Young adults with schizophrenia face highest suicide risk, study says

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[This story discusses suicide. If you or someone you know is having thoughts of suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)]

Suicide prevention efforts for those with schizophrenia should focus on young adults, researchers say, after a large study revealed heightened suicide risks in the 18-34 age group.

Findings from Columbia University and Rutgers were published in JAMA Psychiatry last week, drawing from data on nearly 670,000 schizophrenic patients with Medicare coverage from 2007-2016, with data analysis conducted in 2020-2021. According to the Mayo Clinic, "schizophrenia is a serious mental disorder in which people interpret reality abnormally, [and] may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling."

In the current study, researchers found an overall 4.5-fold greater suicide rate among schizophrenic adults compared to the general population. However, suicide rates fell as patients grew older. Schizophrenic patients aged 18-34 faced the greatest risks with a suicide rate of 141.95 per 100,000 person-years, while those 65 and older had the lowest risk at a rate of 24.01.

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Young adults with schizophrenia faced higher suicide risks when compounded with drug use disorders, self-injury or suicide attempt, per the study.

"When a person with schizophrenia is becoming suicidal, an attempt can happen with little warning," Mark Olfson, lead author and Elizabeth K. Dollard professor of psychiatry at Columbia, said in a statement. "Often, suicidal behavior in schizophrenia is driven by psychotic processes. This aspect can make it difficult to anticipate and prevent."

"Knowing more about which age groups and what personal characteristics are linked to higher risk could increase attention and support for the most vulnerable patients," Olfson added.

According to Columbia University, there are still unknowns behind the decreasing suicide risks in relation to age.

"Young people with schizophrenia are more likely to experience suicidal ideation, suicide attempts, substance use disorders, inpatient mental health admissions, and emergency department visits," the release reads, citing Olfson. "These characteristics might help to explain why younger adults with schizophrenia are at greater risk of dying of suicide."

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The suicide rate for older schizophrenic males declines to levels approximately on par with older adults in the general population, researchers say. However, a so-called "healthy survivor" bias may be at play, with those most at risk for suicide or other health issues potentially dying at a younger age.

"Schizophrenia falls in the middle of diagnoses linked to increased suicide, ranking below mood disorders including major depression and bipolar disorder," the release reads, citing the lead author. Researchers advise focusing prevention efforts on young adults with schizophrenia, while also improving care by broadening access to anti-psychotic medication, clozapine, and treating substance disorders, among other recommendations.

The Associated Press contributed to this report.