Skip to main content Accessibility help

Suicide-related behaviours in schizophrenia in China: a comprehensive meta-analysis

  • M. Dong (a1), S. B. Wang (a2), F. Wang (a1), L. Zhang (a3), G. S. Ungvari (a4), C. H. Ng (a5), X. Meng (a6), Z. Yuan (a1), G. Wang (a3) and Y. T. Xiang (a1)...



Suicide-related behaviours are common in schizophrenia and are significantly associated with premature death. The objective of this meta-analysis study was to estimate the pooled prevalence of suicide-related behaviours in schizophrenia patients in China.


The relevant literature was searched systematically via the relevant electronic databases (PubMed, Embase, PsycINFO, Chinese National Knowledge Infrastructure, Wanfang Databases and Chinese Biological Medical Literature Database) from their inception until 14 September 2016. Only original studies that reported the prevalence of suicide-related behaviours including suicidal ideation (SI), suicide plan, suicide attempt (SA) and completed suicide were selected.


Nineteen articles met the inclusion criteria and were analysed. The pooled lifetime prevalence of SI and SA were 25.8% (95% CI 14.7–41.1%) and 14.6% (95% CI 9.1–22.8%), respectively. The 1-month prevalence of SI was 22.0% (95% CI 18.2–26.4%). Subgroup analyses of lifetime SI and SA showed that gender, sample size, survey year, study location and source of patients have no significant mediating effects on the results.


Suicide-related behaviours are common in Chinese schizophrenia patients. Due to the high mortality risk, regular screening and effective suicide prevention programmes are warranted.


Corresponding author

*Address for correspondence: Dr Y.-T. Xiang, Faculty of Health Sciences, University of Macau, 3/F, Building E12, Avenida da Universidade, Taipa, Macau SAR, China. (Email:


Hide All

These authors contributed equally to the work.



