Addington et al classified the risk factors for suicide and suicidal attempts separately. Hallucinations (especially auditory hallucinations) were not associated with suicide. Those individuals who were predisposed to attempted suicide, hallucinations only increased the risk for suicide. However, it did not act as an independent risk factor. The risk factors for suicide included previous depressions, previous suicide attempts, drug abuse, aggressiveness, fear of deterioration of the condition, poor treatment adhesion and compliance, significant losses, etc.
On the other hand, the risk factors for attempted suicide included past suicidal ideation, causing deliberate harm to self, depressive episodes, drug abuse, psychiatric hospitalizations, etc. Suicide was found to be linked to psychosis, aggressiveness, loss of reality, etc. It was also found that in patients who did not adhere to the treatment guidelines, the chances of suicide were higher (Addington, 2006). Bandolier et al (2007) studied more than 60 trials regarding the schizophrenia and the risk of suicide and death. He observed that in new onset cases the mortality rate was 2.9 %, and about one third were from suicides. In older cases, the mortality rate as about 2. 3 % and about 6 % died from suicide. The risk of suicide was the greatest after onset of the condition. Irrespective of the method of diagnosing schizophrenia, the rates of suicide remained the same.
Bandolier et al randomly assessed several studies and classified risk factors into three types (based on relevance to suicide) namely risk factors associated with successful suicide, risk factors limitedly associated with suicide and risk factors not associated with suicide.
The risk factors that were of limited importance with relation to suicide include male sex, hopelessness, worthlessness, solitary living, no family ties, history of depression, etc. The factors that were associated with successful suicide included suicidal ideation, fear of mental deterioration, drug abuse, recent or past depression, suicidal thought and past unsuccessful attempts, no adherence or compliance with treatment, aggressiveness, agitation, hallucination, etc.
Bandolier et al classified the risk factors into various types namely social and demographic factors, family history, personal history and clinical history. The family history included history of psychiatric disorders, depression, drug abuse, suicide, or alcohol abuse in the family. The personal history included recent loss of a loved one, IQ status, loss of a parent, education levels, etc. Several factors in the clinical history included depression, mental deterioration fears, suicidal ideation, suicidal attempts, etc (Bandolier Journal, 2007).
However, one study that had an alternative view of suicidal ideation in schizophrenia was Tikkanen et al (2009). This study aimed at determining the role school performance and general intelligence levels had to play in adolescents suffering from schizophrenia. In the past, suicidal ideation has only been rarely associated with good school performance. Students on the other hand who had lower cognitive abilities and performed poorly in school had a higher risk for suicide (as felt earlier).
The study included about 500 adolescents who were in psychiatric wards between the periods April 2001 to March 2006. The risk for suicidal ideation and developing several psychiatric disorders were higher in male students who were performing well in school. On the other hand, both boys and girls who performed badly in schools had a higher risk of substance abuse and other substance related disorders. The risk of suicidal ideation in boys performing well in school was about three times higher.
Suicidal ideation is a risk factor for suicidal attempts. The exact reason for higher suicidal ideation in good performers in school may not be known, but higher intelligence levels and ability to mentally have fewer changes with general ability during illness, may in fact create more fear and awareness in the individual. The individual may think forward that mental illness would be a threat to successes and ambitions in life and would hence have suicidal ideation and subsequent suicide attempts (Tikkanen 2009).