Study shows increasing rates of premature death and violent crime in people with schizophrenia since 1970s

June 4, 2014, Lancet
Functional magnetic resonance imaging (fMRI) and other brain imaging technologies allow for the study of differences in brain activity in people diagnosed with schizophrenia. The image shows two levels of the brain, with areas that were more active in healthy controls than in schizophrenia patients shown in orange, during an fMRI study of working memory. Credit: Kim J, Matthews NL, Park S./PLoS One.

New research, published in The Lancet Psychiatry journal, shows that rates of adverse outcomes, including premature death and violent crime, in people with schizophrenia are increasing, compared to the general population.

The results come from a unique study, led by Dr Seena Fazel, at Oxford University, UK, which analyses long-term adverse outcomes – including conviction for a (such as homicide or bodily harm) (before the age of 56), and death by suicide – between 1972 and 2009 in nearly 25,000 people in Sweden diagnosed with schizophrenia or related disorders.

For the first time, the researchers compared adverse outcomes in people with a diagnosis of schizophrenia to both the and to unaffected siblings, allowing them to account for within families (such as parental criminality or violence) which might be expected to affect the risk of suicide or in siblings.

Overall, the results show that within five years of diagnosis, around 1 in 50 men and women with schizophrenia (2.3% of men and 1.7% of women) died by suicide; around one in 10 (10.7%) of men and around one in 37 (2.7%) of women with schizophrenia were convicted of a violent offence within five years of diagnosis. Overall, men and women with schizophrenia were eight times more likely to die prematurely than the general population.

Analysing the changing rate of adverse outcomes across the study period (1972 – 2009), the researchers found that the risk of premature death, suicide, and conviction for a violent offence has increased for men and women with schizophrenia in the last 38 years, compared with both the general population, and their unaffected siblings.

By tracking the number of nights spent in hospital by people with schizophrenia during the study period, the study shows that these increased rates of adverse outcomes appear to be associated with decreasing levels of inpatient care for these patients, although the study does not provide any evidence for a causal connection between decreasing inpatient care and adverse outcomes.

The researchers also analysed risk factors for adverse outcomes in both people with schizophrenia, the general population, and unaffected siblings. Across all three groups, the risk factors for violence and premature death were broadly similar, and included drug use disorders, criminality, and self-harm, all before diagnosis – suggesting that improved strategies to address these risk factors have the potential to reduce violence and premature deaths across the population, and not just in those with schizophrenia.

According to Dr Fazel, "In recent years, there has been a lot of focus on primary prevention of schizophrenia – preventing people from getting ill. While primary prevention is clearly essential and may be some decades away, our study highlights the crucial importance of secondary prevention – treating and managing the risks of adverse outcomes, such as self-harm or violent behaviour, 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."

Dr Eric Elbogen and Sally Johnson, at the University of North Carolina-Chapel Hill School of Medicine, USA, write in a linked Comment that, "One of the unique aspects of this study—that violence and suicide were analysed simultaneously—has an important implication for how we as a society perceive people with mental illness. News coverage of schizophrenia and other psychiatric disorders often focuses on violence and crime. Much less attention is paid to suicide and self-harm in people with severe mental illnesses."

However, they add that, "Importantly, we should remember that, when reporting about the intricate links between schizophrenia and these , 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. Policy makers, researchers, and clinicians need to remember the importance of appropriately weighing up the issue of relative to the myriad of other factors that contribute to increased risk of violence and suicide."

Explore further: Antipsychotic medication associated with reduced rate of violent crime

More information: Paper: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70223-8/abstract

Related Stories

Antipsychotic medication associated with reduced rate of violent crime

May 8, 2014
People who use antipsychotic medication (such as clozapine or risperidone) to treat psychiatric illness are nearly half as likely to commit a violent crime compared to when they are not using such medication, according to ...

People with mental illness at highly increased risk of being murder victims

March 5, 2013
The perpetration of homicide by people with mental disorders has received much attention, but their risk of being victims of homicide has rarely been examined. Yet such information may help develop more effective strategies ...

Women with schizophrenia to get new treatment option

May 26, 2014
(Medical Xpress)—In a world first study, exciting new research has revealed that oestrogen can help treat schizophrenia in previously treatment-resistant women.

Medical conditions add to premature mortality risk of people with mental illness

May 23, 2014
(Medical Xpress)—People using mental health services in New Zealand are dying prematurely from both natural and external causes, a new University of Otago Wellington study has revealed.

Services fail to treat prisoners with schizophrenia – increasing risk of violent reoffending

November 19, 2013
Maintaining psychiatric treatment both during imprisonment and after release can substantially reduce the risk of violent reoffending. Better screening and treatment of prisoners is therefore essential to prevent violence.

Recommended for you

Antidepressants are more effective than placebo at treating acute depression in adults, concludes study

February 22, 2018
Meta-analysis of 522 trials includes the largest amount of unpublished data to date, and finds that antidepressants are more effective than placebo for short-term treatment of acute depression in adults.

Smartphones are bad for some teens, not all

February 21, 2018
Is the next generation better or worse off because of smartphones? The answer is complex and research shows it largely depends on their lives offline.

Researchers uncover novel mechanism behind schizophrenia

February 21, 2018
An international team of researchers led by a Case Western Reserve University School of Medicine scientist has uncovered a novel mechanism in which a protein—neuregulin 3—controls how key neurotransmitters are released ...

Self-compassion may protect people from the harmful effects of perfectionism

February 21, 2018
Relating to oneself in a healthy way can help weaken the association between perfectionism and depression, according to a study published February 21, 2018 in the open-access journal PLOS ONE by Madeleine Ferrari from Australian ...

How people cope with difficult life events fuels development of wisdom, study finds

February 21, 2018
How a person responds to a difficult life event such as a death or divorce helps shape the development of their wisdom over time, a new study from Oregon State University suggests.

When it comes to our brains, there's no such thing as normal

February 20, 2018
There's nothing wrong with being a little weird. Because we think of psychological disorders on a continuum, we may worry when our own ways of thinking and behaving don't match up with our idealized notion of health. But ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.