Prevalence and predictors of suicidal ideation in patients with chronic schizophrenia: A large-scale study on the mediating roles of depression, insomnia and aggression

Jun 24, 2025Journal of affective disorders

How common suicidal thoughts are in people with long-term schizophrenia and how depression, sleep problems, and aggression may influence them

AI simplified

Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

The prevalence of suicidal ideation in patients with chronic schizophrenia is 16.44%.

Depression has both direct and indirect effects on suicidal ideation, with insomnia and aggression acting as mediators.
The indirect effect of depression on suicidal ideation through insomnia is estimated at 0.255.
Aggression also mediates the relationship between depression and suicidal ideation, with an indirect effect of 0.115.
A significant pathway identified is: depression leads to insomnia, which in turn leads to aggression and then suicidal ideation.
Younger age, a family history of mental illness, alcohol consumption, and higher scores on depression and aggression scales are associated with increased suicidal ideation.

AI simplified

BACKGROUND: This study aimed to investigate the prevalence and predictors of suicidal ideation (SI) in patients with chronic schizophrenia, focusing on the mediating roles of depression, insomnia, and aggression.

METHODS: A cross-sectional study was conducted with 1271 patients diagnosed with chronic schizophrenia in China. Participants were assessed using the Beck Scale for Suicide Ideation (SSI), Hamilton Depression Rating Scale (HAMD), Insomnia Severity Index (ISI), Modified Overt Aggression Scale (MOAS), and Positive and Negative Syndrome Scale (PANSS). Mediation and serial mediation analyses were performed to examine the relationships among depression, insomnia, aggression, and SI.

RESULTS: The prevalence of SI was 16.44 %. Depression exhibited both direct and indirect effects on SI, mediated by insomnia (indirect effect = 0.255, 95 % CI [0.116, 0.426]) and aggression (indirect effect = 0.115, 95 % CI [0.014, 0.260]). Serial mediation analysis revealed a significant pathway: depression → insomnia → aggression → SI (β = 0.038, 95 % CI [0.003, 0.094]). Younger age, family history of mental illness, alcohol consumption, higher PANSS scores, and elevated HAMD and MOAS scores were significant predictors of SI.

CONCLUSION: The findings highlight the high prevalence of SI in chronic schizophrenia and underscore the complex interplay of depression, insomnia, and aggression in increasing suicide risk. Targeted interventions addressing these mediators, particularly insomnia and aggression, may mitigate SI in this population.

LIMITATIONS: The cross-sectional design precludes causal inferences. The sample was predominantly male and single, limiting generalizability. Self-reported measures may introduce bias, and medication effects were not controlled.

Full Text

Full text is available at the source.

View full text (XML) ↗View full text ↗

Prevalence and predictors of suicidal ideation in patients with chronic schizophrenia: A large-scale study on the mediating roles of depression, insomnia and aggression

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the circadian biology brief

Abstract

Full Text

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the circadian biology brief