murri M, Amore M, Calcagno P, Respino M, Marozzi V, Masotti M, Bugliani M, Innamorati M, Pompili M, Galderesi S, Maj M. The "insight paradox" in schizophrenia: magnitude, moderators and mediators of the association between insight and depression. Schizophr Bull 2016; 42(5):1225-33.
• 26. Andreasen N C: Scale for the Assesment of Positive Symtoms, Deartment of Psychiatry Colege of Medicine the University of Iowa, 1984.
• 27. Erkoç Ş, Arkonaç O, Ataklı C, Özmen E. Pozitif Semptomları Değerlendirme Ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam Dergisi1991; 4(2): 20-4.
• 28. Andreasen NC. The Scale for the Assessment of Negative Symptoms (SANS).1983; Iowa City, Iowa: The University of Iowa.
• 29. Erkoç Ş, Arkonaç O, Ataklı C, Özmen E. Negatif semptomları değerlendirme ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam 1991; 4(2): 14-5.
• 30. Arslan S, Günay Kılıç B, Karakılıç H. İçgörünün üç bileşenini değerlendirme ölçeği güvenirlik ve geçerlik çalışması. Türkiye’de Psikiyatri 2000; 3:17-24.
• 31. Addington D, Addington J, Matıcka-Tyndale E. Assessing depression in schizophrenia: the Calgary Depression Scale. The British journal of psychiatry 1993; 163(22): 39-44.
• 32. Aydemir Ö, Esen Danacı A, Deveci A, İçelli İ. Calgary Şizofrenide Depresyon Ölçeği’nin Türkçe versiyonunun güvenilirliği ve geçerliliği. Nöropsikiyatri Arşivi 2000; 37(1):82-6.
• 33. Linehan MM, Nielsen SL. Assessment of suicide ideation and parasuicide: hopelessness and social desirability. Journal of Consulting and Clinical Psychology 1981; 49(5): 773-5.
• 34. Laursen TM. Causes of premature mortality in schizophrenia: a review of literature published in 2018. Curr Opin Psychiatry 2019; 32:388–93.
• 35. World Health Organization. Suicide worldwide in 2019: Global health estimates. World Health Organization, Geneva, 2021.
• 36. Fu XL, Qian Y, Jin XH, Yu HR, Wu H, Du L, Chen HL, Shi YQ. Suicide rates among people with serious mental illness: a systematic review and meta-analysis. Psychol Med 2021; 1-11.
• 37. Dong M, Zeng LN, Lu L, Li XH, Ungvari GS, Ng CH, Chow IHI, Zhang L, Zhou Y, Xiang YT. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med 2019; 49(10):1691-1704.
• 38. Cassidy RM, Yang F, Kapczinski F, Passos IC. Risk factors for suicidality in patients with schizophrenia: a systematic review, meta-analysis, and meta-regression of 96 studies. Schizophrenia Bull 2018; 44:787–97.
• 39. Aydın M, İlhan BC, Tekdemir R, Çokünlü Y, Erbasan V, Altınbaş K. Suicide attempts and related factors in schizophrenia patients. Saudi medical journal 2019; 40(5): 475-82.
• 40. Martini M, da Fonseca RC, de Sousa MH, de Azambuja Farias C, Cardoso TA, Kunz M, Longaray VK, Magalhaes PVS. Age and sex trends for suicide in Brazil between 2000 and 2016. Soc Psychiatry Psychiatr Epidemiol 2019; 54:857–60.
• 41. Twenge JM, Cooper AB, Joiner TE, Duffy ME, Binau SG. Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005−2017. J Abnorm Psychol 2019; 128:185–99.
• 42. Hettige NC, Bani-Fatemi A, Sakinofsky I, De Luca V. A biopsychosocial evaluation of the risk for suicide in schizophrenia. CNS Spectr 2018; 23:253-63.
• 43. Zaheer J, Olfson M, Mallia E, Lam JS, de Oliveira C, Rudoler D, Carvalho AF, Jacob BJ, Juda A, Kurdyak P. Predictors of suicide at time of diagnosis in schizophrenia spectrum disorder: a 20-year total population study in Ontario, Canada. Schizophrenia Research 2020; 222: 382-8.
• 44. Naguy A, Al-Rabaie A. Suicidality and survivability in schizophrenia. The Journal of Nervous and Mental Disease 2017; 205(7): 585.
• 45. Penttilä M, Jääskeläinen E, Hirvonen N, Isohanni M, Miettunen J. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 2014; 205:88–94.
• 46. Krynicki CR, Upthegrove R, Deakin JF, Barnes TR. The relationship between negative symptoms and depression in schizophrenia: a systematic review. Acta Psychiatr Scand 2018; 137:380–90.
• 47. De Sousa A, Shah B, Shrivastava A. Suicide and Schizophrenia: An Interplay of Factors. Curr. Psychiatry Rep 2020; 22:65.
• 48. Peritogiannis V, Ninou A, Samakouri M. Mortality in schizophrenia-spectrum disorders: recent advances in understanding and management. In Healthcare 2022; 10(12): 2366.