Leo Sher, M.D.

Our research report, “Clinical features and psychiatric comorbidities in military veterans with schizophrenia with or without suicidality” is published in the November 2021 issue of the Journal of Psychiatric Research (1).

There is a need to increase our understanding of what elevates suicide risk in veterans with schizophrenia as a first step towards the future development of suicide prevention interventions. We compared demographic and clinical features of military veterans with schizophrenia with vs. without suicidality to determine specific risk factors for suicidality.

The sample consisted of two groups of veterans with schizophrenia: suicide ideators and/or attempters (SIA) and individuals without a history of suicidal ideation or attempts (no-SIA). Participants were interviewed using the Structured Clinical Interview for DSM-5 Axis I disorders (SCID-I), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale (HDRS), and Schizotypal Personality Questionnaire (SPQ).

There was no difference between the groups with regard to the demographic parameters: age, gender, race, marital status, years of education, and proportion of participants with at least High School Diploma. In bivariate analyses, the PANSS-Positive Symptom scores, PANSS-General Psychopathology scores, HDRS total score, HDRS-Paranoid symptoms item score, and SPQ total scores were higher among SIA compared with no-SIA patients. In this unique clinical sample of veterans with schizophrenia, SIA patients were more likely to have mood disorders, post-traumatic stress disorder (PTSD), and/or alcohol use disorder in comparison to the no-SIA group. Logistic regression analysis indicated that the HDRS total score and presence/absence of comorbid mood disorder drive the difference between the groups.

Our results indicate that suicide risk assessment in veterans with schizophrenia should include identifying individuals with comorbid mood disorders/symptoms, PTSD, alcohol use disorder, marked positive symptoms, and schizotypal features. Our data have translational relevance with respect to highlighting the need for comprehensive assessment of veterans with schizophrenia who are at increased risk for suicide and suggest that therapeutic targeting of multiple domains may be necessary to mitigate this heightened suicide risk.

References

1. Sher L, Kilmade ME, Feinberg A, Govindarajulu U, Byne W, Kahn RS, Hazlett EA. Clinical features and psychiatric comorbidities in military veterans with schizophrenia with or without suicidality. J Psychiatr Res. 2021 Sep 7;143:262-267. doi: 10.1016/j.jpsychires.2021.09.028.