Risk of suicide in patients with psychotic disorder is less than textbooks indicate – part two: methodological limitations of suicide studies

Czech version

Authors: Ťupová Ester ^1,2; Vevera Jan ^1,2
Authors‘ workplace: Psychiatrická klinika FN Plzeň ¹; Psychiatrická klinika LF UK, Plzeň ²
Published in: Čes. a slov. Psychiat., 121, 2025, No. 1, pp. 15-19.
Category: Review
doi: https://doi.org/10.48095/cccsp202502

Overview

Objective: Czech scientific literature tends to overestimate the suicide rate in patients with psychotic disorders. In a previous review, it was demonstrated that the results of suicide studies vary considerably and show a lifetime risk of suicide ranging from 0.9% to 8.4%. In this article, the reasons for these differences are addressed. Methods: The reviewed studies were divided into prospective and retrospective groups. Systematic biases were discussed for each group separately. Moreover, risk factors, which variably play themselves out in different cultures, are described. Results: The underlying issue with prospective studies of suicidal tendencies is their selection bias, which limits their external validity. Misclassification represents a prominent issue in retrospective studies. The frequency and intensity of risk factors for suicidality vary across cultures. This aspect limits the international and cross-cultural transferability of suicidality data. Representative studies of suicidality in Czech patients with psychosis are still lacking. Conclusion: Suicidality data are affected by errors and biases, which complicate both their external and internal validity. Risk factors for suicidality vary across cultures. This needs to be considered when adopting foreign data and it only highlights the need for national data publications. To reduce suicide rate, a closer understanding of the motives for suicide is necessary. In addition to medical factors, social, economic, political, and psychological factors also play a role. However, psychiatry opens the door to their medicalization, which results in attention being paid primarily to psychiatric solutions. However, this downplays the importance of the above-mentioned factors. Therefore, it is important to partially remove the “disease” label from suicidality considering what Masaryk suggested. In addition, focus needs to be shifted on the study of socio-cultural and economic motives. A closer understanding of these can be achieved, for example, by psychological autopsy. These are lacking in the Czech literature. Such case studies could be the subject for a future board exam thesis.

Keywords:

medicalization – prospective and retrospective studies – risk factors (absolute and relative) – schizophrenia – suicidality – validity (internal and external) – selection bias

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MUDr. Ester Ťupová

Psychiatrická klinika

FN Plzeň

alej Svobody 80

304 60 Plzeň

e-mail: tupovae@fnplzen.cz