Reassessing long-term risk of suicide after a first episode of psychosis

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• 作者：Dr Rina Dutta^a ; ^{rina.2.dutta@kcl.ac.uk} ; Robin M Murray^a ; Matthew Hotopf^a ; Judith Allardyce^b ; Peter B Jones^c ; Jane Boydell^a
• 刊名：The Lancet
• 出版年：2013
• 出版时间：27 February, 2013
• 年：2013
• 卷：381
• 期：supp_S1
• 页码：S37
• 全文大小：43 K

文摘

Background

The long-term risk of suicide after a first episode of psychosis is unknown, because previous studies have often been based on prevalence cohorts, have been biased to more severely ill, hospitalised patients, have extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses. The aim of this study was to determine the epidemiology of suicide in a clinically representative, retrospective inception cohort of patients with a first episode of psychosis.

Methods

All 2723 patients who presented for the first time to secondary care services with psychosis in three defined geographical catchment areas in London (1965-2004, n=2056), Nottingham (1997-1999, n=203), and Dumfries and Galloway (1979-1998, n=464) were traced after a mean follow-up of 11¡¤5 years. The main outcome measure was number of deaths by suicide and open verdicts according to International Classification of Diseases, editions 7-10.

Findings

Case fatality from suicide was considerably lower than expected from previous studies: 1¡¤9 % (53/2723); proportionate mortality was 11¡¤9 % (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with median time to suicide being 5¡¤6 years. Suicide occurred nearly 12 times more than expected from the general population of England and Wales (standardised mortality ratio 11¡¤65, 95 % CI 8¡¤73-15¡¤24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation, suicide risk remained almost four times higher than in the general population (3¡¤92, 95 % CI 2¡¤22-6.89), a time when there may be less intense clinical monitoring of risk.

Interpretation

The highest risk of suicide after a psychotic episode occurs soon after presentation, yet clinicians should still be vigilant in assessing risk a decade or more after first contact. The widely held view that 10-15 % die from suicide is misleading because it refers to proportionate mortality rather than lifetime risk. Nonetheless, after a first espisode of psychosis, risk of suicide is substantially increased compared with that in the general population.

Funding

UK Medical Research Council.