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Lifetime suicide rates in treated schizophrenia: 1875–1924 and 1994–1998 cohorts compared

  • D. Healy (a1), M. Harris (a1), R. Tranter (a1), P. Gutting (a1), R. Austin (a1), G. Jones-Edwards (a1) and A. P. Roberts (a1)...

Recent interest in suicide rates in schizophrenia has been considerable.


To establish the lifetime suicide rate from the pre-chlorpromazineera and to compare this with recent lifetime suicide rates for schizophrenia.


We have compared suicide and suicide attempt rates for 741 admissions for schizophrenia and 1303 admissions for psychoses to the North Wales Asylum between 1875 and 1924, with first admissions for psychosis in North West Wales between 1994 and 1998.


The suicide rate in schizophrenia between 1875 and 1924 was 20 per 100 000 hospital years, a lifetime rate of less than 0.5%. The suicide rate for all psychoses was 16 per 100 000 hospital years. Current rates of suicide for schizophrenia and other psychoses appear 20-fold higher.


These findings point to an increase in suicide rates for patients with schizophrenia.

Corresponding author
Dr D. Healy, North Wales Department of Psychological Medicine, Hergest Unit, Bangor LL57 2PW, UK. Tel: +44 (0) 124 838 4452; fax: +44 (0) 124 837 1397; e-mail:
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See invited commentary, pp. 229–230, this issue.

Declaration of interest

D.H. has links with all major pharmaceutical companies and has been an expert witness in legal cases involving psychotropic drugs. A. P. R. and R. T. have been consultants for or received educational support from most major pharmaceutical companies.

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Lifetime suicide rates in treated schizophrenia: 1875–1924 and 1994–1998 cohorts compared

  • D. Healy (a1), M. Harris (a1), R. Tranter (a1), P. Gutting (a1), R. Austin (a1), G. Jones-Edwards (a1) and A. P. Roberts (a1)...
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Lifetime suicide rates in treated schizophrenia: 1875-1924 and 1994-1998 cohorts compared

Arpan Dutta, ST1 SHO Psychiatry
31 October 2006

Dear Sir,

Dr. Healy and colleagues (2006) looked at lifetime suicide rates in two cohorts of patients with schizophrenia, schizotypal and delusional disorders (1875-1924 and 1994-1998) that were admitted to mental health services from North West Wales. Although the study provides controversial findings, they appear flawed. The title suggests the paper looks only at schizophrenia yet it actually looks at the entire spectrum of schizophrenia and delusional disorders. The groups have not been matched appropriately, not enough detailed demographic data is provided and they appear not to be directly comparable. There may well have been selection bias in the 1994-98 dataset since they were selected from an ongoing study. It is also difficult to believe that the World Wars I and II as well as cultural and lifestyle changes have not affected North Wales. The population may well in a broad 15-55 year age category be the same, but there may be changes in ethnicity and modal age of the population are not demonstrated. The comparison of 1303 patients over a 50 year period to 133admissions in a 4 year period seems due to convenience than methodologicalreasoning. No account is taken for the severity of patients admitted todaycompared to historically or the stage of their illness. Compared to studies in Taiwan the current suicide rate itself is increased at 3.75% over the four year modern cohort, compared to 2% rate of a 15 year period studied in Taiwan (Phillips, 2004). It is also well known that suicide occurs most commonly in the first year after diagnosis (Department of Health, 2001), yet the study looked only compared data to patients who hadcompleted suicide in the first 5 years of contact with asylum services asa subgroup. There is also no calculation of whether the difference in incidences of suicide is statistically significant. Clinically the study, although reporting a higher suicide rate, has not actually demonstrated any explainable reasons for this, and hence has not added to the knowledgewhich may contribute to reducing the 22% of preventable suicides in schizophrenics and other delusional disordered patients.

ReferencesHealy D, et al. (2006) Lifetime suicide rates in treated schizophrenia: 1875-1924 and 1994-1998 cohorts compared British Journal of Psychiatry, 188, 223-228

MR Phillips et al. (2004) Suicide and the unique prevalence pattern of schizophrenia in mainland China: a retrospective observational study. Lancet, 364,1062-1068

Department of Health (2001) Safety First: five year report of the national cofidential enquiry into suicide and homocide by people with mental illness London: Department of Health

Declaration of interestNone

Dr. Arpan Dutta,ST1 (pilot) SHO Psychiatry5 Boroughs Partnership, Sherdley Unit, Whiston Hospital, Merseyside,L35 5DR

Dr. Frances Lindon,Consultant in Old Age Psychiatry5 Boroughs Partnership, Peasley Cross Hospital, Marshalls Cross Road, St. Helens, Merseyside,WA9 3DA
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Conflict of interest: None Declared

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Closure of Asylums: the unseen side

Dr Adil Yusufshah Kadri, Psychiatrist
12 April 2006

Many thanks to the authors for doing such an interesting piece of research. It has certainly altered my way of thinking about the historicalepidemiology and risk of suicide in schizophrenia.

As the authors rightly point out in their discussion, one reason for the increased risk for suicide appears to be the increased emphasis on encouraging patients to live in the community. Though on the surface, living in the community does appear to be the way forward it has not been without pitfalls. As we all know there is a sub-group of patients with schizophrenia who we feel may unfortunately never be able to live in the community for various reasons; some of which are severity of illness, lackof insight, poor compliance with treatment with relapse having severe consequences to but name a few. Historically such patients lived in their own 'communities' within an 'asylum'. With the move towards 'care in the community' such psychiatric institutions are being shut down with patientsbeing forced to move out and live in the community (not willingly in all cases). There are also some patients with schizophrenia whom we treat and follow-up in the community but whom some of us feel may be better treated in a psychiatric unit as in-patients. Unfortunately this is not always possible for various reasons, not the least of which is the dwindling number of psychiatric in-patient beds.

Matters are furthermore not helped by the very nature of today's society. There is increased pressure on all of us to conform, behave in a certain manner, maintain a certain standard of living, maintain relationships, perform well in jobs, meet deadlines, etc. This is stressful enough for 'normal' individuals and one can but imagine what effect this can have on the mental state of those suffering with an illness such as schizophrenia. As somebody once said 'it is a jungle out there' and this saying could easily be applied to the way at least how some of our patients may feel about living in the community. It is is therefore not surprising that living in the community coupled with the stresses of modern day life may all contribute at least in part to the increased risk of suicide in those with schizophrenia.
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Conflict of interest: None Declared

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Confounds in historical contrast

John H Noble Jr, Retired professor
10 March 2006

The lifetime suicide rates for the 1875-1924 and 1994-1998 cohorts could easily be explained by historical differences in (1) diagnosis of schizophrenia and (2) locale of treatment. Psychiatric diagnoses are notoriously unreliable and subject to temporal circumstances. Treatment inthe 1875-1924 pre-psychotropic drug era was largely in institutions, wheresupervision made suicide more difficult than in the post-psychotropic drugera of largely unsupervised community care. Either or both of these two variables interacting provide an alternative explanation for the differentsuicide rates. Valid comparison of the suicide rates for the two eras require statistical control for the two aforementioned confounds. ... More

Conflict of interest: None Declared

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