Suicide and psychosis
This study aims to determine the rates of suicide, self-harm and other causes of premature death in a cohort of patients followed for an average of 20 years after their first episode of psychosis. The research team is also investigating potential individual and neighbourhood-level risk factors for suicide and self-harm.
The project involves studying a cohort of 3,000 people living in south-east London, Nottingham, and Dumfries and Galloway, who had their first episode of psychosis between 1965 and 2004. The group of people from Nottingham and some of the London cohort had their first episode of psychosis between 1997 and 1999 and are part of the AESOP Study, which sets out to determine the rates, and elucidate the biological and social causes of first episode psychosis in black and ethnic minority groups in the UK.
Why carry out the research?
Suicide is one of the major causes of premature death for people with psychosis. The lifetime risk of suicide for people with schizophrenia and bipolar disorder has been estimated at 10-15 per cent.
Suicides tend to occur early in the course of the illness, but the true rate of suicide after a first episode of psychosis, or any change in rate over the last few decades, has not been studied effectively. Research to date has focused on unrepresentative samples – studying patients after their first hospitalisation, for example, rather than including community patients; or selecting inpatients rather than all patients following a first episode of psychosis. Follow-up time has been relatively short, making any conclusions limited.
Amongst patients with psychosis, the lifetime risk of self-harm is estimated to be as high as 20-50 per cent. Premature death from other causes is also high, with the mean lifespan reported to be approximately 10 years shorter than expected.
The UK Government’s White Paper, Saving Lives: Our Healthier Nation (1999) set a target to reduce suicide by 20 per cent by 2010, compared to a 1997 baseline.
There is a downward trend in suicide rates among the general population of England and Wales, but studies from other European countries suggest there may be an increase in the rate of suicide among patients who have had their first episode of psychosis.
Some of the factors involved in suicide might be culture specific and, in the UK, any changes in rate over time must be interpreted in the context of shifts in the ethnic composition of the population. Understanding risk factors for both suicide and self-harm may help develop strategies for prevention.
A December 2006 publication of the National Confidential Inquiry into Suicide and Homicide by People wit