Suicide Risk in Schizophrenia

To the Editor: We read with great interest the excellent article by Hannele Heilä, M.D., and colleagues (1) on the clinical characteristics of suicide victims with schizophrenia in the general population of Finland. One important finding of this study is that suicide may occur at any point during the course of the illness, since three-fourths of the suicides were committed during an active phase. Previous reports, focusing especially on attempted suicide, had led to the general conclusion that active psychotic features were less important than depression and hopelessness in the assessment of suicide risk in schizophrenic patients (2, 3). When we studied the more severe forms of attempted suicide, however, 81% of the schizophrenic subjects presented positive psychotic symptoms at the time of attempting suicide (4). Our study also stressed the importance of previous attempts and the fact that more than one-quarter of the schizophrenic subjects were receiving psychiatric inpatient care when they attempted suicide, a finding similar to those of Heilä et al. (1). Therefore, we believe that clinicians should keep in mind that not only demoralization or depressive symptoms are important in the assessment of suicide risk in schizophrenia, but positive psychotic symptoms are even more significantly related to the risk of a serious attempt or suicide.