Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Demographic and Psychiatric Characteristics
3.2. Model Calculation Using Machine Learning (ML)
3.3. Ranking of Predictor Variables
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Selected Variables and Reference to Previous Literature
Variable in Current Study | Previous Literature w. Similar Variable | Population: Description/Sample Size (n) |
Sociodemographic Data | ||
Age at admission to referenced hospitalization | [56] | NOP with SSD/510 |
[57] | NOP with SSD + depression/132 | |
[58] | NOP with SSD/150 | |
Gender | [56] | NOP with SSD/510 |
[57] | NOP with SSD + depression/132 | |
[58] | NOP with SSD/150 | |
[59] | OP with SSD/223 | |
Country of birth: Switzerland | - | - |
Marital status * | [57] | NOP with SSD + depression/132 |
[59] | OP with SSD/223 | |
Living situation * | [57] | NOP with SSD + depression/132 |
[20] | OP and NOP with schizophrenia/70 | |
Level of education * | [57] | NOP with SSD + depression/132 |
[58] | NOP with SSD/150 | |
Social network * | [60] | NOP with SSD/510 |
Existent low ability ** | [56] | NOP with SSD/510 |
[20] | OP and NOP with schizophrenia/70 | |
Legal supervision 1 | [20] | OP and NOP with schizophrenia/70 |
Psychiatric Data | ||
Age of onset of illness | [56] | NOP with SSD/510 |
[61] | NOP with SSD/156 | |
[58] | NOP with SSD 150 | |
[16] | OP with SSD/356 | |
Comorbid alcohol use disorder | [10] | n.a. (systematic review) |
[20] | OP and NOP with schizophrenia/70 | |
[62] | Inmates/1212 | |
Comorbid substance use disorder | [10] | n.a. (systematic review) |
[62] | Inmates/1212 | |
[20] | OP and NOP with schizophrenia/70 | |
Comorbid personality disorder | [62] | Inmates/1212 |
Previous psychiatric treatment Inpatient outpatient | [20] | OP and NOP with schizophrenia/70 |
Previous compulsory measures | - | - |
Cognitive impairment | [63] | Inmates/254 |
Delusions | [56] | NOP with SSD/510 |
Hallucinations | [64] | NOP with psychosis/290 |
Penetrability of own ego | - | - |
Disorders of affect/drive | [65] | NOP with SSD/59 |
[66] | NOP with psychotic disorder/45 | |
Negative symptoms | [66] | NOP with psychotic disorder/45 |
[67] | NOP with SSD/332 | |
PANSS: P1–P7 1 | [64] | NOP with psychosis/290 |
[38] | NOP with SSD/40 | |
[58] | NOP with SSD/150 | |
PANSS: N1–N7 2 | [57] | NOP with SSD + depression/132 |
[58] | NOP with SSD/150 | |
PANSS: G1–G16 3 | [68] | NOP with first-episode psychosis/101 |
[64] | NOP with psychosis/290 | |
[58] | NOP with SSD/150 | |
PANSS: total 4 | [64] | NOP with psychosis/290 |
[57] | NOP with SSD + depression/132 | |
[16] | OP with SSD/356 | |
Previous suicide attempts | [64] | NOP with psychosis/290 |
[57] | NOP with SSD + depression/132 | |
[69] | NOP with SSD/51 | |
[20] | OP and NOP with schizophrenia/70 | |
[59] | OP with SSD/223 | |
History of self-harm | [70] | NOP with SSD/57 |
History of endangerment of others | [71] | OP/96 |
[72] | OP/266 | |
Data reg. pharmacotherapy | ||
Regular intake of medication as prescribed | [38] | NOP with SSD/40 |
Antipsychotic polypharmacy (>2 substances) | [73] | NOP with SSD/1611 |
Prescription of antidepressants | [73] | NOP with SSD/1611 |
Other | ||
Pre-existing physical disorder 1 | [56] | NOP with SSD/510 |
Appendix B. Detailed List of Investigated Predictor Variables
Variable Code | Label | Definition |
SD1 | Age at admission? | Age (in years and months) at the date of admission to the referenced hospital |
SD2 | Gender? | As indicated in the file |
SD3a | Country of birth: Switzerland? | As indicated in the file |
SD5b | Marital Status: single | Yes, if he/she was unmarried at the time of the offence, respectively, the admission to the referenced hospitalization |
SD6a | Living situation: psychiatric living measure | Yes, if, at the time of the offence, respectively, the admission to the referenced hospitalization, he/she was an inpatient or a semi-inpatient in a mental health care institution |
SD6b | Living situation: complementary facility | Yes, if, at the time of the offence, respectively, the admission to the referenced hospitalization, he/she lived in any type of community-based dwelling equipped with support staff which provided at least a minimum housing standard (does not include homeless shelters) |
SD6c | Living situation: home alone | Yes, if, at the time of the offence, respectively, the admission to the referenced hospitalization, he/she lived on his/her own in any type of community-based dwelling without support staff which provided at least the minimum housing standard |
SD6d | Living situation: home with others | Yes, if item SD6e and/or SD6f applies AND/OR if, at the time of the offence, respectively, the admission to the referenced hospitalization, he/she lived with one or more person(s) in any type of community-based dwelling without support staff which provided at least the minimum housing standard |
SD6e | Living situation: at parents | Yes, if, at the time of the offence, respectively, the admission to the referenced hospitalization, he/she lived with one or both legal parent(s) in any type of community-based dwelling which provided at least the minimum housing standard |
SD6f | Living situation: with relatives | Yes, if item SD6e applies AND/OR if, at the time of the offence, respectively, the admission to the referenced hospitalization, he/she lived with one or more relative(s)/person(s) in law in any type of community-based dwelling which provided at least the minimum housing standard |
SD6g | Living situation: homeless | Yes, if, at the time of the offence, respectively the admission to the referenced hospitalization, he/she lived in a place which was below the minimum housing standard AND had no access to an adequate dwelling |
SD6i | Living situation: other | Yes, if, at the time of the offence, respectively, the admission to the referenced hospitalization, none of the items SD6a-SD6g applies |
