Skip to main content Accessibility help

Prevalence of suicide attempts in individuals with schizophrenia: a meta-analysis of observational studies

  • Li Lu (a1), Min Dong (a1), Ling Zhang (a2), Xiao-Min Zhu (a3), Gabor S. Ungvari (a4) (a5), Chee H. Ng (a6), Gang Wang (a2) and Yu-Tao Xiang (a1)...



Suicide attempt is an important indicator of suicide and potential future mortality. However, the prevalence of suicide attempts has been inconsistent across studies. This meta-analysis aimed to examine the prevalence of suicide attempts in individuals with schizophrenia and associated correlates.


Relevant publications in Embase, PsycINFO, PubMed, Web of science and Cochrane were systematically searched. Data on the prevalence of suicide attempts in individuals with schizophrenia were pooled using a random-effects model.


Thirty-five studies with 16 747 individuals with schizophrenia were included. The pooled lifetime prevalence of suicide attempts was 26.8% (95% CI 22.1–31.9%; I2 = 97.0%), while the 1-year prevalence, 1-month prevalence and the prevalence of suicide attempts from illness onset were 3.0% (95% CI 2.3–3.7%; I2 = 95.6%), 2.7% (95% CI 2.1–3.4%; I2 = 78.5%) and 45.9% (95% CI 42.1–49.9%; I2 = 0), respectively. Earlier age of onset (Q = 4.38, p = 0.04), high-income countries (Q = 53.29, p < 0.001), North America and Europe and Central Asia (Q = 32.83, p < 0.001) were significantly associated with a higher prevalence of suicide attempts.


Suicide attempts are common in individuals with schizophrenia, especially those with an early age of onset and living in high-income countries and regions. Regular screening and effective preventive measures should be implemented as part of the clinical care.


Corresponding author

Author for correspondence: Yu-Tao Xiang, E-mail:


Hide All

These authors contributed equally to the work.



