Dr. Heilä and Colleagues Reply

To the Editor: We thank Dr. Vieta and colleagues for their comments. We agree with the conclusion they have drawn that among persons with schizophrenia, active schizophrenia symptoms are associated with suicide more frequently than are stabilized illness phases with depressive symptoms, a finding that is somewhat at variance with some earlier studies. In our suicide study group, 71% (N=55 of 77) of the suicide victims with schizophrenia had currently prominent (two or more) positive schizophrenia symptoms before suicide. This is in line with the recent research findings (1, 2) suggesting that positive symptoms are associated with heightened suicide risk and that among subjects with prominent negative symptoms, the risk may be low. Regardless of the illness phase, however, the significance of depression in suicides of persons with schizophrenia seems also evident: altogether, slightly more than one-half (N=38 of 74; 51%) of our suicide victims simultaneously had depressive symptoms and prominent positive schizophrenia symptoms. For suicide prevention, assessing and identifying the depressive symptoms among subjects with schizophrenia is important also during the active illness phase of schizophrenia.