Hide All
Barrett, EA, Sundet, K, Simonsen, C, Agartz, I, Lorentzen, S, Mehlum, L, Mork, E, Andreassen, OA, Melle, I (2011). Neurocognitive functioning and suicidality in schizophrenia spectrum disorders. Comprehensive Psychiatry 52, 156163.
Bhatia, T, Thomas, P, Semwal, P, Thelma, B, Nimgaonkar, V, Deshpande, SN (2006). Differing correlates for suicide attempts among patients with schizophrenia or schizoaffective disorder in India and USA. Schizophrenia Research 86, 208214.
Calati, R, Porcelli, S, Giegling, I, Hartmann, AM, Moller, HJ, De Ronchi, D, Serretti, A, Rujescu, D (2011). Catechol-o-methyltransferase gene modulation on suicidal behavior and personality traits: review, meta-analysis and association study. Journal of Psychiatric Research 45, 309321.
Caldwell, CB, Gottesman, II (1990). Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin 16, 571589.
Cao, XL, Zhong, BL, Xiang, YT, Ungvari, GS, Lai, KY, Chiu, HF, 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.
Carlborg, A, Winnerbäck, K, Jönsson, EG, Jokinen, J, Nordström, P (2010). Suicide in schizophrenia. Expert Review of Neurotherapeutics 10, 11531164.
Chan, KY, Zhao, FF, Meng, S, Demaio, AR, Reed, C, Theodoratou, E, Campbell, H, Wang, W, Rudan, I (2015). Prevalence of schizophrenia in China between 1990 and 2010. Journal of Global Health 5, 010410.
Crisp, A, Gelder, M, Goddard, E, Meltzer, H (2005). Stigmatization of people with mental illnesses: a follow-up study within the changing minds campaign of the royal college of psychiatrists. World Psychiatry 4, 106113.
De Hert, M, McKenzie, K, Peuskens, J (2001). Risk factors for suicide in young people suffering from schizophrenia: a long-term follow-up study. Schizophrenia Research 47, 127134.
De Leo, D, Cerin, E, Spathonis, K, Burgis, S (2005). Lifetime risk of suicide ideation and attempts in an Australian community: prevalence, suicidal process, and help-seeking behaviour. Journal of Affective Disorders 86, 215224.
Deng, ZH (2000). The related factors of suicide in schizophrenia (in Chinese). Health Psychology Journal 13, 688689.
Drake, RE, Gates, C, Whitaker, A, Cotton, PG (1985). Suicide among schizophrenics: a review. Comprehensive Psychiatry 26, 90100.
Egger, M, Davey Smith, G, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.
Fenton, WS, McGlashan, TH, Victor, BJ, Blyler, CR (1997). Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. American Journal of Psychiatry 154, 199204.
Gonzalez-Castro, TB, Tovilla-Zarate, C, Juarez-Rojop, I, Pool Garcia, S, Velazquez-Sanchez, MP, Genis, A, Nicolini, H, Lopez Narvaez, L (2013). Association of the 5HTR2A gene with suicidal behavior: case-control study and updated meta-analysis. BMC Psychiatry 13, 25.
Gonzalez-Pinto, A, Aldama, A, Gonzalez, C, Mosquera, F, Arrasate, M, Vieta, E (2007). Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain. Journal of Clinical Psychiatry 68, 242247.
Harkavy-Friedman, JM, Restifo, K, Malaspina, D, Kaufmann, CA, Amador, XF, Yale, SA, 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, Sutton, L, Haw, C, Sinclair, J, Deeks, JJ (2005). Schizophrenia and suicide: systematic review of risk factors. British Journal of Psychiatry 187, 920.
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.
Hor, K, Taylor, M (2010). Suicide and schizophrenia: a systematic review of rates and risk factors. Journal of Psychopharmacology 24, 8190.
Hunt, IM, Kapur, N, Windfuhr, K, Robinson, J, Bickley, H, Flynn, S, Parsons, R, Burns, J, Shaw, J, Appleby, L (2006). Suicide in schizophrenia: findings from a national clinical survey. Journal of Psychiatric Practice 12, 139147.
Inskip, HM, Harris, EC, Barraclough, B (1998). Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. British Journal of Psychiatry 172, 3537.
Jiang, SA, Gao, BL, Liu, PZ, Su, LY (1998). Clinical features of suicidal behavior in inpatients with schizophrenia or depression (in Chinese). Chinese Journal of Clinical Psychology 6, 2831.
Kao, YC, Liu, YP, Cheng, TH, Chou, MK (2012). Subjective quality of life and suicidal behavior among Taiwanese schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology 47, 523532.
Kessler, RC, Borges, G, Walters, EE (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry 56, 617626.
Kessler, RC, Berglund, P, Borges, G, Nock, M, Wang, PS (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA 293, 24872495.
Kia-Keating, BM, Glatt, SJ, Tsuang, MT (2007). Meta-analyses suggest association between COMT, but not HTR1B, alleles, and suicidal behavior. American Journal of Medical Genetics Part B 144b, 10481053.
Krupinski, M, Fischer, A, Grohmann, R, Engel, RR, Hollweg, M, Moller, HJ (2000). Schizophrenic psychoses and suicide in the clinic. Risk factors, psychopharmacologic treatment. Nervenarzt 71, 906911.
Law, S, Liu, P (2008). Suicide in China: unique demographic patterns and relationship to depressive disorder. Current Psychiatry Reports 10, 8086.
Lee, S, Fung, S, Tsang, A, Liu, Z, Huang, Y-Q, He, Y, Zhang, M, Shen, Y-C, Nock, MK, Kessler, RC (2007). Lifetime prevalence of suicide ideation, plan, and attempt in metropolitan China. Acta Psychiatrica Scandinavica 116, 429437.
Long, J, Huang, G, Liang, W, Liang, B, Chen, Q, Xie, J, Jiang, J, Su, L (2014). The prevalence of schizophrenia in mainland China: evidence from epidemiological surveys. Acta Psychiatrica Scandinavica 130, 244256.
Ma, X, Xiang, YT, Cai, ZJ, Li, SR, Xiang, YQ, Guo, HL, Hou, YZ, Li, ZB, Li, ZJ, Tao, YF, Dang, WM, Wu, XM, Deng, J, Chan, SS, Ungvari, GS, Chiu, HF (2009). Lifetime prevalence of suicidal ideation, suicide plans and attempts in rural and urban regions of Beijing, China. Australian and New Zealand Journal of Psychiatry 43, 158166.
Miles, CP (1977). Conditions predisposing to suicide: a review. Journal of Nervous and Mental Disease 164, 231246.
