The relationship between subjective quality of life (QOL) and suicide attempts in patients with schizophrenia has been understudied. The current study tested the hypothesis that QOL is negatively associated with a history of suicidality of patients with schizophrenia. QOL, as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), was investigated in 227 inpatients with DSM-IV diagnosis of schizophrenia with and without a lifetime history of suicide attempts. The statistical analysis included analysis of variance (ANOVA), t tests, and analysis of covariance (ANCOVA). The patients who had attempted suicide multiple times were less satisfied with regard to a larger number of life domains than the nonattempters and the single attempters. The differences in QOL remained significant after adjusting for psychiatric history and current psychopathology variables, e.g., age of onset of the disorder, number and length of hospitalizations, and positive, negative, and depressive symptoms. Dissatisfaction with QOL in general and with reference to four specific domains was associated with repeated suicide attempts. Clinicians should include QOL in the evaluation of patients with schizophrenia that are suspected to be suicidal.
SUBJECTIVE quality of life (QOL) is a nonspecific perception of an individual’s total existence,1, 2 and 3 and its assessment serves as an indicator of subjective well-being.4, 5 and 6 Most conceptualizations of health-related QOL include the dimensions of physical, social, and role functioning, mental health, and general health perceptions, including concepts such as energy, fatigue, pain, and cognitive functioning. These physical, psychological, and social domains of health are seen as distinct areas that are influenced by a person’s experiences, beliefs, expectations, and perceptions.8 While there is no universal operational definition of QOL, most researchers agree that patients’ statements on satisfaction with major life domains of daily functioning are relevant indicators of subjective QOL.9, 10 and 11
Subjective QOL has been investigated as an outcome measure for patients with severe mental disorders, particularly those with chronic schizophrenia.12, 13 and 14 QOL of persons with schizophrenia is significantly decreased compared to members of the general population.15, 16 and 17 Clinical variables associated with poor QOL of patients with schizophrenia are: negative symptoms,18 and 19 general psychopathological symptoms,20 and 21 depressive symptoms,13 medication side effects,15 and 16 and overall duration of illness and hospitalizations.22 A number of follow-up studies suggested that life is very difficult for a large number of patients with schizophrenia,23 and 24 and they are more likely to despair about the quality of their lives,25 yet few studies have explored dissatisfaction with different aspects of life as a putative factor of risk for suicidal behavior among them.
Clearly, reducing morbidity and mortality from suicidal behavior remains a clinical challenge in the care of patients with schizophrenia. Suicide risk in patients with schizophrenia is alarmingly high: between 10% and 13% of all people with this disorder die by suicide,26, 27, 28 and 29 and as much as half of all patients report to have made suicide attempts at some time during the course of the disorder.30 The risk factors include being male, young, and never married, being socially isolated in the community, having earlier age of onset of illness,31 history of and/or current depression,32 and 33 substance abuse,28 and 30 prominent psychotic symptoms in the absence of negative symptoms,34 and 35 and previous suicide attempts.36 Attempted suicide is the strongest and, probably, the most universal of all known predictors of eventual suicide. Approximately 10% of persons who have been admitted to psychiatric treatment after a suicide attempt will eventually complete it37; an additional 10% to 50% will repeat their suicide attempts.38
To our knowledge, the association between life dissatisfaction and suicide has been explored in a single study showing that reduced QOL has a long-term effect on the risk of suicide in the Finnish general population.39 Investigation of subjective QOL of persons with schizophrenia who have or have not attempted suicide would meaningfully enrich the pool of information we have on the possible factors that increase suicide risk in this disorder. It may thus have important implications for suicide prevention efforts, and target a high-risk group for therapeutic and rehabilitative interventions.
The present study explored the hypothetic association between QOL and suicidality among patients with schizophrenic disorders. With this purpose, we compared the satisfaction with QOL domains along with the psychiatric history and current levels of psychopathology between patients with schizophrenia who either never attempted suicide or had performed single or repeated suicide attempts.