SD7a | Highest graduation: no compulsory school | Yes, if he/she had not completed primary or (lower) secondary school education (school period from about age 6 to about age 16) at the time of the investigated offence, respectively, the admission to the referenced hospitalization |
SD7b | Highest graduation: compulsory school | Yes, if he/she had completed primary AND (lower) secondary school education (school period from about age 6 to about age 16) at the time of the investigated offence, respectively, the admission to the referenced hospitalization |
SD7c | Type of graduation | His/her highest completed level of education at the time of the investigated offence, respectively, the admission to the referenced hospitalization: (1) no graduation (2) primary school (3) secondary school (4) gymnasium (5) vocational school (6) “Fachmittelschule” (technical school) (7) college (8) university degree (9) other |
SD7d | Highest graduation: college/university | Yes, if he/she had graduated from college and/or university and/or another higher education institution (e.g., university of applied sciences) at the time of the investigated offence, respectively, the admission to the referenced hospitalization |
PH1 | Age at which the F2x diagnosis was given? | Age (in years) at which the patient was diagnosed with any schizophrenia spectrum disorder for the first time (ICD-10: F2x.x) |
PH2 | Age at which the patient showed first symptoms of the F2x diagnosis? | Age (in years) at which he/she showed any of the symptoms that are described in the ICD-10 under the corresponding F2x.x diagnosis (see item PH1) for the first time; unless the symptoms can be better explained by other causes (e. g. substance consumption) |
PH3 | History of delusions | Yes, if he/she (had) experienced any type of delusion (persecutory delusions, delusions of grandeur). ‘Delusion’ was defined as “a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g., it is not an article of religious faith)” |
PH4 | History of hallucinations | Yes, if he/she (had) experienced any visual, auditory, olfactory, tactile, and/or gustatory hallucinations. |
PH5 | History of penetrability of the own ego | Yes, if he/she (had) experienced any of the following: thought insertion, thought withdrawal, thought broadcasting, thought echo, depersonalisation, derealisation and/or delusions of control |
PH6 | History of disorders of affect or drive | Yes, if he/she (had) experienced any mania- and/or depression-like symptoms with the consequence of any type of functional impairment (distress and/or disability) |
PH7 | History of negative symptoms | Yes, if he/she (had) experienced any types of negative symptoms which are listed in the positive and negative syndrome scale (PANSS), which cannot be better explained by other causes (such as another mental illness) |
PH10a | History of suicide attempts | Yes, if he/she had harmed himself/herself intentionally with suicidal intent at any one time before the investigated offence, respectively, the time of the referenced hospitalization |
PH11a | History of endangerment of others | Yes, if, at any one time before the investigated offence, respectively, the referenced hospitalization, he/she had deliberately or negligently put one or more person(s) at any type of risk (e.g., by the exertion of violence), which entailed the potential or actual consequence of a substantial mental and/or physical impairment of the corresponding person(s) |
PH12a | Was there ever any compulsory measure during a hospitalization used? | Yes, if one or more of the following measures had been forced upon the patient in a psychiatric hospital at any one time before the investigated offence, respectively, the referenced hospitalization:
|
PH13 | Alcohol abuse | Yes, if he/she (had) had an alcohol consumption pattern corresponding to the ICD-10 diagnosis “Harmful use (F10.1)” or “Dependence syndrome (F10.2x)” at the time of or at any one time before the investigated offence, respectively, the referenced hospitalization |
PH14a | Drug abuse | Yes, if he/she did not have and had not had a substance consumption pattern corresponding to the ICD-10 diagnosis “Harmful use (F1x.1)” or “Dependence syndrome (F1x.2x)” at the time of and at any one time before the investigated offence, respectively, the referenced hospitalization. In this item, the term ‘substance’ refers to illicit drugs and prescription medications but not to alcohol. |
PH14b | Cannabis abuse/-dependence? | Yes, if he/she (had) had a cannabinoid consumption pattern corresponding to the ICD-10 diagnosis “Harmful use (F12.1)” or “Dependence syndrome (F12.2x)” at the time of or at any one time before the investigated offence, respectively, the referenced hospitalization |
PH15a | Presence of a personality disorder (PD)? | Yes, if he/she had ever been diagnosed with any personality disorder listed in the ICD-10 (F60.x, F61) and/or the DSM-V |
PH18a | Any outpatient psychiatric treatment(s)? | Yes, if he/she had visited a mental health care provider (psychologist and/or psychiatrist) as an outpatient at any time before the investigated offence, respectively, the referenced hospitalization, regardless of the duration of said treatment |
PH19a | Any inpatient psychiatric treatment(s)? | Yes, if he/she had been an inpatient and/or a semi-inpatient in a mental health care institution at any time before the investigated offence, respectively, the referenced hospitalization, regardless of the duration of said treatment |
PH22a | Was the patient ever compulsorily admitted? | Yes, if he/she had been involuntarily admitted to any mental health care institution by order of an authorised person (such as a physician) at any one time before the investigated offence, respectively, the referenced hospitalization. Compulsory admission is defined as application of the Swiss “Fürsorgerische Unterbringung (FU)” OR “Fürsorgerischer Freiheitsentzug (FFE)” according to the Swiss child and adult protection law (KESR). |
