OPAL 1 Suicide Supplement Project

Identifying age-related antecedents to suicide in schizophrenia

The NIMH OPAL Center (P50 MH115843 ) is dedicated to conducting research that addresses important issues in the treatment and delivery of services for schizophrenia across the lifespan but does not currently include projects with a focus on suicide. Suicide is a leading cause of premature death among individuals with schizophrenia. The distribution of suicide by age among individuals with schizophrenia is unique—the risk is higher among younger people with schizophrenia, during the initial years of the illness. Because of the higher suicide risk at a younger age, suicide risk among middle aged and older patients with schizophrenia has been poorly studied, with most research focusing on the period following initial diagnosis or the overall population with schizophrenia.  While several general risk factors for suicide have been identified among people with schizophrenia, such as a history of attempted suicide, depression, and poor adherence to treatment, the effects of age on these and other antecedents of suicide in schizophrenia remain poorly understood. 

In response to NIMH NOT-MH-19-026, we seek supplemental funding, under the aims of the parent P50 Center grant, to establish a national cohort of adults with schizophrenia from Medicare claims and National Death Index data (2007-2017).  The schizophrenia cohort will be used to 1) determine the incidence of suicide in relation to the general population stratified by age group and sex; 2) examine clinical diagnostic, pharmacological, and service use risk and protective factors for suicide death across the lifespan; 3) develop the foundation for a suicide prediction risk calculator to improve prediction of suicide in schizophrenia across the lifespan, using supervised machine learning methods.

The results will serve as the basis for a competitive application to NIMH for age-specific research on where, when, and how to identify suicide risk and to intervene to prevent suicide in schizophrenia.  In addition to experts on suicide, the project team includes an early-career investigator and established mental health researchers who are new to suicide research.

Investigators:

  • Scott Stroup, MD, MPH, Project Lead
  • Mark Olfson, MD, MPH, Co-Investigator
  • Melanie Wall, PhD, Co-Investigator
  • Tobias Gerhard, PhD, Co-Investigator
  • Natalie Bareis, PhD, Co-Investigator

What we found:

668,836 adults were included with 2218 suicide decedents: 1444 men and 774 women. In this cohort study of adult Medicare patients with schizophrenia, suicide risk was elevated, with the highest absolute and relative risk among young adults. These patterns support suicide prevention efforts with a focus on young adults with schizophrenia, especially those with suicidal symptoms and substance use.

The most common means of suicide was poisoning (36.8 %), with a significant sex difference by means: 55.9 % of women died by poisoning, 13.8 % by firearms, 11.0 % by hanging and 9.4 % by jumping, while among men suicide by poisoning (26.6 %), firearms (25.5 %), and hanging (24.2 %) were similar, followed by jumping (12.0 %). Suicide by poisoning among the schizophrenia cohort was 10 times that of the general population, while suicide by firearm was twice that of the general population.

Publications:

  1. Olfson M, Stroup TS, Huang C, Wall MM, Crystal S, Gerhard T. Suicide Risk in Medicare Patients With Schizophrenia Across the Life Span. JAMA Psychiatry. 2021 Aug 1;78(8):876-885. doi: 10.1001/jamapsychiatry.2021.0841. PMID: 34037667; PMCID: PMC8156163. (Link)
  2. Bareis N, Olfson M, Gerhard T, Rolin S, Stroup TS. Means of suicide among adults with schizophrenia across the life span. Schizophr Res. 2022 Dec 31;251:82-90. doi: 10.1016/j.schres.2022.12.004. Epub ahead of print. PMID: 36592524. (Link)

Presentations:

  1. Mark Olfson, Natalie Bareis, Tobias Gerhard, Cecilia Huang, Melanie Wall, Stephanie Rolin, Scott Stroup, Suicide Across the Lifespan Among Individuals Diagnosed with Schizophrenia: Distinctive Patterns of Age, Sex, and Means. Poster presentation at 3rd Columbia Psychiatry Science Celebration/Poster Session on February 16, 2023
  2. Bareis N; Stroup TS, Suicide Methods Among Adults With Schizophrenia Across the Life Span, Poster P5-110 at American Psychiatric Association Annual Meeting in New Orleans, LA, May 21 – 25 2022. 
  3. Gerhard T, Stroup TS, Huang C, Wall MM, Crystal S, Olfson M. Suicide Risk in Schizophrenia Across the Lifespan. Pharmacoepidemiology and Drug Safety, 2021;30(S1):344. Presented at the International Conference for Pharmacoepidemiology (Annual Meeting of the International Society for Pharmacoepidemiology. August 2021. Virtual Meeting.