1. Suicidal Ideation and Suicidal Behaviour in Postmenopausal Schizophrenia Women: the Relevance of Suicide Risk Assessment
Alexandre González-Rodríguez 1, Rosa Catalán 2, Rafael Penadés 2, Victoria Ruiz-Cortés 3, Mercè Torra 4, Miquel Bernardo 2
Barcelona Clinic Schizophrenia Unit (BCSU). Neurosciences Institute, Hospital Clinic of Barcelona. Department of Medicine. University of Barcelona. Barcelona, Spain
Barcelona Clinic Schizophrenia Unit (BCSU). Neurosciences Institute, Hospital Clinic of Barcelona. University of Barcelona. CIBERSAM, IDIBAPS. Barcelona, Spain
Neurosciences Institute. Hospital Clinic of Barcelona. Barcelona, Spain
Pharmacology and Toxicology. Biochemistry and Molecular Genetics Department. Hospital Clinic of Barcelona. University of Barcelona. Barcelona, Spain
Corresponding author:
Introduction
Suicide is a global phenomenon associated with premature death in schizophrenia and related disorders’ patients (Hor and Taylor, 2010), and gender differences in suicidal ideation and behaviour have been widely discussed (Hor and Taylor, 2010; González-Rodríguez et al., 2015). Although suicidal ideation and suicide attempts among women seem to be related to low oestrogen and progesterone levels (Usall et al., 2009; Baca-Garcia et al., 2010), to the best of our knowledge, to date, few studies have specifically investigated suicidal ideation and behaviour in postmenopausal schizophrenia women.
Objectives
The main goal of this study was to investigate whether postmenopausal and premenopausal women and men with schizophrenia, differ in frequency of suicidal ideation and behaviour, intensity of suicidal ideation, and potential lethality of suicide attempts by using a widely accepted and validated scale.
Methods
Patients and study design: Cross-sectional study including schizophrenia patients fulfilling DSM-IV-TR criteria.
Measures: (1) Sociodemographic and clinical variables were recorded.
(2) Psychopathological assessment:
Positive and Negative Syndrome Scale (PANSS) for psychotic symptoms; Personal and Social Performance Scale (PSP) for functionality; Clinical Global Impression Scale (CGI-SCH); Columbia-Suicide Severity Rating Scale (C-SSRS) (Suicidal ideation, intensity of suicidal ideation and suicidal behaviour).
(3) Definition of Menopause (IMS criteria): permanent cessation of menstruation resulting from the loss of ovarian follicular activity.
Statistical analysis (SPSS version 20):Differences in psychopathology were investigated by applying ANOVA, using the C-SSRS variables as dependent factors and group (i.e. post-, premenopausal women and men) as fixed-factor. In a further step, antipsychotic doses, age at onset, DUP, N. of psychotic episodes and social support were introduced as covariates. Logistic regression models were performed to investigate the association between clinical and demographic factors, and suicidality.
Results
Table 1. Sociodemographic and clinical features in pre-, postmenopausal women and men with schizophrenia (N=169)
Total sample
N=169
Men
n=74
Premenopausal women
n=32
Postmenopausal women
n=63
Statistic
Sociodemographic and clinical features
Marital status, n (%)
-Married/Partner
-Separated
-Widowed
-Divorced
-Single
40 (24.1)
4 (2.4)
11 (6.6)
7 (4.2)
104 (62.7)
16 (22.2)
1 (1.4)
0 (0)
3 (4.2)
52 (72.2)
5 (16.1)
1 (3.2)
25 (80.6)
19 (30.2)
2 (3.2)
11 (17.5)
4 (6.3)
27 (42.9)
χ²=1.566 , df=2, p=0.457
Age at onset of disease, mean (SD)
33.29 (15.24)
29 (12.33)
24.30 (7.20)
42.61 (16.40)
F (2,163)=25.628, p=0.000*
N. Past psychotic episodes, mean (SD)
3.90 (2.83)
5.04 (2.89)
4.06 (2.53)
3.21 (2.99)
F (2,159))=4.248, p=0.014*
Antipsychotic equivalent doses, mean (SD)
16.85 (14.12)
20.03 (15.35)
16.91 (12.12)
13.16 (12.83)
F (2,163)=4.059, p=0.037*
Lifetime suicidal ideation, [n(%)]
73 (43.2)
33 (45.8)
16 (51.6)
24 (38.1)
χ²=1.719, df=2, p=0.423
Lifetime suicidal behaviour, [n(%)]
43 (23.7)
19 (25.68)
8 (25)
16 (25.4)
χ²=0.669, df=2, p=0.716
*p<0.05
Figure 2. Deterrents that stopped patients from attempting suicide (after adjustment)
Figure 3. Reasons for suicidal ideation (after adjustment)
p=0.004*
p=0.039*
Conclusions
Postmenopausal schizophrenia women showed higher intensity of suicidal ideation, and deterrents were less likely to stop them from attempting suicide compared to men and premenopausal women.
No differences were found between groups (i.e. premenopausal, postmenopausal women and men) with regard to the frequency of suicidal ideation and behaviour.
Low oestrogen levels after menopause should be considered a potential neurobiological underpinning of suicidal behaviour among schizophrenia women.
DISCLOSURES: Miquel Bernardo has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of ABBiotics, Adamed, Boehringer, Eli Lilly, Ferrer, Forum Pharmaceuticals, Janssen-Cilag, Lundbeck, Otsuka, Pfizer. Alexandre González-Rodríguez has received honoraria or has been paid for travels from Pfizer, Janssen, and Ferrer. Rosa Catalán has received honoraria or has been paid for travels from Lilly, Lundbeck, Janssen, Ferrer, Pfizer, and Bristol. Rafael Penadés has received honoraria or been paid for travels from Otsuka-Lundbeck. The remaining authors report no other conflicts of interest in this work.
Baca-Garcia E, Díaz-Sastre C, Ceverino A, et al., Suicide attempts among women during low estradiol/low progesterone states. J Psychiatr Res. 2010;44 (4):
González-Rodríguez A, Molina-Andreu O, Penadés R, et al. Delusional disorder over the Reproductive Life Span: The Potential Influence of Menopause on the Clinical Course. Schizophr Res Treatment. 2015;2015:
Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010; 24 (4 Suppl):
Usall J, Pinto-Meza A, Fernández A, et al. Suicide ideation across reproductive life cycle of women. Results from a European epidemiological study. J Affect Disord. 2009; 116:144-7.
Acknowledgements:This study was supported by CIBERSAM; Instituto de Salud Carlos III (PI11/02006; PI16/01029), Comissionat per a Universitats i Recerca del DIUE (2009SGR1295,2009SGR827) and FEDER.
the Ministerio de Economía y Competitividad. Instituto de Salud Carlos III- Fondo Europeo de Desarrollo Regional, Unión Europea, Un manera de hacer Europa, Centro de Investigación Biomédica en Red de salud Mental, CIBERSAM, by the Government of Catalonia, and Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2014SGR441) and Juan José López-Ibor Foundation.