PH23p | Regular intake of antipsychotic medication | Yes, if he/she, mental health professionals and trusted private persons (e.g., close family members) had not reported/documented a lack of compliance/adherence to any antipsychotic medications at any time before the investigated offence AND if mental health professionals and trusted private persons (e.g., close family members) had not had reasonable grounds for suspecting that the patient lacked medication compliance/adherence to any antipsychotic medications at any time before the investigated offence, respectively, the referenced hospitalization. |
N2 | Global cognitive deficits | Yes, if any report in the file states that he/she had shown deficits in any of the domains “general intelligence” (N1b), “attention”, “verbal memory”, “verbal fluency”, “verbal learning and memory” or “executive functioning” (adopted from Bowie and Harvey, 2006, p.532–533) for a period of at least 1 year before admission to the referenced hospitalization |
S1 | Does/did the patient have satisfying friendships? | Yes, if, at the time of admission to the referenced hospital, he/she reported to have had AND to still have at least one good friend who is not related to him/her Note: relationships with intimate partners were excluded in this item |
S2 | Does/did the patient have a satisfying relationship with his parents? | Yes, if, at the time of admission to the referenced hospital, he/she reported to have had AND to still have a good relationship with at least one of his/her parents OR, if the corresponding parent(s) had passed away, to have had a good relationship with the deceased parent(s) |
S5 | Does/did the patient suffer from social isolation? | Yes, if he/she had suffered from social isolation for a period of at least 1 year before admission to the referenced hospital Note: Signs of social isolation include “small social networks, infrequent social contacts, absence of confidante connections, living alone, and lack of participation in social activities” |
R9b | Polypharmacy at admission | Yes, if his/her prescription schedule included two or more different antipsychotics on the date of admission to the referenced hospital (does not include antipsychotics which were prescribed on the date of admission itself) |
R9f | Polypharmacy at discharge | Yes, if his/her prescription schedule included two or more different antipsychotics at the time of discharge from the referenced hospital |
R9l | Additional Antidepressant prescribed | Yes, if his/her prescription schedule included two or more different antipsychotics at the time of discharge from the referenced hospital AND if his/her prescription schedule included any antidepressant at the time of discharge from the referenced hospital Note: Herbal and homeopathic remedies are not considered in this item |
R10 | Was the patient ever suicidal during the referenced hospitalization? | Yes, if he/she reported that he/she has experienced active suicidal ideation at any one time during the referenced hospitalisation AND/OR if he/she attempted suicide during the current hospitalisation (see item R12) |
R11 | Did the patient ever show any self-harming behaviour during the referenced hospitalization? | Yes, if he/she intentionally harmed himself/herself (by cutting, burning, or other means) at any one time during the referenced hospitalisation (including self-harming behaviour with suicidal intent (see item R12)) |
R12 | Did the patient ever attempt suicide during the referenced hospitalization? | Yes, if he/she intentionally harmed himself/herself with suicidal intent at any one time during the referenced hospitalisation |
R20b/c | Did the patient ever show any endangerment of others during the referenced hospitalization? | Yes, if he/she showed any physical or verbal aggressions towards one or more staff member(s) or one or more patient(s) at any one time during the referenced hospitalization Note: Aggression is defined as “a behaviour that is intended to harm another person who Is motivated to avoid that harm” |
PA1 | PANSS at admission: Scale Delusion | Score in the PANSS item ‘delusion’ at the time of admission to the referenced hospital |
PA2 | PANSS at admission: Scale Conceptual disorganization | Score in the PANSS item ‘conceptual disorganisation’ at the time of admission to the referenced hospital |
PA3 | PANSS at admission: Scale Hallucinations | Score in the PANSS item ‘hallucinations’ at the time of admission to the referenced hospital |
PA4 | PANSS at admission: Scale Hyperactivity | Score in the PANSS item ‘hyperactivity’ at the time of admission to the referenced hospital |
PA5 | PANSS at admission: Scale Grandiosity | Score in the PANSS item ‘grandiosity’ at the time of admission to the referenced hospital |
PA6 | PANSS at admission: Scale suspiciousness/persecution | Score in the PANSS item ‘suspiciousness/persecution’ at the time of admission to the referenced hospital |
PA7 | PANSS at admission: Scale Hostility | Score in the PANSS item ‘hostility’ at the time of admission to the referenced hospital |
PA8 | PANSS at admission: Scale Blunted affect | Score in the PANSS item ‘blunted affect’ at the time of admission to the referenced hospital |
PA9 | PANSS at admission: Scale Emotional withdrawal | Score in the PANSS item ‘emotional withdrawal’ at the time of admission to the referenced hospital |
PA10 | PANSS at admission: Scale Poor rapport | Score in the PANSS item ‘poor rapport’ at the time of admission to the referenced hospital |
PA11 | PANSS at admission: Scale Passive/apathetic social withdrawal | Score in the PANSS item ‘passive/apathetic social withdrawal’ at the time of admission to the referenced hospital |
PA12 | PANSS at admission: Scale Difficulty in abstract thinking | Score in the PANSS item ‘difficulty in abstract thinking’ at the time of admission to the referenced hospital |
PA13 | PANSS at admission: Scale Lack of spontaneity and flow of conversation | Score in the PANSS item ‘lack of spontaneity and flow of conversation’ at the time of admission to the referenced hospital |
