Pathways Leading to Suicide in Schizophrenia

The aim of this systematic review is to report the pre- and postmorbid trajectories leading to suicide in schizophrenia, with special focus on novel research published in 2003-2006. Individuals with schizophrenia who commit suicide seem to follow a developmental trajectory that differs partly from that of other schizophrenia patients. According to the studies analysed, there seem to be five main pathways for schizophrenia patients leading to suicide. One obvious pathway is comorbid depression that leads to suicide. Second, there is a group of patients with a difficult, chronic course of illness and many relapses and exacerbations. They lose their hope progressively over time. The third group comprises patients (mostly young males) with impulsiveness, dysphoric affect and substance abuse. Fourth, there is a relatively small but theoretically interesting and clinically important group of mainly young patients with high premorbid functioning and above average intellectual capacity. The high suicide rate among this group may be a consequence of their own and their relatives' high expectations that are in line with their good premorbid functioning. The fifth group, failure in treatment, comprises patients lacking social support whose treatment has failed. We also propose a life span model showing these five different pathways to suicide in schizophrenia. These suicidal trajectories could be useful in clinical work when evaluating patients' possible suicide risk and treating them. They might also provoke some further research ideas and hypotheses.