Pompili et al. Suicide and schizophrenia Suicide and awareness of illness in schizophrenia: An overview Maurizio Pompili, MD Amedeo Ruberto, MD Giorgio D. Kotzalidis, MD Paolo Girardi, MD Roberto Tatarelli, MD Suicide is the first cause of premature death in patients with schizophrenia. Numerous studies have identified risk factors for suicide among these patients. This study reviews available literature focusing on awareness of illness in patients with schizophrenia. Insight, or awareness of illness, has been considered a risk factor for suicide in schizophrenic patients. In assessing insight, many issues have to be taken into account, because a high degree of insight is not desirable in some conditions. (Bulletin of the Menninger Clinic, 68[4], 297-318) Suicide is the major cause of premature death in patients with schizo- phrenia. Followup studies have estimated that 10–13% of individuals with schizophrenia die by suicide (Caldwell & Gottesman, 1990). Most authors agree that the schizophrenic patient who is more likely to com- mit suicide is young, male, white, has never married, has good premorbid function, has postpsychotic depression, and has a history of substance abuse and suicide attempts. Hopelessness, social isolation, awareness of illness, and hospitalization are also important risk factors in schizophrenic individuals who commit suicide. Deteriorating health with a high level of premorbid functioning, recent loss or rejection, lim- ited external support, and family stress or instability are other risk fac- tors traceable in patients with schizophrenia who commit suicide. These patients usually fear further mental deterioration and experience excessive treatment dependence or loss of faith in treatment. Among these risk factors, insight or awareness of illness has received mixed opinions. Investigators of suicide in schizophrenia generally re- port that painful insight into one’s own illness may drive a patient to Vol. 68, No. 4 (Fall 2004) 297 The authors are from the Department of Psychiatry, Sant’Andrea Hospital, University of Rome “La Sapienza,” Italy. Correspondence may be sent to Dr. Pompili at the Dipartimento di Psichiatria, Ospedale Sant’Andrea, Via di Grottarossa, 1035, 00189 Roma – Italy; e–mail: maurizio.pompili@uniroma1.it. (Copyright © 2004 The Menninger Foundation)