Young Adults With Schizophrenia Have Highest Suicide Risk

Schizophrenia poses many challenges, including the risk of suicide. A recent study in JAMA Psychiatry has found that Medicare patients aged 18 to 34 with schizophrenia have the highest risk of suicide.

With suicide rates on the rise in the United States, these research findings can assist with much-needed outreach and programming to support the mental health needs of patients with schizophrenia across the country.

Especially given how treatment of schizophrenia and suicide risk continues to be limited by racial healthcare disparities, subsequent studies need to further explore how oppression may exacerbate the high risks of suicide.

Understanding the Research

Based on this cohort study of 668,836 patients with schizophrenia and Medicare coverage, participants demonstrated a greater risk of suicide than the general population of Americans, with the highest rate among those aged 18-34, and the lowest rate among those aged 65 and over.

In the general population of Americans, suicide risk tends to increase with age, but this study found that among people with schizophrenia, risk factors such as suicidal ideation, suicide attempt, self-injury, substance use, inpatient psychiatric hospitalization, and emergency room visits decline with age.

A limitation of this study is potential selection bias because the sample only included Medicare patients with schizophrenia who had been enrolled for at least 1 year with at least 1 inpatient or at least 2 outpatient schizophrenia codes, so those factors may impact the findings of this research.

Interventions Must Respond to Oppression

Clinical psychologist Aimee Daramus, PsyD, says, "This study is a place to begin when trying to create targeted interventions to prevent suicide in people with schizophrenia. During adolescence, suicide tends to be in response to bullying and social rejection or isolation, but as people move into young adulthood, and in males in particular, suicide is most often related to despair about fulfilling financial, career, and other adult goals."

In terms of age, Daramus highlights that schizophrenia often manifests in the late teens and early to mid twenties, so the increased rates of suicide may be due to the ways that schizophrenia is associated with social rejection and greater difficulty in fulfilling career goals. Daramus cautions that BIPOC and LGBTQ individuals are further marginalized, as they often also confront the negative impacts of race, sexuality, and gender.

Daramus says, "If someone is rejected by their family for their sexual orientation or gender, they’re going to have a higher risk of homelessness, in addition to the downward social drift that leaves many people with schizophrenia without homes."

She adds that effective intervention has to be about more than just therapy and meds. "We also need interventions for housing, jobs, education, and community-level educational interventions to reduce stigma. This piece of research is an important piece of a complex puzzle," she says.

Marginalization Can Exacerbate Psychotic Symptoms

Johns Hopkins-trained psychiatrist and regional medical director for Community Psychiatry, Leela R. Magavi, MD, says, "Many individuals are unable to maintain relationships with loved ones or maintain a job. This leads to homelessness and substance use, the latter of which can exacerbate psychotic symptoms. Additionally, many schizophrenic individuals experience frightening command auditory hallucinations where they hear a voice, which commands them to harm themselves or others."

While the reality of navigating positive and negative symptoms of schizophrenia can be challenging, Magavi asserts that it is possible to collectively assist schizophrenic individuals and their families with appropriate community support, therapy, and medication management.

Magavi says, "When individuals first experience voices, they often experience significant depressive and anxiety. This could cause panic attacks and social withdrawal as well as shame, guilt and fear of rejection. For this reason, some individuals self-medicate with alcohol and substances to numb the pain and lessen the voices. Alcohol withdrawal, cocaine use, and marijuana use can trigger and exacerbate psychotic symptoms."