Suicide in schizophrenia: a comprehensive narrative review of risk factors and prevention strategies
Abstract
Suicidal behavior is common in schizophrenia, significantly worsens prognosis, and represents the leading cause of premature mortality in this population. Challenges in assessing suicide risk and implementing effective prevention strategies in individuals with schizophrenia pose major difficulties for clinicians and healthcare systems. This review aimed to summarize the key suicide risk factors and current preventive strategies associated with schizophrenia. A comprehensive narrative review of the literature was conducted. Electronic searches were performed in major biomedical databases, including PubMed/MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Cochrane Library, from database inception to June 2026. Relevant studies addressing suicide risk factors and preventive interventions in schizophrenia were selected according to predefined eligibility criteria. The review primarily relied on systematic reviews, meta-analyses, randomized controlled trials, large observational studies, and international clinical practice guidelines. Suicidal behavior in schizophrenia results from a complex interaction of clinical, neurobiological, genetic, and psychosocial factors. A comprehensive assessment of these factors may improve suicide risk assessment and guide individualized preventive strategies, while emerging artificial intelligence–based approaches may further support risk prediction in the future. Accordingly, a range of pharmacological and non-pharmacological preventive strategies can be implemented according to the individual’s clinical profile and suicide risk. Clozapine is the most extensively validated pharmacological treatment for reducing suicide risk in schizophrenia, although its use requires adherence to established clinical guidelines. Other pharmacological treatments may be considered in selected clinical situations. Non-pharmacological strategies are essential complements and include neuromodulation techniques, psychotherapy, and psychosocial intervention programs.