Premature death, violent crimes increased among schizophrenics since 1970s

Increased rates of violent crime, suicide and premature mortality were found among patients with schizophrenia and related disorders, according to recent study findings published in The Lancet Psychiatry.

Seena Fazel, BSc, MBChB, MD, of the department of psychiatry at the University of Oxford, and colleagues evaluated 24,297 patients with schizophrenia and related disorders between 1972 and 2009 to determine rates and risk factors for adverse outcomes, including conviction of a violent offense, suicide and premature mortality. Participants were sex- and age-matched to the general population (n=485,940) and unaffected sibling controls (n=26,537).

Major adverse outcomes within 5 years of diagnosis were found among 13.9% of men and 4.7% of women. Compared with the general population, patients with schizophrenia and related disorders had higher odds of convictions for a violent offense, suicide and premature mortality rates.

Within 5 years of a first diagnosis, 10.7% of men and 2.7% of women were convicted of a violent offense. Violent convictions among patients with schizophrenia and related disorders were not associated with birth complications, being single or parental suicide.

Death by suicide within 5 years of a first diagnosis happened among 2.3% of men and 1.5% of women. Among the general population and unaffected sibling controls, low income and low IQ were associated with suicide.

Patients with schizophrenia and related disorders had higher odds of premature mortality compared with the general population and unaffected controls.

“In recent years, there has been a lot of focus on primary prevention of schizophrenia — preventing people from getting ill,” Fazel said in a press release. “While primary prevention is clearly essential and may be some decades away, our study highlights the crucial importance of secondary prevention — treating and managing risks of adverse outcomes, such as self-harm or violent behavior, in patients. Risks of these adverse outcomes relative to others in society appear to be increasing in recent decades, suggesting that there is still much work to be done in developing new treatments and mitigating risks of adverse outcomes in people with schizophrenia.”

In an accompanying editorial, Eric B. Elbogen, PhD, and Sally C. Johnson, MD, of the University of North Carolina School of Medicine, wrote that most people with schizophrenia and related disorders are neither violent nor suicidal.

“Despite the need to ensure people with schizophrenia are provided help to reduce their risks of suicide, violence, or premature death, researchers reporting findings also bear the burden of ensuring that most people with schizophrenia and related disorders, who are not violent, are not left to contend with stigma and discrimination,” they wrote. “Policymakers, researchers, and clinicians need to remember the importance of appropriately weighing up the issue of schizophrenia relative to the myriad of other factors that contribute to increased risk of violence and suicide.”

For more information:

Elbogen EB. Lancet Psychiatry. 2014;1:6-8.

Fazel S. Lancet Psychiatry. 2014;1:44-54.

Disclosure: The study was funded in part by the Wellcome Trust and the Swedish Research Council.