Observational Study
Copyright ©The Author(s) 2020.
World J Clin Cases. Feb 26, 2020; 8(4): 757-770
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.757
Table 1 Comparison of basic characteristics and clinical outcomes of schizophrenic patients with different levels of suicide risk
CharacteristicsTotal (n = 214)No risk (n = 172)Low risk (n = 20)Moderate/Severe risk (n = 22)P value
Sociodemographic
Sex0.059
Male169 (79.0)139 (82.2)17 (10.1)13 (7.7)
Female45 (21.0)33 (73.3)3 (6.7)9 (20.0)
Age (yr) (n = 213)37.9 (32.2-47.3)38.9 (33.4-47.4)33.5 (31.2-47.8)32.9 (22.7-43.7)0.051
Educational level0.962
Uneducated18 (8.4)16 (88.8)1 (5.6)1 (5.6)
1-6 yr93 (43.5)74 (79.6)10 (10.7)9 (9.7)
7-9 yr53 (24.8)43 (81.1)4 (7.6)6 (11.3)
10-12 yr33 (15.4)24 (72.7)4 (12.1)5 (15.2)
13 yr or more17 (7.9)15 (88.2)1 (5.9)1 (5.9)
Marital status0.433
Single145 (67.8)117 (80.7)15 (10.3)13 (9.0)
Married32 (14.9)28 (87.5)1 (3.1)3 (9.40)
Divorced/Separated31 (14.5)22 (71.0)3 (9.7)6 (19.3)
Widowed6 (2.8)5 (83.3)1 (16.7)0 (0)
Occupation0.396
Unemployed81 (37.8)61 (75.3)9 (11.1)11 (13.6)
Laborer81 (37.8)68 (83.9)5 (6.2)8 (9.9)
Agriculturist32 (15.0)27 (84.4)3 (9.4)2 (6.2)
Entrepreneur11 (5.1)10 (90.9)0 (0)1 (9.1)
Government officer1 (0.5)1 (100.0)0 (0)0 (0)
State enterprise/Private agency0 (0)0 (0)0 (0)0 (0)
Student1 (0.5)1 (100.0)0 (0)0 (0)
Priest7 (3.3)4 (57.1)3 (42.9)0 (0)
Personal annual income (US dollars1) (n = 204)1125 (563-1875)1125 (563-1969)750 (300-1875)1875 (938-1875)0.235
Household annual income (US dollars1) (n = 203)2438 (1125-3750)2250 (1125-3750)1875 (938-3750)3188 (1875-5625)0.263
Debt (n = 204)0.132
No142 (69.6)113 (79.6)16 (11.3)13 (9.1)
Yes62 (30.4)52 (83.9)2 (3.2)8 (12.9)
Mental illness
Major depressive episode: Current< 0.001a
No205 (95.8)171 (83.4)19 (9.3)15 (7.3)
Yes9 (4.2)1 (11.1)1 (11.1)7 (77.8)
ICD10: Schizophrenia type0.083
Paranoid147 (68.7)120 (81.6)13 (8.8)14 (9.5)
Disorganized3 (1.4)2 (66.7)1 (33.3)0 (0)
Catatonic1 (0.5)0 (0)0 (0)1 (100.0)
Undifferentiated62 (28.9)50 (80.6)6 (9.7)6 (9.68)
Postschizophrenia depression0 (0)0 (0)0 (0)0 (0)
Residual0 (0)0 (0)0 (0)0 (0)
Simple schizophrenia1 (0.5)0 (0)0 (0)1 (100.0)
Duration of schizophrenia (yr) (n = 209)3.79 (0.04-10.39)3.49 (0.04-10.38)9.86 (0.04-14.22)1.38 (0.02-8.95)0.137
Medication in previous month
Oral antipsychotic drugs
Clozapine0.775
Not received140 (65.4)114 (81.4)13 (9.3)13 (9.3)
Received74 (34.6)58 (78.4)7 (9.4)9 (12.2)
Dose (mg/d)100 (50-100)100 (50-100)100 (50-100)100 (50-100)
Risperidone0.511
Not received179 (83.6)145 (81.0)15 (8.4)19 (10.6)
Received35 (16.4)27 (77.1)5 (14.3)3 (8.6)
Dose (mg/d)4 (4-6)4 (4-6)6 (6-6)4 (2-6)
Haloperidol0.536
Not received199 (93.0)159 (79.9)20 (10.0)20 (10.0)
Received15 (7.0)13 (86.6)0 (0)2 (13.3)
Dose (mg/d)10 (8-10)10 (8-10)0 (0)9 (8-10)
Trifluoperazine0.097
Not received167 (78.0)131 (78.4)15 (9.0)21 (12.6)
Received47 (22.0)41 (87.2)5 (10.7)1 (2.1)
Dose (mg/d)20 (15-20)20 (15-20)20 (20-20)20 (20-20)
Perphenazine0.518
Not received139 (65.0)113 (81.3)14 (10.1)12 (8.6)
Received75 (35.0)59 (78.7)6 (8.0)10 (13.3)
Dose (mg/d)24 (16-24)24 (16-24)24 (24-24)16 (16-24)
Chlorpromazine0.112
Not received156 (72.9)122 (78.2)14 (9.0)20 (12.8)
