Suicidal ideation and behavior in recent-onset schizophrenia

About 10% of people with schizophrenia die by suicide, and the period of greatest risk is the first decade of illness. To better predict suicidality in schizophrenia, we examined data from a sample of patients with recent-onset schizophrenia to characterize: 1) the temporal course of suicidal ideation and behavior, and 2) the extent to which anxiety, depression and mild suicidal ideation are followed by significant suicidal ideation or behavior. Ninety-six patients with a recent onset of schizophrenia or schizoaffective disorder were rated every two weeks for one year using the Expanded UCLA version of the Brief Psychiatric Rating Scale. There were no deaths due to suicide in this study. The severity of suicidality changed rapidly. Depressed mood was moderately correlated with concurrent suicidality, but not independently associated with future suicidality. Low levels of suicidal ideation dramatically increased the risk for significant suicidal ideation or behavior during the subsequent three months. A clinical algorithm based on this result correctly predicted significant suicidal ideation or behavior over the next 3 months in 8 out of 14 subjects. Low levels of suicidal ideation may predict future suicidal ideation and behavior better than depressed mood in people with schizophrenia. Patients who are monitored infrequently may benefit from more frequent assessment or an educational intervention following mild suicidal ideation. The generalizability of the clinical algorithm developed here will need to be assessed in another sample.