Factors involved in suicidal behavior among adults diagnosed with schizophrenia: A secondary analysis of data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE).

摘要

Suicide is among the leading causes of death for adults diagnosed with schizophrenia, with risk estimates being over eight folds greater than the general population. While research has largely focused on the role of symptoms of depression, there is a lack of consensus and understanding of the role positive symptoms of psychosis (i.e. hallucinations and delusions) play in suicide risk. Further, suicide continues to be a major public health problem with an absence of effective evidence-based interventions. Guided by Williams' Theory of Suicide and Beck's Cognitive Theory of Suicide, the current study aimed to increase understandings of suicide risk within this vulnerable population by testing a multi-level framework to identify the specific pathways of influence between symptoms of depression, positive symptoms of psychosis (hallucinations and delusions), hopelessness, social support, and suicidal behavior (ideation and attempt). Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), a longitudinal randomized controlled trial comparing the effectiveness of antipsychotics among a sample of adults diagnosed with schizophrenia in the United States (n = 1,460). Structural Equation Modeling (SEM) was used to analyze the proposed conceptual model at baseline, 6 months, and 12 months. Suicide attempt was not examined due to low base rates. Findings supported the consistently demonstrated role that symptoms of depression and hopelessness play in suicidal ideation at all three time points. Positive symptoms of psychosis were found to condition the way in which symptoms of depression and suicidal ideation related at baseline. Additionally, emotional social support served as a protective factor attenuating the effect of symptoms of depression on hopelessness at 12 months. Implications for practice, policy, and research are identified and discussed. This research represents the first of several future prospective longitudinal studies that will ultimately inform the development of a suicide prevention-focused intervention tailored to adults diagnosed with schizophrenia.