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Meta‐analysis of the association between suicidal ideation and later suicide among patients with either a schizophrenia spectrum psychosis or a mood disorder
Author(s) -
Chapman C. L.,
Mullin K.,
Ryan C. J.,
Kuffel A.,
Nielssen O.,
Large M. M.
Publication year - 2015
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12359
Subject(s) - suicidal ideation , psychosis , psychiatry , schizophreniform disorder , schizophrenia (object oriented programming) , mood disorders , clinical psychology , psychology , bipolar disorder , mood , poison control , suicide prevention , medicine , schizoaffective disorder , anxiety , medical emergency
Objective Recent studies of patients with a mix of psychiatric diagnoses have suggested a modest or weak association between suicidal ideation and later suicide. The aim of this study was to examine the extent to which the association between expressed suicidal ideation and later suicide varies according to psychiatric diagnosis. Method A systematic meta‐analysis of studies that report the association between suicidal ideation and later suicide in patients with ‘mood disorders’, defined to include major depression, dysthymia and bipolar disorder, or ‘schizophrenia spectrum psychosis’, defined to include schizophrenia, schizophreniform disorder and delusional disorder. Results Suicidal ideation was strongly associated with suicide among patients with schizophrenia spectrum psychosis [14 studies reporting on 567 suicides, OR = 6.49, 95% confidence interval ( CI ) 3.82–11.02]. The association between suicidal ideation and suicide among patients with mood disorders (11 studies reporting on 860 suicides, OR = 1.49, 95% CI 0.92–2.42) was not significant. Diagnostic group made a significant contribution to between‐study heterogeneity ( Q ‐value = 16.2, df = 1, P < 0.001) indicating a significant difference in the strength of the associations between suicidal ideation and suicide between the two diagnostic groups. Meta‐regression and multiple meta‐regression suggested that methodological issues in the primary research did not explain the findings. Suicidal ideation was weakly but significantly associated with suicide among studies of patients with mood disorders over periods of follow‐up of <10 years. Conclusion Although our findings suggest that the association between suicidal ideation and later suicide is stronger in schizophrenia spectrum psychosis than in mood disorders this result should be interpreted cautiously due to the high degree of between‐study heterogeneity and because studies that used stronger methods of reporting had a weaker association between suicidal ideation and suicide.