PA14 | PANSS at admission: Scale Stereotyped thinking | Score in the PANSS item ‘stereotyped thinking’ at the time of admission to the referenced hospital |
PA15 | PANSS at admission: Scale Somatic concern | Score in the PANSS item ‘somatic concern’ at the time of admission to the referenced hospital |
PA16 | PANSS at admission: Scale Anxiety | Score in the PANSS item ‘anxiety’ at the time of admission to the referenced hospital |
PA17 | PANSS at admission: Scale Guilt feelings | Score in the PANSS item ‘guilt feelings’ at the time of admission to the referenced hospital |
PA18 | PANSS at admission: Scale Tension | Score in the PANSS item ‘tension’ at the time of admission to the referenced hospital |
PA19 | PANSS at admission: Scale Mannerisms and posturing | Score in the PANSS item ‘mannerism and posturing’ at the time of admission to the referenced hospital |
PA20 | PANSS at admission: Scale Depression | Score in the PANSS item ‘depression’ at the time of admission to the referenced hospital |
PA21 | PANSS at admission: Scale Motor retardation | Score in the PANSS item ‘motor retardation’ at the time of admission to the referenced hospital |
PA22 | PANSS at admission: Scale Uncooperativeness | Score in the PANSS item ‘uncooperativeness’ at the time of admission to the referenced hospital |
PA23 | PANSS at admission: Scale Unusual thought content | Score in the PANSS item ‘unusual thought content’ at the time of admission to the referenced hospital |
PA24 | PANSS at admission: Scale Disorientation | Score in the PANSS item ‘disorientation’ at the time of admission to the referenced hospital |
PA25 | PANSS at admission: Scale Poor attention | Score in the PANSS item ‘poor attention’ at the time of admission to the referenced hospital |
PA26 | PANSS at admission: Scale Lack of judgement and insight | Score in the PANSS item ‘lack of judgement and insight’ at the time of admission to the referenced hospital |
PA27 | PANSS at admission: Scale Disturbance of volition | Score in the PANSS item ‘disturbance of volition’ at the time of admission to the referenced hospital |
PA28 | PANSS at admission: Scale Poor impulse control | Score in the PANSS item ‘poor impulse control’ at the time of admission to the referenced hospital |
PA29 | PANSS at admission: Scale Preoccupation | Score in the PANSS item ‘preoccupation’ at the time of admission to the referenced hospital |
PA30 | PANSS at admission: Scale Active social avoidance | Score in the PANSS item ‘active social avoidance’ at the time of admission to the referenced hospital |
PA_A | PANNS Score at admission | PANSS total score at the time of admission to the referenced hospital |
PA32 | PANSS at discharge: Scale Delusion | Score in the PANSS item ‘delusion’ at the time of discharge from the referenced hospital |
PA33 | PANSS at discharge: Scale Conceptual disorganization | Score in the PANSS item ‘conceptual disorganisation’ at the time of discharge from the referenced hospital |
PA34 | PANSS at discharge: Scale Hallucinations | Score in the PANSS item ‘hallucinations’ at the time of discharge from the referenced hospital |
PA35 | PANSS at discharge: Scale Hyperactivity | Score in the PANSS item ‘hyperactivity’ at the time of discharge from the referenced hospital |
PA36 | PANSS at discharge: Scale Grandiosity | Score in the PANSS item ‘grandiosity’ at the time of discharge from the referenced hospital |
PA37 | PANSS at discharge: Scale Suspiciousness/persecution | Score in the PANSS item ‘suspiciousness/persecution’ at the time of discharge from the referenced hospital |
PA38 | PANSS at discharge: Scale Hostility | Score in the PANSS item ‘hostility’ at the time of discharge from the referenced hospital |
PA39 | PANSS at discharge: Scale Blunted affect | Score in the PANSS item ‘blunted affect’ at the time of discharge from the referenced hospital |
PA40 | PANSS at discharge: Scale Emotional withdrawal | Score in the PANSS item ‘emotional withdrawal’ at the time of discharge from the referenced hospital |
PA41 | PANSS at discharge: Scale Poor rapport | Score in the PANSS item ‘poor rapport’ at the time of discharge from the referenced hospital |
PA42 | PANSS at discharge: Passive/apathetic social withdrawal | Score in the PANSS item ‘passive/apathetic social withdrawal’ at the time of discharge from the referenced hospital |
PA43 | PANSS at discharge: Scale Difficulty in abstract thinking | Score in the PANSS item ‘difficulty in abstract thinking’ at the time of discharge from the referenced hospital |
PA44 | PANSS at discharge: Scale Lack of spontaneity and flow of conversation | Score in the PANSS item ‘spontaneity and flow of conversation’ at the time of discharge from the referenced hospital |
PA45 | PANSS at discharge: Scale Stereotyped thinking | Score in the PANSS item ‘stereotyped thinking’ at the time of discharge from the referenced hospital |
PA46 | PANSS at discharge: Scale Somatic concern | Score in the PANSS item ‘somatic concern’ at the time of discharge from the referenced hospital |
PA47 | PANSS at discharge: Scale Anxiety | Score in the PANSS item ‘anxiety’ at the time of discharge from the referenced hospital |
PA48 | PANSS at discharge: Scale Guilt feelings | Score in the PANSS item ‘guilt feelings’ at the time of discharge from the referenced hospital |
PA49 | PANSS at discharge: Scale Tension | Score in the PANSS item ‘tension’ at the time of discharge from the referenced hospital |
PA50 | PANSS at discharge: Scale Mannerisms and posturing | Score in the PANSS item ‘mannerisms and posturing’ at the time of discharge from the referenced hospital |
PA51 | PANSS at discharge: Scale Depression | Score in the PANSS item ‘depression’ at the time of discharge from the referenced hospital |
PA52 | PANSS at discharge: Scale Motor retardation | Score in the PANSS item ‘motor retardation’ at the time of discharge from the referenced hospital |
PA53 | PANSS at discharge: Scale Uncooperativeness | Score in the PANSS item ‘uncooperativeness’ at the time of discharge from the referenced hospital |