Hide All
Andriopoulos, I, Ellul, J, Skokou, M and Beratis, S (2011) Suicidality in the ‘prodromal’ phase of schizophrenia. Comprehensive Psychiatry 52, 479485.
Assefa, D, Shibre, T, Asher, L and Fekadu, A (2012) Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study. BMC Psychiatry 12, 239.
Bhugra, D (2005) The global prevalence of schizophrenia. PLoS Medicine 2, e151, quiz e175.
Brown, S (1997) Excess mortality of schizophrenia. A meta-analysis. British Journal of Psychiatry 171, 502508.
Caldwell, CB and Gottesman, II (1992) Schizophrenia – a high-risk factor for suicide: clues to risk reduction. Suicide and Life-Threatening Behavior 22, 479493.
Cao, XL, Zhong, BL, Xiang, YT, Ungvari, GS, Lai, KY, Chiu, HF and Caine, ED (2015) Prevalence of suicidal ideation and suicide attempts in the general population of China: a meta-analysis. International Journal of Psychiatry in Medicine 49, 296308.
Chong, SA, Lee, WL, Tan, CH, Tay, AH, Chan, AO and Tan, EC (2000) Attempted suicide and polymorphism of the serotonin transporter gene in Chinese patients with schizophrenia. Psychiatry Research 97, 101106.
Cooper, SL, Lezotte, D, Jacobellis, J and Diguiseppi, C (2006) Does availability of mental health resources prevent recurrent suicidal behavior? An ecological analysis. Suicide and Life-Threatening Behavior 36, 409417.
De Luca, V, Voineskos, D, Wong, GW, Shinkai, T, Rothe, C, Strauss, J and Kennedy, JL (2005) Promoter polymorphism of second tryptophan hydroxylase isoform (TPH2) in schizophrenia and suicidality. Psychiatry Research 134, 195198.
Dixon, L, Postrado, L, Delahanty, J, Fischer, PJ and Lehman, A (1999) The association of medical comorbidity in schizophrenia with poor physical and mental health. The Journal of Nervous and Mental Disease 187, 496502.
Dong, M, Wang, SB, Wang, F, Zhang, L, Ungvari, GS, Ng, CH, Meng, X, Yuan, Z, Wang, G and Xiang, YT (2017) Suicide-related behaviours in schizophrenia in China: a comprehensive meta-analysis. Epidemiology and Psychiatric Sciences 28, 110.
Drake, RE, Gates, C, Whitaker, A and Cotton, PG (1985) Suicide among schizophrenics: a review. Comprehensive Psychiatry 26, 90100.
Duko, B and Ayano, G (2018) Suicidal ideation and attempts among people with severe mental disorder, Addis Ababa, Ethiopia, comparative cross-sectional study. Annals of General Psychiatry 17, 23.
Egger, M, Davey Smith, G, Schneider, M and Minder, C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629634.
Finseth, PI, Sonderby, IE, Djurovic, S, Agartz, I, Malt, UF, Melle, I, Morken, G, Andreassen, OA, Vaaler, AE and Tesli, M (2014) Association analysis between suicidal behaviour and candidate genes of bipolar disorder and schizophrenia. Journal of Affective Disorders 163, 110114.
Freeman, MF and Tukey, JW (1950) Transformations related to the angular and the square root. The Annals of Mathematical Statistics 21, 607611.
Fulginiti, A and Brekke, JS (2016) Suicide attempt status and quality of life disparity among individuals with schizophrenia: a longitudinal analysis. Journal of the Society for Social Work and Research 7, 269288.
Fuller-Thomson, E and Hollister, B (2016) Schizophrenia and suicide attempts: findings from a representative community-based Canadian sample. Schizophrenia Research and Treatment 2016, 3165243.
Harkavy-Friedman, JM, Restifo, K, Malaspina, D, Kaufmann, CA, Amador, XF, Yale, SA and Gorman, JM (1999) Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. American Journal of Psychiatry 156, 12761278.
Hawton, K (2000) Sex and suicide. Gender differences in suicidal behaviour. The British Journal of Psychiatry 177, 484485.
Higgins, JP and Green, S (2011) Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, Uk: John Wiley & Sons.
Higgins, JP, Thompson, SG, Deeks, JJ and Altman, DG (2003) Measuring inconsistency in meta-analyses. BMJ 327, 557560.
Hor, K and Taylor, M (2010) Suicide and schizophrenia: a systematic review of rates and risk factors. Journal of Psychopharmacology 24, 8190.
Hung, CF, Lung, FW, Chen, CH, O'Nions, E, Hung, TH, Chong, MY, Wu, CK, Wen, JK and Lin, PY (2011) Association between suicide attempt and a tri-allelic functional polymorphism in serotonin transporter gene promoter in Chinese patients with schizophrenia. Neuroscience Letters 504, 242246.
Jakhar, K, Beniwal, RP, Bhatia, T and Deshpande, SN (2017) Self-harm and suicide attempts in Schizophrenia. Asian Journal of Psychiatry 30, 102106.
