Relationship between Suicidality and Low Self-esteem in Patients with Schizophrenia

Objective: Low self-esteem is associated with suicide risk in the general psychiatric population. The aim of this study was to examine associations between suicidality and self-esteem in patients with schizophrenia. Methods: Subjects meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria for schizophrenia were enrolled. