Suicide Attempts Among Patients with Schizophrenia

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Suicide Attempts Among Patients with Schizophrenia

Schizophrenia is a severe form of psychological disorder and is considered to be a psychosis. People with schizophrenia are out of touch with reality and tend to not understand what is going on around them and how to interact. People with schizophrenia generally have a hard time interacting with others as their diagnosis gives them severe impairments in thinking; which may cause hallucinations where they hear or see things that are not present. Some patients may experience delusions or irrational belief systems. Often the delusions or hallucinations a patient may experience will strengthen and support one another. Schizophrenia affects 1 percent worldwide and has a strong genetic basis. It is found that stressors may factor in on the onset of the disorder, some being severe poverty and poor parenting could be considered triggers. One-third of people with schizophrenia will attempt suicide and 10 percent will eventually succeed.

Ali Bani-Fatemi took it upon herself to question the connection between childhood trauma and suicide attempt among people diagnosed with schizophrenia. Bani-Fatemi, states in her journal that Suicide runs in families, with adoption and twin studies indicating that the familial transmission can be attributed to genetic factors. Genetic factors determine a large proportion of the risk for schizophrenia as well, with up to 81% heritability being suggested (Bani-Fatemi, 169). Genetically, it is found that 10-15 percent of first-degree relatives to a schizophrenic patient will also develop schizophrenia. In fraternal twins if one has schizophrenia, the other has a 15 percent risk of also developing the disorder. In identical twins, if one has schizophrenia, the others risk of the disorder increases to 50 percent. As suicide is accountable for 5 percent of death among the schizophrenic, they hold a higher risk of attempting suicide. The hypothesis reached for the study states how schizophrenia risk loci is more delicate to environmental insults which may influence suicidal actions and childhood trauma increases the chances of suicide.

Previous studies explain how trauma is associated in suicide attempt among the schizophrenic. Among early life adversities, childhood trauma has been associated with suicide attempt in schizophrenia. In our previous study, we found that childhood maltreatment increases the risk for suicide attempt in psychosis when controlling for confounding factors (Bani-Fatemi, 170). More studies found that patients with childhood trauma have had more severe clinical and psychotic symptoms compared to those with low childhood trauma. It was also found that patients with prior suicide attempts had higher sexual abuse than those without suicide attempts. Patients with high suicidal risk had higher physical neglect than those without suicidal risk. Sexual abuse predicted lifetime suicide attempts, and physical neglect and depression predicted suicidal ideation.

The goal of the study was to determine if there were any connections between polygenic scores with childhood trauma that could lead to suicide attempt within schizophrenics. 224 participants were recruited for the study from the Centre for Addiction and Mental Health, all participants being able to provide written consent. Participants were in the age range 18 to 75 years old, all with white caucasian ancestry. Out of the 224 participants, 93 were suicide attempters and 131 were non-suicide attempters. A suicide attempter was defined as anyone who attempted suicide at least once in his/her lifetime, as assessed by the Columbia Suicide Severity Rating Scale which allows to clearly differentiate between a suicide attempt versus an aborted or interrupted attempt.

Data that was taken from each participant was their sex, age, age of onset, and duration of illness. The Childhood Trauma Questionnaire (CTQ) was given to the participants to measure the presence and severity of trauma and neglect before the age of 18 years. The CTQ is a self-report inventory that provides a brief and reliable history of abuse and neglect. The questionnaire measures the severity of physical, emotional and sexual abuse, as well as emotional and physical neglect (Bani-Fatemi, 170). This background knowledge is necessary in order to calculate statistics and get results from the data.

The results from the tests showed that in 131 non-attempters and 93 suicide attempters, The mean unweighted score in suicide attempters was 95.26(6.47) and in non-attempters was 95.42(6.60) while the mean weighted score in suicide attempters was 0.910 (0.050) and in non-attempters was 0.909(0.048). The maximum difference between the cumulative distributions of unweighted polygenic scores D was 0.1207 with a corresponding P > .05. Furthermore, there was no significant difference in weighted polygenic score distribution between suicide attempters and non-attempters (p > .05) (Bani-Fatemi, 171). Seeing no significant differences, Bani-Fatemi performed subsidiary analysis due to the extensive data she collected.

