Study highlights relationship between schizophrenia and suicide in China

The potential relationship of two important public health problems for China—schizophrenia and suicide—is highlighted by an epidemiological study in this week’s issue of THE LANCET.

Unlike other countries in the world, the prevalence of both schizophrenia and suicide in China is higher in women than men, suggesting that there may be a relationship between these two important public-health problems in China. Michael Phillips (Beijing Suicide Research and Prevention Center, China) and colleagues used data from the national psychiatric epidemiology study, the Ministry of Health’s mortality registry, the census, and the national psychological autopsy study to estimate the rates of schizophrenia, suicide, and suicide in people with schizophrenia among people aged 15 years and older in mainland China during 1995–99.

The investigators found that 4.25 million people have schizophrenia, 285,000 die of suicide each year, and 10% of those who die of suicide have schizophrenia. More women than men had schizophrenia (hazard ratio 1.77), and schizophrenia was more common in urban than rural areas (hazard ratio 1.62). Suicide was more common among women (hazard ratio 1.22), and substantially more prevalent in rural areas (hazard ratio 3.61). People with schizophrenia were around 24 times more likely to die by suicide than people who did not have schizophrenia.

Dr Phillips comments: “Our high estimate of annual suicide deaths in people with schizophrenia in China indicates that this is a major public-health problem for the country that will require development of suicide-prevention strategies specifically designed for people with schizophrenia”.

In an accompanying commentary (p 1016), Mao- Sheng Ran (University of Hong Kong) concludes: “Overall, Phillips and colleagues’ study proposes a specific relation between suicide and the prevalence pattern of schizophrenia by cultural differences. This report should make an important contribution to the literature even though the methodological approach of the study limits interpretation of the findings”.