PA54 | PANSS at discharge: Scale Unusual thought content | Score in the PANSS item ‘unusual thought content’ at the time of discharge from the referenced hospital |
PA55 | PANSS at discharge: Scale Disorientation | Score in the PANSS item ‘disorientation’ at the time of discharge from the referenced hospital |
PA56 | PANSS at discharge: Scale Poor attention | Score in the PANSS item ‘poor attention’ at the time of discharge from the referenced hospital |
PA57 | PANSS at discharge: Scale Lack of judgement and insight | Score in the PANSS item ‘lack of judgement and insight’ at the time of discharge from the referenced hospital |
PA58 | PANSS at discharge: Scale Disturbance of volition | Score in the PANSS item ‘disturbance of volition’ at the time of discharge from the referenced hospital |
PA59 | PANSS at discharge: Scale Poor impulse control | Score in the PANSS item ‘poor impulse control’ at the time of discharge from the referenced hospital |
PA60 | PANSS at discharge: Scale Preoccupation | Score in the PANSS item ‘Preoccupation’ at the time of discharge from the referenced hospital |
PA61 | PANSS at discharge: Scale Active social avoidance | Score in the PANSS item ‘active social avoidance’ at the time of discharge from the referenced hospital |
PAS62 | PANNS Score at discharge | PANSS total score at the time of discharge from the referenced hospital |
References
- Charlson, F.J.; Ferrari, A.J.; Santomauro, D.F.; Diminic, S.; Stockings, E.; Scott, J.G.; McGrath, J.J.; Whiteford, H.A. Global Epidemiology and Burden of Schizophrenia: Findings from the Global Burden of Disease Study 2016. Schizophr. Bull. 2018, 44, 1195–1203. [Google Scholar] [CrossRef] [PubMed]
- Laursen, T.M.; Nordentoft, M.; Mortensen, P.B. Excess early mortality in schizophrenia. Annu. Rev. Clin. Psychol. 2014, 10, 425–448. [Google Scholar] [CrossRef] [PubMed]
- Yung, N.C.L.; Wong, C.S.M.; Chan, J.K.N.; Chen, E.Y.H.; Chang, W.C. Excess Mortality and Life-Years Lost in People with Schizophrenia and Other Non-affective Psychoses: An 11-Year Population-Based Cohort Study. Schizophr. Bull. 2021, 47, 474–484. [Google Scholar] [CrossRef] [PubMed]
- Olfson, M.; Gerhard, T.; Huang, C.; Crystal, S.; Stroup, T.S. Premature Mortality Among Adults with Schizophrenia in the United States. JAMA Psychiatry 2015, 72, 1172–1181. [Google Scholar] [CrossRef] [Green Version]
- Bai, W.; Liu, Z.H.; Jiang, Y.Y.; Zhang, Q.E.; Rao, W.W.; Cheung, T.; Hall, B.J.; Xiang, Y.T. Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: A meta-analysis and systematic review of epidemiological surveys. Transl. Psychiatry 2021, 11, 552. [Google Scholar] [CrossRef]
- Dutta, R.; Murray, R.M.; Hotopf, M.; Allardyce, J.; Jones, P.B.; Boydell, J. Reassessing the long-term risk of suicide after a first episode of psychosis. Arch. Gen. Psychiatry 2010, 67, 1230–1237. [Google Scholar] [CrossRef] [Green Version]
- Hor, K.; Taylor, M. Suicide and schizophrenia: A systematic review of rates and risk factors. J. Psychopharmacol. 2010, 24 (Suppl. S4), 81–90. [Google Scholar] [CrossRef] [Green Version]
- Baillargeon, J.; Binswanger, I.A.; Penn, J.V.; Williams, B.A.; Murray, O.J. Psychiatric disorders and repeat incarcerations: The revolving prison door. Am. J. Psychiatry 2009, 166, 103–109. [Google Scholar] [CrossRef]
- Voulgaris, A.; Kielisch, S.; Konrad, N.; Opitz-Welke, A. Suizide im Gefängnis und im Maßregelvollzug-eine Berliner Vergleichsstudie. Recht. Psychiatr. 2018, 36, 15–20. [Google Scholar]
- Hawton, K.; Sutton, L.; Haw, C.; Sinclair, J.; Deeks, J.J. Schizophrenia and suicide: Systematic review of risk factors. Br. J. Psychiatry 2005, 187, 9–20. [Google Scholar] [CrossRef] [Green Version]
- Fazel, S.; Cartwright, J.; Norman-Nott, A.; Hawton, K. Suicide in prisoners: A systematic review of risk factors. J. Clin. Psychiatry 2008, 69, 1721–1731. [Google Scholar] [CrossRef]
- Conner, K.R.; Cox, C.; Duberstein, P.R.; Tian, L.; Nisbet, P.A.; Conwell, Y. Violence, alcohol, and completed suicide: A case-control study. Am. J. Psychiatry 2001, 158, 1701–1705. [Google Scholar] [CrossRef] [PubMed]
- Gvion, Y.; Apter, A. Aggression, impulsivity, and suicide behavior: A review of the literature. Arch. Suicide Res. 2011, 15, 93–112. [Google Scholar] [CrossRef] [PubMed]
- Zhong, S.; Senior, M.; Yu, R.; Perry, A.; Hawton, K.; Shaw, J.; Fazel, S. Risk factors for suicide in prisons: A systematic review and meta-analysis. Lancet Public Health 2021, 6, e164–e174. [Google Scholar] [CrossRef] [PubMed]
- Webb, R.T.; Qin, P.; Stevens, H.; Mortensen, P.B.; Appleby, L.; Shaw, J. National study of suicide in all people with a criminal justice history. Arch. Gen. Psychiatry 2011, 68, 591–599. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kappes, J.R.; Huber, D.A.; Kirchebner, J.; Sonnweber, M.; Günther, M.P.; Lau, S. Self-Harm Among Forensic Psychiatric Inpatients with Schizophrenia Spectrum Disorders: An Explorative Analysis. Int J. Offender Comp. Criminol. 2021, 306624x211062139. [Google Scholar] [CrossRef] [PubMed]
- Žarkovic Palijan, T.; Mužinić, L.; Radeljak, S. Psychiatric comorbidity in forensic psychiatry. Psychiatr. Danub. 2009, 21, 429–436. [Google Scholar]
- Goethals, K.R.; Vorstenbosch, E.C.; van Marle, H.J. Diagnostic comorbidity in psychotic offenders and their criminal history: A review of the literature. Int. J. Forensic. Ment. Health 2008, 7, 147–156. [Google Scholar] [CrossRef]
- Gunn, J.; Taylor, P.; Hutcheon, I.D. Forensic Psychiatry: Clinical, Legal and Ethical Issues; CRC Press: Boca Raton, FL, USA, 2014. [Google Scholar]
- Landgraf, S.; Blumenauer, K.; Osterheider, M.; Eisenbarth, H. A clinical and demographic comparison between a forensic and a general sample of female patients with schizophrenia. Psychiatry Res. 2013, 210, 1176–1183. [Google Scholar] [CrossRef]
- Fazel, S.; Gulati, G.; Linsell, L.; Geddes, J.R.; Grann, M. Schizophrenia and violence: Systematic review and meta-analysis. PLoS Med. 2009, 6, e1000120. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision; World Health Organization: Geneva, Switzerland, 2004.