While comparing different components of data the results showed that In our samples, there were 45 multiple attempters (subjects who attempted suicide twice or more lifetime) and 45 non-attempters who never showed suicidal behavior and experienced suicide ideation lifetime. When comparing the weighted scores in non-attempters/non-ideators and multiple attempters we found no difference in polygenic weighted scores and in unweighted polygenic scores D = 0.133 with a corresponding P of: 0.790 (Bani-Fatemi, 171). The differences in unweighted scores from the 45 multiple attempts to non-attempters is slightly higher than the first results of data.

Continuing comparing different levels of suicidal schizophrenics to non-attempters the data showed There were 31 subjects who committed an attempt that produced high medical damage (3 or 4 medical damage scores at the C-SSRS when considering the most serious attempt lifetime). We performed the comparison with the 45 non-suicide attempters/non ideators considering only the 31 high medical damage attempters. When comparing the weighted polygenic scores for the subjects with high medical damage attempts with non-attempters, we found that the maximum difference between the cumulative distributions, D, is 0.241 (Bani-Fatemi, 171). There was no trend for higher polygenic scores in suicide attempters with high lethality compared to non-attempter/non-ideators.

Bani-Fetami then chose to compare the participants that had a least one violent attempt to the non-attempters. Among the attempters, there were 38 subjects who had at least one violent attempt lifetime using the classification by Dumais et al., 2005. We compared the violent attempters with the non-attempters/non-ideators and we did not find any differences in weighted polygenic scores, the maximum difference between the cumulative distributions, D, was 0.0982 with a corresponding P of 0.984. When we compared the unweighted polygenic scores, we found that the maximum difference between the cumulative distributions, D, was 0.0924 with a corresponding P of 0.992 (Bani-Fatemi, 171). The differences in the scores was not very high, but also showed a larger difference than other comparisons

The last comparison made was between participants that had high intent to kill themselves justified by the Beck Scale for Suicide Ideation and the non-attempters. The journal following passage from the journal states the results. We considered the attempters with high intent using the item 21 of the BSS that is characterizing subjects who had high intent to kill themselves in the last attempt. According to this classification, there were around 29 attempters who reported high intent during the last attempt. When we compared the weighted polygenic scores, the maximum difference between the high intent attempters and non-attempters/ non-ideators was not significant (D = 0.1609; P = .712). When we analyzed the unweighted polygenic scores, we found that the maximum difference between the cumulative distributions, D, was 0.1073 with a corresponding P of 0.982 (Bani Fatemi, 171). The results from the high intent to non-attempters shows a slight variation compared to the rest of the data.

Contradicting Bani-Fatemis hypothesis, the research found that the polygenic risk score did not predict suicide attempt. Showing that schizophrenia polygenic risk scores are not related with suicide attempt. Variables that may have affected the data is family history of schizophrenia and the amount of suicide attempters in comparison to the sample size. When gathering statistical data the participants used can make a huge difference. If all the participants used were fraternal twins affected with schizophrenia the results could be more valuable.

More research should be done to further the knowledge and prediction of suicide attempts among those with schizophrenia. Both genetic risk and abuse or neglect received during childhood are factors that should be further analysed. Although Bani-Fatemi data does not support her hypothesis, genetic risk for schizophrenia with childhood trauma could help predict those who may be at risk for potential suicide attempt in the future. Other studies data contradicts the results Bani-Fatemi received. Each study using participants with different variables. The suicide rate within schizophrenic is high, continuing this research could prevent future suicides. While childhood trauma may be a trigger to schizophrenia, it is hard to relate each individual’s experience and actions to the next.

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