Kao, YC, Liu, YP, Cheng, TH and Chou, MK (2012) Subjective quality of life and suicidal behavior among Taiwanese schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology 47, 523532.
Kaplan, KJ and Harrow, M (1996) Positive and negative symptoms as risk factors for later suicidal activity in schizophrenics versus depressives. Suicide and Life-Threatening Behavior 26, 105121.
Karch, DL, Barker, L and Strine, TW (2006) Race/ethnicity, substance abuse, and mental illness among suicide victims in 13 US states: 2004 data from the National Violent Death Reporting System. Injury Prevention 12(suppl. 2), ii22ii27.
Kebede, D, Alem, A, Shibre, T, Negash, A, Fekadu, A, Fekadu, D, Deyassa, N, Jacobsson, L and Kullgren, G (2003) Onset and clinical course of schizophrenia in Butajira-Ethiopia – a community-based study. Social Psychiatry and Psychiatric Epidemiology 8, 625631.
Landmark, J, Cernovsky, ZZ and Merskey, H (1987) Correlates of suicide attempts and ideation in schizophrenia. The British Journal of Psychiatry 151, 1820.
Laursen, TM (2011) Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophrenia Research 131, 101104.
Lee, JL, Ma, WF, Yen, WJ, Huang, XY and Chiang, LC (2012) Predicting the likelihood of suicide attempts for rural outpatients with schizophrenia. Journal of Clinical Nursing 21, 28962904.
Li, Y, Cao, XL, Zhong, BL, Ungvari, GS, Chiu, HF, Lai, KY, Zheng, W, Correll, CU and Xiang, YT (2016) Smoking in male patients with schizophrenia in China: a meta-analysis. Drug and Alcohol Dependence 162, 146153.
Limosin, F, Loze, JY, Philippe, A, Casadebaig, F and Rouillon, F (2007) Ten-year prospective follow-up study of the mortality by suicide in schizophrenic patients. Schizophrenia Research 94, 2328.
Loney, PL, Chambers, LW, Bennett, KJ, Roberts, JG and Stratford, PW (1998) Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Disease in Canada 19, 170176.
Long, J, Huang, G, Liang, W, Liang, B, Chen, Q, Xie, J, Jiang, J and Su, L (2014) The prevalence of schizophrenia in mainland China: evidence from epidemiological surveys. Acta Psychiatrica Scandinavica 130, 244256.
Malandain, L, Thibaut, F, Grimaldi-Bensouda, L, Falissard, B, Abenhaim, L and Nordon, C (2018) Correlates and predictors of antipsychotic drug polypharmacy in real-life settings: results from a nationwide cohort study. Schizophrenia Research 192, 213218.
Marcinko, D, Popovic-Knapic, V, Franic, T, Karlovic, D, Martinac, M, Brataljenovic, T and Jakovljevic, M (2008) Association of cholesterol and socio-demographic parameters with suicidality in the male patients with schizophrenia. Psychiatria Danubina 20, 390395.
Mata, DA, Ramos, MA, Bansal, N, Khan, R, Guille, C, Di Angelantonio, E and Sen, S (2015) Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA 314, 23732383.
Ndetei, DM, Khasakhala, L, Meneghini, L and Aillon, JL (2013) The relationship between schizo-affective, schizophrenic and mood disorders in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya. African Journal of Psychiatry (Johannesbg) 16, 110117.
Niehaus, DJ, Laurent, C, Jordaan, E, Koen, L, Oosthuizen, P, Keyter, N, Muller, JE, Mbanga, NI, Deleuze, JF, Mallet, J, Stein, DJ and Emsley, R (2004) Suicide attempts in an African schizophrenia population: an assessment of demographic risk factors. Suicide and Life-Threatening Behavior 34, 320327.
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, de Girolamo, G, Gluzman, S, de Graaf, R, Gureje, O, Haro, JM, Huang, Y, Karam, E, Kessler, RC, Lepine, JP, Levinson, D, Medina-Mora, ME, Ono, Y, Posada-Villa, J and Williams, D (2008) Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98105.
Okusaga, O, Langenberg, P, Sleemi, A, Vaswani, D, Giegling, I, Hartmann, AM, Konte, B, Friedl, M, Groer, MW, Yolken, RH, Rujescu, D and Postolache, TT (2011) Toxoplasma gondii antibody titers and history of suicide attempts in patients with schizophrenia. Schizophrenia Research 133, 150155.
Olfson, M, Gerhard, T, Huang, C, Crystal, S and Stroup, TS (2015) Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 72, 11721181.
Palmer, BA, Pankratz, VS and Bostwick, JM (2005) The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry 62, 247253.
Panariello, F, O'Driscoll, L, de Souza, RP, Tiwari, A, Manchia, M, Kennedy, J and De Luca, V (2010) Age at onset in Canadian schizophrenia patients: admixture analysis. Schizophrenia Research 122, 278279.