- Slee, V.N. The International Classification of Diseases: Ninth Revision (ICD-9); American College of Physicians: Philadelphia, PA, USA, 1978; pp. 424–426. [Google Scholar]
- Hsieh, H.-F.; Shannon, S.E. Three approaches to qualitative content analysis. Qual. Health Res. 2005, 15, 1277–1288. [Google Scholar] [CrossRef] [PubMed]
- Seifert, D. Die entwicklung des psychiatrischen massregelvollzzugs (§ 63StGB) in Nordrhein-Wesfalen. Psychiat Prax. 1997, 24, 237–244. [Google Scholar]
- Hofmann, L.A.; Lau, S.; Kirchebner, J. Advantages of Machine Learning in Forensic Psychiatric Research— Uncovering the Complexities of Aggressive Behavior in Schizophrenia. Appl. Sci. 2022, 12, 819. [Google Scholar]
- Kay, S.R.; Fiszbein, A.; Opler, L.A. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr. Bull. 1987, 13, 261–276. [Google Scholar] [CrossRef] [PubMed]
- McKnight, P.E.; Najab, J. Mann-Whitney U Test. In The Corsini Encyclopedia of Psychology; Wiley Online Library: Hoboken, NY, USA, 2010; p. 1. [Google Scholar] [CrossRef]
- Bower, K.M. When to Use Fisher’s Exact Test; American Society for Quality: Milwaukee, WI, USA, 2003; Volume 2, pp. 35–37. [Google Scholar]
- Jiang, T.; Gradus, J.L.; Rosellini, A.J. Supervised Machine Learning: A Brief Primer. Behav. Ther. 2020, 51, 675–687. [Google Scholar] [CrossRef]
- Yarkoni, T.; Westfall, J. Choosing Prediction Over Explanation in Psychology: Lessons from Machine Learning. Perspect. Psychol. Sci. 2017, 12, 1100–1122. [Google Scholar] [CrossRef]
- Browne, M.W. Cross-Validation Methods. J. Math. Psychol. 2000, 44, 108–132. [Google Scholar] [CrossRef] [Green Version]
- Machetanz, L.; Günther, M.; Lau, S.; Kirchebner, J. High risk, high dose?—Pharmacotherapeutic prescription patterns of offender and non-offender patients with schizophrenia spectrum disorder. Biomedicines 2022, 10, 3243. [Google Scholar] [CrossRef]
- Kramer, M.S.; Vogel, W.H.; DiJohnson, C.; Dewey, D.A.; Sheves, P.; Cavicchia, S.; Little, P.; Schmidt, R.; Kimes, I. Antidepressants in ‘depressed’ schizophrenic inpatients. A controlled trial. Arch. Gen. Psychiatry 1989, 46, 922–928. [Google Scholar] [CrossRef]
- Mao, Y.M.; Zhang, M.D. Augmentation with antidepressants in schizophrenia treatment: Benefit or risk. Neuropsychiatr. Dis. Treat 2015, 11, 701–713. [Google Scholar] [CrossRef] [Green Version]
- Patchan, K.; Vyas, G.; Hackman, A.L.; Mackowick, M.; Richardson, C.M.; Love, R.C.; Wonodi, I.; Sayer, M.A.; Glassman, M.; Feldman, S.; et al. Clozapine in Reducing Aggression and Violence in Forensic Populations. Psychiatr. Q. 2018, 89, 157–168. [Google Scholar] [CrossRef]
- Hennen, J.; Baldessarini, R.J. Suicidal risk during treatment with clozapine: A meta-analysis. Schizophr. Res. 2005, 73, 139–145. [Google Scholar] [CrossRef] [PubMed]
- Pompili, M.; Lester, D.; Grispini, A.; Innamorati, M.; Calandro, F.; Iliceto, P.; De Pisa, E.; Tatarelli, R.; Girardi, P. Completed suicide in schizophrenia: Evidence from a case-control study. Psychiatry Res. 2009, 167, 251–257. [Google Scholar] [CrossRef]
- Sher, L.; Kahn, R.S. Suicide in Schizophrenia: An Educational Overview. Medicina 2019, 55, 361. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Haller, R.; Kemmler, G.; Kocsis, E.; Maetzler, W.; Prunlechner, R.; Hinterhuber, H. Schizophrenia and violence. Results of a comprehensive inquiry in an Austrian providence. Nervenarzt 2001, 72, 859–866. [Google Scholar] [CrossRef]
- Habermeyer, E.; Wolff, R.; Gillner, M.; Strohm, R.; Kutscher, S. Patienten mit schizophrenen Störungen im psychiatrischen Maßregelvollzug. Der. Nervenarzt 2010, 81, 1117–1124. [Google Scholar] [CrossRef] [PubMed]
- Hachtel, H.; Harries, C.; Luebbers, S.; Ogloff, J.R. Violent offending in schizophrenia spectrum disorders preceding and following diagnosis. Aust. N. Z. J. Psychiatry 2018, 52, 782–792. [Google Scholar] [CrossRef]
- Barlati, S.; Nibbio, G.; Stanga, V.; Giovannoli, G.; Calzavara-Pinton, I.; Necchini, N.; Lisoni, J.; Deste, G.; Vita, A. Cognitive and clinical characteristics of offenders and non-offenders diagnosed with schizophrenia spectrum disorders: Results of the Recoviwel observational study. Eur. Arch. Psychiatry Clin. Neurosci. 2022, 1–10. [Google Scholar] [CrossRef] [PubMed]
- Slotboom, J.; Hoppenbrouwers, S.S.; Bouman, Y.H.A.; in ’t Hout, W.; Sergiou, C.; van der Stigchel, S.; Theeuwes, J. Visual attention in violent offenders: Susceptibility to distraction. Psychiatry Res. 2017, 251, 281–286. [Google Scholar] [CrossRef] [PubMed]
- Pennington, C.R.; Cramer, R.J.; Miller, H.A.; Anastasi, J.S. Psychopathy, depression, and anxiety as predictors of suicidal ideation in offenders. Death Stud. 2015, 39, 288–295. [Google Scholar] [CrossRef] [PubMed]
- Harmer, B.; Lee, S.; Duong, T.V.H.; Saadabadi, A. Suicidal Ideation. In StatPearls; StatPearls Publishing: Tampa, FL, USA, 2022. [Google Scholar]
