Проблема суицида при шизофрении: в фокусе внимания семья больного (обзор литературы)

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Abstract

THE PROBLEM OF SUICIDE IN SCHIZOPHRENIA: THE FAMILY OF THE PATIENT IS IN FOCUS (LITERATURE REVIEW)

O.Ya. Simak, The Rostov State Medical University, Rostov-on-Don, Russia;

The article contains current data on suicidal risk in schizophrenia using the theory of biopsychosocial approach. Methods: Studies were obtained by searching in electronic databases: Pub Med, Scopus, Wiley Online Library, e- LIBRARY. Results. During the lifetime, 44.3% of patients with schizophrenia had at least one suicide attempt. About 4.9% of patients with schizophrenia commit suicide during their lifetime, most of the fatal cases occur in the first years of the disease. Genetic factors account for 43% of suicidal behavior, the remaining 57% are environmental factors.

According to 2005 data, the suicide risk factors among patient diagnosed with schizophrenia included: previous depressive disorders (Odds ratio (OR)=3.03, 95% Confidence Interval (CI) 2.06-4.46), previous suicide attempts (OR=4.09; 95%; CI 2.79-6.01), drug misuse (OR=3.21; 95%; CI 1.99-5.17), agitation or motor restlessness (OR=2.61; 95%; CI 1.54-4.41), fear of mental disintegration (OR=12.1; 95%; CI 1.89-81.3), poor adherence to treatment (OR=3.75; 95%; CI 2.20-6.37) and recent loss (OR=4.03; 95%; CI 1.37-11.8). In the last 10 years, there has been growing interest in research regarding awareness of the disease, stigmatization, quality of life of patients with schizophrenia and the risk of suicide. The regression analysis showed that insight of the disease in schizophrenia explains 47.4% of the variance of depression and 32.2% of the variance of suicidal ideation.

The experience of discrimination in people with schizophrenia and affective disorders led 38% of patients to suicidal feelings, and 20% reported that this contributed to their suicide attempts. Studies show: up to 44.7% of patients had their own families, up to 27% of patients were married at the time of suicide. The family itself could be viewed both as a pro-suicide risk, and as an anti-suicidal factor. The next-of-kin had much more information about the signs of suicide than the health care professionals: 90.5% versus 44.6%. People bereaved by suicide (n=614) had higher stigma scores than people bereaved by sudden natural death (n=2106; adjusted coefficient =2.52; 95%; CI=2.13-2.90; p=<0.001) and people bereaved by sudden unnatural death (n=712; adjusted coefficient =1.69; 95%; CI=1.25-2.13; p=<0.001). Conclusions. In order to reduce the risk of suicide in patients with schizophrenia, it is important to provide patients, their families and friends with psychological and psychotherapeutic support. Reduction of stigmatization and continuity of care are important factors in prevention of suicide in schizophrenia.

Keywords: suicide, schizophrenia, family, biopsychosocial approach, risk factors

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