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Early intervention may cut suicide rate in first-episode schizophrenia

Researchers from the University of Hong Kong found that patients with first-episode schizophrenia-spectrum disorders who underwent a 2-year early intervention service had a significantly lower suicide rate than those who did not over the course of 12 years.

“Many studies have reported the benefits of an [early intervention] service in improving short-term clinical and functional outcomes, including randomized clinical trials and historical control studies when the services were introduced as a regionwide program,” Sherry Kit Wa Chan, MRCPsych, department of psychiatry, University of Hong Kong, and colleagues wrote in JAMA Psychiatry. “A well-designed historical control study evaluating the long-term outcomes of a regionwide [early intervention] service can perhaps obtain a sufficient sample size to study the potential association of an [early intervention] service with the suicide rate.”

Researchers examined the short- and long-term links between a 2-year, regionwide early intervention service and the suicide rate of patients in Hong Kong with first-episode schizophrenia-spectrum disorders during a 12-year period. Separately, the investigators evaluated risk factors associated with early suicide — in the first 3 years — and late suicide — in years 4 through 12. They compared clinical data from 617 patients with schizophrenia who underwent the early intervention with 617 patients who underwent standard care collected over the first 3 years.

Overall, 73 patients completed suicide during the 12-year period, including 27 (4.4%) in the early intervention group and 46 (7.5%) in the standard care group (P = .02). The standardized mortality ratios for all-cause mortality and suicide were lower in the intervention group compared to the standard care group (5.67 vs. 8.38 for all-cause mortality and 28.01 vs. 44.66 for suicide). The number of patients needed to treat was 61.7 at year 1 and 29.4 at year 12, with the sharpest decrease observed between years 1 and 3, according to the researchers.

Relapse and adherence during the early stage of schizophrenia indicated late suicide. Chan and colleagues observed a significant link between early intervention and suicide survival during the 12 years (HR = 0.57; 95% CI, 0.36-0.91; P = .02), with the main association observed during the first 3 years. When comparing overall suicide survival between the two groups, propensity score-adjusted HRs were 0.32 (P = .007) for years 1 through 3 and 0.87 (P = .65) for years 4 through 12.

“Relapse and adherence during the early stage of the illness indicated late suicide. This finding highlights the importance of the further improvement of the [early intervention] model to effectively reduce the relapse rate,” Chan and colleagues wrote. “Different sets of risk factors were associated with suicide at different stages of illness, suggesting the importance of phase-specific intervention.”

These findings add to the evidence supporting global implementation of early intervention services for people with schizophrenia, Nikolai Albert, PhD, Mental Health Services in the Capital Region of Denmark, Copenhagen University Hospital, and colleagues wrote in a related comment.

“Early intervention services demand more money upfront and therefore call for politicians’ willingness to make the long-term investment to affect the outcome of one of the most debilitating illnesses in the world,” Albert and colleagues wrote. “To make this change happen, we need high-quality research such as this study, and we as a research community have to engage with user organizations and other lobbying organizations and make the argument for implementation.” – by Savannah Demko

Disclosures: Chan reports being a member of the working group in a voluntary position. Please see the full study for all other authors’ relevant financial disclosures. Albert and colleagues report no relevant financial disclosures.