Received58 (27.1)50 (86.2)6 (10.4)2 (2.4)
Dose (mg/d)50 (50-50)50 (50-50)50 (50-50)50 (50-50)
Long-acting antipsychotic drugs
Fluphenazine decanoate0.008a
Not received160 (74.8)128 (80.0)11 (6.9)21 (13.1)
Received54 (25.2)44 (81.5)9 (16.7)1 (1.8)
Dose (mg/mo)25 (25-25)25 (25-25)25 (25-25)25 (25-25)
Haloperidol decanoate0.337
Not received198 (92.5)160 (80.8)17 (8.6)21 (10.6)
Received16 (7.5)12 (75.0)3 (18.8)1 (6.2)
Dose (mg/mo)50 (50-50)50 (50-50)50 (50-50)50 (50-50)
Anxiolytic and hypnotic drugs
AMA20.605
Not received199 (93.0)158 (79.4)20 (10.1)21 (10.5)
Received15 (7.0)14 (93.3)0 (0)1 (6.7)
Clonazepam1.000
Not received203 (94.9)163 (80.3)19 (9.4)21 (10.3)
Received11 (5.1)9 (81.8)1 (9.1)1 (9.1)
Dose (mg/d)2 (2-2)2 (2-2)2 (2-2)2 (2-2)
Lorazepam0.161
Not received202 (94.4)163 (80.7)20 (9.9)19 (9.4)
Received12 (5.6)9 (75.0)0 (0)3 (25.0)
Dose (mg/d)2 (1-2)2 (1-2)0 (0)2 (1-2)
Diazepam0.931
Not received186 (86.9)148 (79.6)18 (9.7)20 (10.7)
Received28 (13.1)24 (85.7)2 (7.1)2 (7.1)
Dose (mg/d)10 (5-10)7.5 (5-10)10 (10-10)10 (10-10)
Antidepressants
Fluoxetine< 0.001a
Not received201 (93.9)169 (84.1)19 (9.4)13 (6.5)
Received13 (6.1)3 (23.1)1 (7.7)9 (69.2)
Dose (mg/d)20 (20-20)20 (20-20)20 (20-20)20 (20-20)
Sertraline0.483
Not received211 (98.6)170 (80.6)20 (9.5)21 (9.9)
Received3 (1.4)2 (66.7)0 (0)1 (33.3)
Dose (mg/d)50 (50-50)50 (50-50)0 (0)50 (50-50)
Mianserin0.196
Not received213 (99.5)172 (80.7)20 (9.4)21 (9.9)
Received1 (0.5)0 (0)0 (0)1 (100.0)
Dose (mg/d)30 (30-30)0 (0)0 (0)30 (30-30)
Other drugs
Lithium carbonate0.018a
Not received189 (88.3)157 (83.1)15 (7.9)17 (9.0)
Received25 (11.7)15 (60.0)5 (20.0)5 (20.0)
Dose (mg/d)600 (600-600)600 (600-600)600 (600-600)600 (600-600)
Valproate0.161
Not received201 (93.9)163 (81.1)17 (8.5)21 (10.4)
Received13 (6.1)9 (69.2)3 (23.1)1 (7.7)
Dose (mg/d)600 (400-600)600 (400-600)600 (600-800)600 (600-600)
Trihexyphenidyl HCl0.637
Not received18 (8.4)14 (77.7)1 (5.6)3 (16.7)
Received196 (91.6)158 (80.6)19 (9.7)19 (9.7)
Dose (mg/d)4 (4-6)4 (4-6)4 (4-6)4 (4-6)
Level of medication compliance0.413
Score less than 5133 (62.2)110 (82.7)12 (9.0)11 (8.3)
Score 5 or more81 (37.8)62 (76.5)8 (9.9)11 (13.6)
History of treatment
Electroconvulsive therapy0.290
No150 (70.1)124 (82.7)11 (7.3)15 (10.0)
Yes64 (29.9)48 (75.0)9 (14.1)7 (10.9)
Psychotherapy0.232
No200 (93.5)162 (81.0)17 (8.5)21 (10.5)
Yes14 (6.5)10 (71.5)3 (21.4)1 (7.1)
Family therapyNA
No214 (100.0)172 (80.4)20 (9.3)22 (10.3)
Yes0 (0)0 (0)0 (0)0 (0)
Other treatment1.000
No205 (95.8)164 (80.0)20 (9.8)21 (10.2)
Yes9 (4.2)8 (88.9)0 (0)1 (11.1)
Treatment satisfaction (n = 212)8 (7-10)8 (7-10)9 (7-10)8 (6-10)0.379
Other indices
Charlson Comorbidity index score (n = 213)0.086
None (0 score)207 (97.2)169 (81.6)18 (8.7)20 (9.7)
Low (1-2 score)4 (1.8)2 (50.0)1 (25.0)1 (25.0)
Moderate (3-4 score)1 (0.5)1 (100.0)0 (0)0 (0)
High (5 score or more)1 (0.5)0 (0)1 (100.0)0 (0)
Psychosocial score (n = 208)21 (18-25)21 (18-25)19 (18-24)20 (18-23)0.214
Level of psychosocial score (n = 208)0.128
Good (less than 25 score)156 (75.0)120 (76.9)17 (10.9)19 (12.2)
Poor (25 score or more)52 (25.0)47 (90.3)2 (3.9)3 (5.8)
