287. Suicidal behaviour and self-harm in schizophrenia: a cross-sectional study of outpatient sample

Abstract

Abstract Background Suicide is the leading cause of premature death in schizophrenia, making 10 – 13%, in other sources – up to 55% lifetime risk. Childhood trauma emerges as a critical distal vulnerability, with meta-analyses linking it to increased odds of suicide attempts in schizophrenia spectrum disorders. This problem is particularly concerning in outpatient settings, where more than 40% of stable patients may report non-suicidal self-harm histories, underscoring the need for targeted screening beyond acute phases. Aims & Objectives The objective of this study is to examine childhood trauma (CT) rates, the prevalence and interrelationship of lifetime non-suicidal self-harm (NSSH) and suicide attempts (SA) in a sample of outpatients diagnosed with schizophrenia. Method The study involved 60 patients with schizophrenia in a stable phase of illness (no acute exacerbation in the preceding ≥ 3 months) who attended outpatient consultation department. Lifetime history of SA and NSSH was assessed using two direct questions adapted from the Risk Assessment Suicidality Scale (RASS). CT rates were investigated using the Childhood Trauma Questionnaire Short Form (CTQ-SF). All data were collected in MS Excel and analyzed using IBM SPSS 29.0.1.0. (Chi-squared test, Fisher's exact test, Binary logistic regression). Results Sixty clinically stable outpatients with schizophrenia completed the CTQ-SF and direct questions on self-harm, and suicide attempts. Consistent with previous reports, childhood trauma was highly prevalent (53.3%), with women being significantly more likely than men to screen positive on the CTQ-SF (66.7% vs. 40.0%, p = .038). Intercorrelations among CTQ subscales revealed that emotional abuse and emotional neglect were most strongly related (r = .64, p < .001). A history of at least one SA was present in 50% of participants, 21.7% (n=13) of whom reported multiple attempts. Nearly half of the outpatients (46.7%, n=28) endorsed at least one episode of NSSH. The vast majority (41.7%, n=25) exhibited both suicide attempt(s) and NSSH, highlighting the near-complete overlap between them in this sample. Clinically significant CT was associated with a threefold increase in the odds of lifetime SA (OR = 3.00, 95% CI [1.06–8.50], p = .041) and with a 5.7-fold increased odds of lifetime NSSH (OR = 5.73, 95% CI [2.00–16.43], p = .002). Binary logistic regression showed that a lifetime history of NSSH was a highly significant predictor of lifetime suicide attempts (χ2(1) = 36.37, p < .001). Discussion & Conclusions The present study examined the prevalence and interrelationships of childhood trauma, NSSH, and SA in clinically stable outpatients with schizophrenia where childhood trauma emerged as a significant factor for both non-suicidal self-harm and suicide attempts, yet lifetime self-harm proved to be strong predictor of suicide attempts. Routine screening for any history of deliberate NSSH should be incorporated into standard psychiatric care of schizophrenia outpatients – it is simple, non-stigmatising, and highly informative for suicide risk stratification.