Awareness of disorder and suicide risk in the treatment of schizophrenia: results of the international suicide prevention trial

Am J Psychiatry. 2004 Aug;161(8):1494-6. doi: 10.1176/appi.ajp.161.8.1494.


Objective: Schizophrenia is characterized by high suicide risk and low awareness of disorder. Although awareness has benefits for medication compliance and clinical outcome, it is unclear how it may relate to suicide risk in this population.

Method: This multicenter investigation assessed awareness and suicide-related behavior in 980 patients with schizophrenia or schizoaffective disorder. Patients were followed over 2 years and assessed by blinded raters for suicide-related events.

Results: Awareness of psychiatric condition at baseline was associated with increased risk of suicide events over the follow-up. This effect was mediated by depression and hopelessness levels. By contrast, changes in awareness associated with treatment decreased the risk of suicide.

Conclusions: Although some patients may become depressed after acknowledging the clinical handicaps of their disorder, treatment-related changes in awareness are generally associated with a positive outcome relative to suicide risk. The complex interactions and mediation effects of these clinical variables require careful monitoring.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use
  • Awareness*
  • Benzodiazepines / therapeutic use
  • Clozapine / therapeutic use
  • Comorbidity
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Female
  • Health Status*
  • Humans
  • Male
  • Middle Aged
  • Olanzapine
  • Proportional Hazards Models
  • Risk Factors
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy*
  • Schizophrenia / epidemiology
  • Schizophrenic Psychology*
  • Suicide / prevention & control
  • Suicide / psychology*
  • Suicide / statistics & numerical data
  • Treatment Outcome


  • Antipsychotic Agents
  • Benzodiazepines
  • Clozapine
  • Olanzapine