Patterson, GR, DeBaryshe, BD and Ramsey, E (1989) A developmental perspective on antisocial behavior. American Psychologist 44, 329335.
Polsinelli, G, Zai, CC, Strauss, J, Kennedy, JL and De Luca, V (2013) Association and CpG SNP analysis of HTR4 polymorphisms with suicidal behavior in subjects with schizophrenia. Journal of Neural Transmission (Vienna) 120, 253258.
Popovic, D, Benabarre, A, Crespo, JM, Goikolea, JM, Gonzalez-Pinto, A, Gutierrez-Rojas, L, Montes, JM and Vieta, E (2014) Risk factors for suicide in schizophrenia: systematic review and clinical recommendations. Acta Psychiatrica Scandinavica 130, 418426.
Prasad, AJ and Kellner, P (1988) Suicidal behaviour in schizophrenic day patients. Acta Psychiatrica Scandinavica 77, 488490.
Prince, J (2018) Substance use disorder and suicide attempt among people who report compromised health. Substance Use & Misuse 53, 915.
Radomsky, ED, Haas, GL, Mann, JJ and Sweeney, JA (1999) Suicidal behavior in patients with schizophrenia and other psychotic disorders. American Journal of Psychiatry 156, 15901595.
Ran, MS, Wu, QH, Conwell, Y, Chen, EY and Chan, CL (2004) Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China. Suicide and Life-Threatening Behavior 34, 311319.
Ran, MS, Mao, WJ, Chan, CLW, Chen, EYH and Conwell, Y (2015) Gender differences in outcomes in people with schizophrenia in rural China: 14-year follow-up study. The British Journal of Psychiatry 206, 283288.
Roy, A (1983) Family history of suicide. Archives of General Psychiatry 40, 971974.
Roy, A, Mazonson, A and Pickar, D (1984) Attempted suicide in chronic schizophrenia. The British Journal of Psychiatry 144, 303306.
Shrivastava, AK, De Sousa, AA, Karia, SB and Shah, NB (2016) Study of suicidality and suicide behavior among individuals with long-standing duration of schizophrenia in India: an explorative study. Asean Journal of Psychiatry 17, 179187.
Tamminga, CA, Ivleva, EI, Keshavan, MS, Pearlson, GD, Clementz, BA, Witte, B, Morris, DW, Bishop, J, Thaker, GK and Sweeney, JA (2013) Clinical phenotypes of psychosis in the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP). American Journal of Psychiatry 170, 12631274.
Tang, YL, Gillespie, CF, Epstein, MP, Mao, PX, Jiang, F, Chen, Q, Cai, ZJ and Mitchell, PB (2007) Gender differences in 542 Chinese inpatients with schizophrenia. Schizophrenia Research 97, 8896.
Togay, B, Noyan, H, Tasdelen, R and Ucok, A (2015) Clinical variables associated with suicide attempts in schizophrenia before and after the first episode. Psychiatry Research 229, 252256.
Tremeau, F, Staner, L, Duval, F, Correa, H, Crocq, MA, Darreye, A, Czobor, P, Dessoubrais, C and Macher, JP (2005) Suicide attempts and family history of suicide in three psychiatric populations. Suicide and Life-Threatening Behavior 35, 702713.
Uzun, O, Tamam, L, Ozculer, T, Doruk, A and Unal, M (2009) Specific characteristics of suicide attempts in patients with schizophrenia in Turkey. The Israel Journal of Psychiatry and Related Sciences 46, 189194.
Vinokur, D, Levine, SZ, Roe, D, Krivoy, A and Fischel, T (2014) Age of onset group characteristics in forensic patients with schizophrenia. European Psychiatry 29, 149152.
Whiteford, HA, Degenhardt, L, Rehm, J, Baxter, AJ, Ferrari, AJ, Erskine, HE, Charlson, FJ, Norman, RE, Flaxman, AD, Johns, N, Burstein, R, Murray, CJ and Vos, T (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382, 15751586.
Winsper, C, Ganapathy, R, Marwaha, S, Large, M, Birchwood, M and Singh, SP (2013) A systematic review and meta-regression analysis of aggression during the first episode of psychosis. Acta Psychiatrica Scandinavica 128, 413421.
Xiang, YT, Weng, YZ, Leung, CM, Tang, WK and Ungvari, GS (2008) Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients. Journal of Psychiatric Research 42, 495502.
Zhang, XY, Al Jurdi, RK, Zoghbi, AW, Chen, DC, Xiu, MH, Tan, YL, Yang, FD and Kosten, TR (2013) Prevalence, demographic and clinical correlates of suicide attempts in Chinese medicated chronic inpatients with schizophrenia. Journal of Psychiatric Research 47, 13701375.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Lu et al. supplementary material
Table S1

 Word (17 KB)
17 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed