Predicting the likelihood of suicide attempts for rural outpatients with schizophrenia

Aims and objectives. To explore suicide predictors in rural outpatients with schizophrenia. Background. Suicide is a major cause of mortality in patients with schizophrenia. Evidence indicates that patients in rural areas are at high risk for inadequate health care services. However, information is limited on suicide risk in outpatients with schizophrenia in rural areas. Design. Cross‐sectional survey. Methods. Data were collected on individuals enrolled in the 2007 Taiwan National Health Insurance program as diagnosed with schizophrenia, ≥18 years, and living in a rural county. Eligible individuals (n = 1655) were assessed by 12 community‐based nurses at 12 public health centres. Participants’ personal information was retrieved from National Health Insurance records using a personal data sheet, and treatment experiences were obtained by interviewing patients with a 10‐item risk‐assessment inventory. Data were collected over 18 months (2007–2008) and analysed by descriptive statistics and regression analyses. Results. Risk of suicide attempt in the previous year had four significant predictors: number of self‐harm incidents during the previous year, violent incidents towards others during the previous year, number of follow‐ups by mental health clinics and number of involuntary hospitalisations during the previous year (R2 = 0·337, adjusted R2 = 0·334, F = 133·19, p = 0·000). Conclusion. Health care providers should assess rural outpatients with schizophrenia for suicidal thoughts by asking simple questions to evaluate for a history of self‐harm and violence and by comparing this information with health system data on follow‐ups by mental health clinics and involuntary hospitalisations. Relevance to clinical practice. Community‐based health providers may use these results to prioritise assessments when they have a high case load of patients with schizophrenia. Community‐based nurses need to be trained to recognise these four predictors to increase their sensitivity to suicidality among patients with schizophrenia.