Early Intervention May Reduce Long-Term Suicide Rates in Schizophrenia

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An early intervention service may be associated with a decreased suicide rate among patients with schizophrenia-spectrum disorders.
An early intervention service may be associated with a decreased suicide rate among patients with schizophrenia-spectrum disorders.

Patients with first-episode schizophrenia-spectrum enrolled in a 2-year early intervention (EI) service show significantly reduced suicide rates within a 12-year window, according to a study in JAMA Psychiatry.

Researchers compared 2 individually matched groups in this historical control study: 617 patients with first-episode schizophrenia-spectrum who participated in an early intervention service from July 1, 2001 to June 30, 2003 and 617 patients with first-episode schizophrenia-spectrum who underwent standard care from July 1, 1998 to June 30, 2001.

The primary outcome of this study was 12-year suicide rate. Early suicide between years 1 and 3 was indicated by number of suicide attempts, whereas late suicide between 4 and 12 was indicated by number of relapses, poor adherence, and premorbid occupational impairment.

Researchers studied the first 3 years of clinical information as well as records of suicide-related death for 12 years after the start of early intervention or standard care services. There was a better survival rate in the early intervention group (propensity score–adjusted hazard ratio [aHR], .57; P =.02), with a suicide rate of 4.4% among the 617 patients in the early intervention group and a suicide rate of 7.5% in the standard care group (McNemar χ2 = 5.55; P =.02).

The early intervention and standard care groups compared closely in age and sex, with the early intervention group's mean age at 21.2 (standard deviation 3.4) years and overall sex 51.5% male, and the standard care group's mean age at 21.3 (standard deviation 3.4) years and overall sex 52.2% male.

The authors concluded that “the EI service may be associated with reductions in the long-term suicide rate. Suicide at different stages of schizophrenia was associated with unique risk factors, highlighting the importance of a phase-specific service.”

Reference

Chan SKW, Chan SWY, Pang HH, et al. Association of an early intervention service for psychosis with suicide rate among patients with first-episode schizophrenia-spectrum disorders [published online April 4, 2018]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.0185

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