Insight and suicidal behavior in first-episode schizophrenia

Suicidal behavior and suicide is prevalent in schizophrenia, with an estimated lifetime risk of approximately 5%. The risk is particularly high in the early phases of the disorder, and especially during the years around treatment initiation. Suicide attempts before first treatment contact are also prevalent, with the risk of suicide attempt associated with the length of untreated illness. Several risk factors are in common with the general population, and include previous suicide attempts, impulsive personality traits, substance abuse, depression and feelings of hopelessness. Recent research examines how patients' subjective experiences, including their insight into having a severe mental illness and their beliefs about mental illnesses, may influence suicidal behavior. In this article, we will present a review of studies illustrating the complex background of suicide risk in schizophrenia, with a particular emphasis on the role of insight in the early phases of schizophrenia.