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, Williams, D (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98105.
Palmer, BA, Pankratz, VS, Bostwick, JM (2005). The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry 62, 247253.
Phillips, MR, Li, X, Zhang, Y (2002). Suicide rates in China, 1995–99. Lancet 359, 835840.
Phillips, MR, Yang, G, Li, S, Li, Y (2004). Suicide and the unique prevalence pattern of schizophrenia in mainland China: a retrospective observational study. Lancet 364, 10621068.
Phillips, MR, Zhang, J, Shi, Q, Song, Z, Ding, Z, Pang, S, Li, X, Zhang, Y, Wang, Z (2009). Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet 373, 20412053.
Pompili, M, Amador, XF, Girardi, P, Harkavy-Friedman, J, Harrow, M, Kaplan, K, Krausz, M, Lester, D, Meltzer, HY, Modestin, J, Montross, LP, Mortensen, PB, Munk-Jorgensen, P, Nielsen, J, Nordentoft, M, Saarinen, PI, Zisook, S, Wilson, ST, Tatarelli, R (2007). Suicide risk in schizophrenia: learning from the past to change the future. Annals of General Psychiatry 6, 10.
Pompili, M, Lester, D, Grispini, A, Innamorati, M, Calandro, F, Iliceto, P, De Pisa, E, Tatarelli, R, Girardi, P (2009). Completed suicide in schizophrenia: evidence from a case-control study. Psychiatry Research 167, 251257.
Popovic, D, Benabarre, A, Crespo, JM, Goikolea, JM, Gonzalez-Pinto, A, Gutierrez-Rojas, L, Montes, JM, Vieta, E (2014). Risk factors for suicide in schizophrenia: systematic review and clinical recommendations. Acta Psychiatrica Scandinavica 130, 418426.
Ran, MS, Wu, QH, Conwell, Y, Chen, EY, Chan, CL (2004). Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China. Suicide and Life-Threatening Behavior 34, 311319.
Ran, MS, Xiang, MZ, Mao, WJ, Hou, ZJ, Tang, MN, Chen, EY, Chan, CL, Yip, PS, Conwell, Y (2005). Characteristics of suicide attempters and nonattempters with schizophrenia in a rural community. Suicide and Life-Threatening Behavior 35, 694701.
Ran, MS, Chen, EY, Conwell, Y, Chan, CL, Yip, PS, Xiang, MZ, Caine, ED (2007). Mortality in people with schizophrenia in rural China: 10-year cohort study. British Journal of Psychiatry 190, 237242.
Scocco, P, de Girolamo, G, Vilagut, G, Alonso, J (2008). Prevalence of suicide ideation, plans, and attempts and related risk factors in Italy: results from the European study on the Epidemiology of Mental Disorders-World Mental Health study. Comprehensive Psychiatry 49, 1321.
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283, 20082012.
Suominen, K, Isometsä, E, Suokas, J, Haukka, J, Achte, K, Lönnqvist, J (2004). Completed suicide after a suicide attempt: a 37-year follow-up study. American Journal of Psychiatry 161, 562563.
van Os, J, Kapur, S (2009). Schizophrenia. Lancet 374, 635645.
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gotzsche, PC, Vandenbroucke, JP (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370, 14531457.
Wan, Y, Hu, Q, Li, T, Jiang, L, Du, Y, Feng, L, Wong, JC, Li, C (2013). Prevalence of autism spectrum disorders among children in China: a systematic review. Shanghai Archives of Psychiatry 25, 7080.
Wang, CW, Shi, JF, Yuan, HD (2006). Risk factors of suicide in outpatients with schizophrenia (in Chinese). Chinese Journal of Public Health 22, 99100.
Wang, CW, Chan, CL, Yip, PS (2014). Suicide rates in China from 2002 to 2011: an update. Social Psychiatry and Psychiatric Epidemiology 49, 929941.
WHO (2012). Public health action for the prevention of suicide: a framework. World Health Organization: Geneva.
Winsper, C, Ganapathy, R, Marwaha, S, Large, M, Birchwood, M, Singh, SP (2013). A systematic review and meta-regression analysis of aggression during the first episode of psychosis. Acta Psychiatrica Scandinavica 128, 413421.
Wu, DM (2002). Suicide attempts in patients with schizophrenia (in Chinese). Henan Medical Information 10, 6768.
Xiang, YT, Weng, YZ, Leung, CM, Tang, WK, 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.
Xue, HY (2010). Suicidal behavior in patients with depression and schizophrenia (in Chinese). Chinese Journal of Health Psychology 18, 516518.
Xue, W, Zhang, HY (2006). Suicide behaviors in schizophrenia patients recently discharged from hospitalization: the demographic and clinical correlates (in Chinese). Shanghai Archives of Psychiatry 18, 205209.
Yan, F, Xiang, Y-T, Hou, Y-Z, Ungvari, GS, Dixon, LB, Chan, SS, Lee, EH, Li, W-Y, Li, W-X, Zhu, Y-L (2013). Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology 48, 447454.
Yan, HF, Wei, SN (2012). Survey of suicidal ideation in community-dwelling schizophrenia patients (in Chinese). Chinese Community Doctors 14, 395396.
Yin, H, Xu, L, Shao, Y, Li, L, Wan, C (2016). Relationship between suicide rate and economic growth and stock market in the People's Republic of China: 2004–2013. Neuropsychiatric Disease and Treatment 12, 31193128.
Zhang, HS, Xiao, SY (2002). Suicide behavior of inpatients with schizophrenia (in Chinese). Chinese Mental Health Journal 16, 260262.
Zhang, X (1998). A survey of psychological condition in male patients with schizophrenia (in Chinese). Health Psychology Journal 6, 297298.
Zhao, GF, Ma, DD, Wang, GX, Guo, CQ, Liu, ZX (1992). Follow-up survey of death in schizophrenia patients after discharge (in Chinese). Chinese Mental Health Journal 6, 233234.
Zheng, W, Tang, LR, Weng, YZ, Zhao, XQ, Wang, QJ, Ma, X, Xiang, YQ (2015). Quality of life and its associations with oral health and suicide attempts in hospitalized schizophrenia patients (in Chinese). Chinese Journal of Health Psychology 23, 324328.
Zhong, BL, Chiu, HF, Conwell, Y (2016). Rates and characteristics of elderly suicide in China, 2013–14. Journal of Affective Disorders 206, 273279.


Type Description Title
Supplementary materials

Dong et al. supplementary material
Dong et al. supplementary material 1

 Word (49 KB)
49 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