- Temmingh, H.; Stein, D.J. Anxiety in Patients with Schizophrenia: Epidemiology and Management. CNS Drugs 2015, 29, 819–832. [Google Scholar] [CrossRef] [PubMed]
- Jovanović, N.; Podlesek, A.; Medved, V.; Grubišin, J.; Mihaljevic-Peleš, A.; Goran, T.; Lovretić, V. Association between psychopathology and suicidal behavior in schizophrenia. A cross-sectional study of 509 participants. Crisis 2013, 34, 374–381. [Google Scholar] [CrossRef] [PubMed]
- Carragher, N.; Krueger, R.F.; Eaton, N.R.; Slade, T. Disorders without borders: Current and future directions in the meta-structure of mental disorders. Soc. Psychiatry Psychiatr. Epidemiol. 2015, 50, 339–350. [Google Scholar] [CrossRef] [PubMed]
- Kröber, H.-L. Selbstbestimmung und Zwang in der Behandlung; Springer: Berlin/Heidelberg, Germany, 2019; Volume 13, pp. 1–3. [Google Scholar]
- Höfer, F.X.; Habermeyer, E.; Mokros, A.; Lau, S.; Gairing, S.K. The impact of legal coercion on the therapeutic relationship in adult schizophrenia patients. PLoS ONE 2015, 10, e0124043. [Google Scholar] [CrossRef]
- Bukten, A.; Stavseth, M.R. Suicide in prison and after release: A 17-year national cohort study. Eur. J. Epidemiol. 2021, 36, 1075–1083. [Google Scholar] [CrossRef]
- Radeloff, D.; Stoeber, F.; Lempp, T.; Kettner, M.; Bennefeld-Kersten, K. Murderers or thieves at risk? Offence-related suicide rates in adolescent and adult prison populations. PLoS ONE 2019, 14, e0214936. [Google Scholar] [CrossRef] [Green Version]
- Hartley, C.M.; Pettit, J.W.; Castellanos, D. Reactive Aggression and Suicide-Related Behaviors in Children and Adolescents: A Review and Preliminary Meta-Analysis. Suicide Life Threat. Behav. 2018, 48, 38–51. [Google Scholar] [CrossRef]
- Stratton, J.; Cobia, D.J.; Reilly, J.; Brook, M.; Hanlon, R.E. Differences in Neuropsychological Functioning Between Homicidal and Nonviolent Schizophrenia Samples. J. Forensic. Sci. 2018, 63, 1435–1443. [Google Scholar] [CrossRef]
- Ran, M.S.; Chen, E.Y.; Conwell, Y.; Chan, C.L.; Yip, P.S.; Xiang, M.Z.; Caine, E.D. Mortality in people with schizophrenia in rural China: 10-year cohort study. Br. J. Psychiatry 2007, 190, 237–242. [Google Scholar] [CrossRef]
- Montross, L.P.; Kasckow, J.; Golshan, S.; Solorzano, E.; Lehman, D.; Zisook, S. Suicidal ideation and suicide attempts among middle-aged and older patients with schizophrenia spectrum disorders and concurrent subsyndromal depression. J. Nerv. Ment. Dis. 2008, 196, 884–890. [Google Scholar] [CrossRef]
- Loas, G.; Azi, A.; Noisette, C.; Legrand, A.; Yon, V. Fourteen-year prospective follow-up study of positive and negative symptoms in chronic schizophrenic patients dying from suicide compared to other causes of death. Psychopathology 2009, 42, 185–189. [Google Scholar] [CrossRef] [PubMed]
- Gazdag, G.; Belán, E.; Szabó, F.A.; Ungvari, G.S.; Czobor, P.; Baran, B. Predictors of suicide attempts after violent offences in schizophrenia spectrum disorders. Psychiatry Res. 2015, 230, 728–731. [Google Scholar] [CrossRef] [PubMed]
- Ran, M.S.; Chan, C.L.; Chen, E.Y.; Tang, C.P.; Lin, F.R.; Li, L.; Li, S.G.; Mao, W.J.; Hu, S.H.; Schwab, G.; et al. Mortality of geriatric and younger patients with schizophrenia in the community. Suicide Life Threat. Behav. 2008, 38, 143–151. [Google Scholar] [CrossRef] [PubMed]
- Kuo, C.J.; Tsai, S.Y.; Lo, C.H.; Wang, Y.P.; Chen, C.C. Risk factors for completed suicide in schizophrenia. J. Clin. Psychiatry 2005, 66, 579–585. [Google Scholar] [CrossRef] [PubMed]
- Favril, L.; Indig, D.; Gear, C.; Wilhelm, K. Mental disorders and risk of suicide attempt in prisoners. Soc. Psychiatry Psychiatr. Epidemiol. 2020, 55, 1145–1155. [Google Scholar] [CrossRef] [Green Version]
- Vadini, F.; Calella, G.; Pieri, A.; Ricci, E.; Fulcheri, M.; Verrocchio, M.C.; De Risio, A.; Sciacca, A.; Santilli, F.; Parruti, G. Neurocognitive impairment and suicide risk among prison inmates. J. Affect Disord. 2018, 225, 273–277. [Google Scholar] [CrossRef] [PubMed]
- Fialko, L.; Freeman, D.; Bebbington, P.E.; Kuipers, E.; Garety, P.A.; Dunn, G.; Fowler, D. Understanding suicidal ideation in psychosis: Findings from the Psychological Prevention of Relapse in Psychosis (PRP) trial. Acta. Psychiatr. Scand. 2006, 114, 177–186. [Google Scholar] [CrossRef] [Green Version]
- Johnson, J.; Gooding, P.; Tarrier, N. Suicide risk in schizophrenia: Explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychol. Psychother. Theory Res. Pract. 2008, 81, 55–77. [Google Scholar] [CrossRef]
- Jarbin, H.; von Knorring, A.-L. Suicide and suicide attempts in adolescent-onset psychotic disorders. Nord. J. Psychiatry 2004, 58, 115–123. [Google Scholar] [CrossRef]
- Fenton, W.S.; McGlashan, T.H.; Victor, B.J.; Blyler, C.R. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am. J. Psychiatry 1997, 154, 199–204. [Google Scholar]