Weapons and toxic chemicals accessibility score (n = 208)18 (9.5-29)18 (10-28)19 (11-30)15 (9-30)0.585
Level of weapons and toxic chemicals accessibility score (n = 208)0.791
Low (less than 25 score)142 (68.3)114 (80.2)12 (8.5)16 (11.3)
High (25 score or more)66 (31.7)53 (80.3)7 (10.6)6 (9.1)
Table 2 Univariable analysis of potential risk factors for suicide risk
CharacteristicsUnivariable ordinal logistic regression
OR (95%CI)P value
Sociodemographic
Sex0.116
Male1.00
Female1.85 (0.86-3.98)
Age (yr)0.96 (0.93-0.99)0.026a
Educational level0.609
Uneducated1.00
1-6 yr2.03 (0.43-9.56)
7-9 yr1.90 (0.38-9.57)
10-12 yr3.01 (0.58-15.70)
13 yr or more1.07 (0.13-8.53)
Marital status0.316
Single1.00
Married0.63 (0.20-1.93)
Divorced/Separated/Widowed1.60 (0.70-3.66)
Occupation0.272
Unemployed1.00
Employed0.60 (0.28-1.30)
Other0.29 (0.04-2.42)
Personal annual income (US dollars1)1.00 (1.00-1.00)0.918
Household annual income (US dollars1)1.00 (1.00-1.00)0.881
Debt0.598
No1.00
Yes0.81 (0.37-1.78)
Mental illness
Major depressive episode: Current< 0.001a
No1.00
Yes43.62 (8.51-223.65)
ICD10: schizophrenia type0.638
Paranoid1.00
Other1.19 (0.58-2.44)
Duration of schizophrenia (years)1.00 (0.96-1.05)0.877
Medication in previous month
Clozapine0.565
Not received1.00
Received1.23 (0.61-2.45)
Risperidone0.683
Not received1.00
Received1.20 (0.51-2.84)
Fluphenazine0.583
Not received1.00
Received0.80 (0.37-1.75)
Chlorpromazine0.151
Not received1.00
Received0.54 (0.24-1.25)
Haloperidol0.603
Not received1.00
Received0.67 (0.14-3.08)
Haloperidol decanoate0.685
Not received1.00
Received1.27 (0.40-4.08)
Trifluoperazine0.143
Not received1.00
Received0.50 (0.20-1.27)
Perphenazine0.565
Not received1.00
Received1.23 (0.61-2.45)
AMA20.234
Not received1.00
Received0.29 (0.04-2.25)
Clonazepam0.897
Not received1.00
Received0.90 (0.19-4.30)
Lorazepam0.47
Not received1.00
Received1.65 (0.42-6.45)
Diazepam0.445
Not received1.00
Received0.65 (0.21-1.97)
Fluoxetine< 0.001a
Not received1.00
Received26.77 (7.53-95.20)
Sertraline0.443
Not received1.00
Received2.62 (0.22-30.46)
Lithium carbonate0.01a
Not received1.00
Received3.09 (1.31-7.29)
Depakine0.4
Not received1.00
Received1.67 (0.51-5.51)
Artane0.685
Not received1.00
Received0.79 (0.25-2.52)
Score for medication compliance0.244
Less than 51.00
5 or more1.50 (0.76-2.95)
History of treatment
Electroconvulsive therapy0.242
No1.00
Yes1.52 (0.75-3.06)
Psychotherapy0.492
No1.00
Yes1.51 (0.46-4.94)
Other treatment0.66
No1.00
Yes0.62 (0.07-5.21)
Treatment satisfaction (score)0.99 (0.83-1.18)0.911
Other indices
Charlson Comorbidity index (score)1.10 (0.95-1.26)0.195
Psychosocial score (score)0.93 (0.86-1.00)0.046a
Weapons and toxic chemicals accessibility score (score)0.98 (0.95-1.02)0.438
Table 3 Factors associated with suicidal risk in multivariable analysis (n = 212)
CharacteristicsMultivariable ordinal logistic regression1
aOR (95%CI)P valuePseudo R2
Age (per 1 yr increase)0.95 (0.92-0.99)0.031a0.2084
Current major depressive episode26.88 (4.05-178.59)0.001a
Received fluoxetine in previous month18.59 (4.50-76.77)< 0.001a
Received lithium carbonate in previous month2.97 (1.10-8.01)0.032a
Charlson comorbidity index (per 1 point increase)1.20 (1.03-1.40)0.020a