Am J Psychiatry 154:9, September 1997 HEILÄ, ISOMETSÄ, HENRIKSSON, ET AL. SUICIDE AND SCHIZOPHRENIA Suicide and Schizophrenia: A N ationwide Psychological Autopsy Study on Age- and Sex-Specific Clinical Characteristics of 92 Suicide Victims With Schizophrenia Hannele Heilä, M.D., Erkki T. Isometsä, M.D., Ph.D., Markus M. Henriksson, M.D., Ph.D., Martti E. Heikkinen, M.D., Ph.D., Mauri J. Marttunen, M.D., Ph.D., and Jouko K. Lönnqvist, M.D., Ph.D. O bjective: The authors examined the clinical characteristics of suicide victims with schizo- phrenia in the general population of Finland. Method: As part of the nationwide National Suicide Prevention Project in Finland, all suicides over a 12-month period of persons with DSM-III-R schizophrenia were investigated by using the psychological autopsy method. Clini- cal characteristics and their variation with age, sex, and illness duration were examined. Re - sults: Among all suicide victims, 7% (N =92) were identified as having suffered schizophrenia. Suicides occurred throughout the course of schizophrenia. Both active illness (78%) and de- pressive symptoms (64% ) were highly prevalent immediately before suicide, and a history of suicide attempts (71%) was also common. Women were more likely than men to have com- mitted suicide during an acute exacerbation of the illness. Marked variation in depressive symptoms, alcoholism, and suicide methods was found among sexes and age groups. Alco- holism was most common among middle-aged men (45%), whereas middle-aged women had a high rate of depressive symptoms (88%). Younger male subjects most often used violent suicide methods. Conclusions: Suicide may occur at any point during the course of schizophre- nia. The results indicate clinically important variation in depression, alcoholism, and suicide methods among suicide victims with schizophrenia. This suggestion of age- and sex-specific risk factors for suicide in schizophrenia needs further investigation. (Am J Psychiatry 1997; 154:1235–1242) T he risk of suicide in schizophrenia is high; it is es- timated that 10%–13% of all persons suffering from schizophrenia commit suicide (1). Suicide rates vary among mortality studies, between 147 and 750 per 100,000 persons with schizophrenia per year (2–6). The rate is consistently higher among men than women, but some studies have shown a higher standardized mortality ratio for women (7–9). The prevalence of schizophrenia among unselected persons who commit- ted suicide has varied from 2% to 12% (10–16). Many studies of clinical characteristics of suicide vic- tims with schizophrenia have been compromised by the relatively small numbers of subjects and thus inade- quate representation of women for comparisons of the sexes, by the heterogenous diagnostic criteria used, by the frequent selection of the suicide population from hospitals, and by data based only on patient records. Seven studies (17–23) have so far investigated com- pleted suicides among groups of 15 or more suicide vic- tims with DSM-III or DSM-III-R schizophrenia. In these studies young adult age, male sex, and mean ill- ness duration under 10 years have characterized suicide victims with schizophrenia. Some studies, however, have shown an increased rate of suicide mortality over the span of the illness (24). Comorbid depressive symp- toms, alcoholism, previous suicide attempts, and com- munication of suicidal intent have been associated with suicide risk (15, 17, 19–21). These, as well as some physical disorders, have also been found to be associ- ated with suicide in the general population (25). Mental disorders, suicide method, and history of previous sui- cide attempts have been found to vary with age and sex Received Oct. 28, 1996; revision received Feb. 13, 1997; accepted Feb. 25, 1997. From the Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, and the School of Public Health, University of Tampere, Tampere, Finland. Address reprint requests to Dr. Heilä, National Public Health Institute, De- partment of Mental Health and Alcohol Research, Mannerheimintie 166, FIN-00300 Helsinki, Finland; Hannele.Heila@ktl.fi (e-mail). Supported by a grant from the Academy of Finland. Am J Psychiatry 154:9, September 1997 1235