- Crumlish, N.; Whitty, P.; Kamali, M.; Clarke, M.; Browne, S.; McTigue, O.; Lane, A.; Kinsella, A.; Larkin, C.; O’Callaghan, E. Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder. Acta Psychiatr. Scand. 2005, 112, 449–455. [Google Scholar] [CrossRef] [PubMed]
- Sinclair, J.M.; Mullee, M.A.; King, E.A.; Baldwin, D.S. Suicide in schizophrenia: A retrospective case-control study of 51 suicides. Schizophr. Bull. 2004, 30, 803–811. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pluck, G.; Lekka, N.P.; Sarkar, S.; Lee, K.H.; Bath, P.A.; Sharif, O.; Woodruff, P.W. Clinical and neuropsychological aspects of non-fatal self-harm in schizophrenia. Eur. Psychiatry 2013, 28, 344–348. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Swogger, M.T.; Walsh, Z.; Maisto, S.A.; Conner, K.R. Reactive and proactive aggression and suicide attempts among criminal offenders. Crim. Justice Behav. 2014, 41, 337–344. [Google Scholar] [CrossRef]
- Swogger, M.T.; You, S.; Cashman-Brown, S.; Conner, K.R. Childhood physical abuse, aggression, and suicide attempts among criminal offenders. Psychiatry Res. 2011, 185, 363–367. [Google Scholar] [CrossRef] [Green Version]
- Haukka, J.; Tiihonen, J.; Härkänen, T.; Lönnqvist, J. Association between medication and risk of suicide, attempted suicide and death in nationwide cohort of suicidal patients with schizophrenia. Pharmacoepidemiol. Drug Saf. 2008, 17, 686–696. [Google Scholar] [CrossRef]
Characteristics | Total n/N (%) | Non-Offender Patients n/N (%) | Offender Patients n/N (%) | p-Value |
---|---|---|---|---|
Male sex | 363/399 (91) | 152/167 (91) | 211/232 (90.9) | 1 |
Age at admission (mean, SD) | 34.4 (10.7) | 35.7 (11.9) | 33.5 (9.6) | 0.189 |
Native Country Switzerland | 210/398 (52.8) | 105/166 (63.3) | 105/232 (45.3) | 0.001 * |
Single 1 | 303/399 (75.9) | 123/166 (74.1) | 180/232 (77.6) | 0.335 |
Diagnosis: Schizophrenia | 308/399 (77.2) | 129/166 (77.7) | 179/229 (79) | 0.904 |
Suicide attempt in past | 208/375 (55.5) | 92/149 (61.7) | 116/226 (51.3) | 0.056 |
Suicide attempt during referenced hospitalisation | 12/388 (3) | 2/163 (1.2) | 10/225 (4.4) | 0.081 |
Endangerment of others in past | 260/381 (65.2) | 90/152 (59.2) | 170/229 (74.2) | 0.002 * |
Endangerment of others during referenced hospitalisation | 105/387 (26.3) | 33/165 (20) | 72/222 (32.4) | 0.008 * |
Statistical Procedure | Balanced Accuracy (%) | AUC | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) |
---|---|---|---|---|---|---|
Logistic Regression | 62.50 | 75.70 | 79.30 | 45.50 | 50.40 | 76.90 |
Tree | 67.50 | 75.60 | 85.20 | 49.80 | 54.40 | 82.80 |
Random Forest | 66.2 | 75.7 | 84 | 48.3 | 52.9 | 82.2 |
Gradient Boosting | 76.9 | 0.85 | 65.1 | 88.7 | 78.6 | 79.4 |
KNN | 64.1 | 76.5 | 81.9 | 46.3 | 51.3 | 80.2 |
SVM | 73.7 | 0.85 | 54.2 | 93.2 | 84.4 | 74.7 |
Naïve Bayes | 76.6 | 0.87 | 63.6 | 89.7 | 81.1 | 77.7 |
Variable Code * | Variable Description | NOP n/N (%) | OP n/N (%) |
---|---|---|---|
PH18a | Any outpatient psychiatric treatment(s) in the past | 134/153 (87.6) | 130/218 (59.6) |
PH23p | Regular intake of antipsychotic medication | 80/143 (55.9) | 17/150 (11.3) |
N2 | Global cognitive deficit | 133/152 (87.5) | 148/230 (64.3) |
R9l | Antidepressant during current hospitalisation | 63/167 (37.7) | 23/195 (11.8) |
PA13 | PANSS—adapted scale at admission: Lack of spontaneity and flow of conversation | ||
symptom absent | 77/166 (46.4) | 144/224 (65.2) | |
symptom discreetly | 48/166 (28.9) | 33/224 (14.7) | |
symptom substantially | 41/166 (24.7) | 47/224 (21) | |
PA47 | PANSS—adopted scale at admission: Anxiety | ||
symptom absent | 79/52.7 (52.7) | 170/224 (75.9) | |
symptom discreetly | 57/150 (38) | 38/224 (17) | |
symptom substantially | 14/150 (9.3) | 16/224 (7.1) |
Performance Measures | % (95% CI) |
---|---|
Balanced Accuracy | 71.2 (62.4–78.3) |
AUC | 0.81 (0.73–0.89) |
Sensitivity | 61.5 (47.0–74.4) |
Specificity | 80.9 (69.2–89.0) |
PPV | 71.1 (55.5–83.2) |
NPV | 73.3 (61.7–82.6) |
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Machetanz, L.; Lau, S.; Habermeyer, E.; Kirchebner, J. Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning. Brain Sci. 2023, 13, 97. https://doi.org/10.3390/brainsci13010097
Machetanz L, Lau S, Habermeyer E, Kirchebner J. Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning. Brain Sciences. 2023; 13(1):97. https://doi.org/10.3390/brainsci13010097
Chicago/Turabian StyleMachetanz, Lena, Steffen Lau, Elmar Habermeyer, and Johannes Kirchebner. 2023. "Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning" Brain Sciences 13, no. 1: 97. https://doi.org/10.3390/brainsci13010097
APA StyleMachetanz, L., Lau, S., Habermeyer, E., & Kirchebner, J. (2023). Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning. Brain Sciences, 13(1), 97. https://doi.org/10.3390/brainsci13010097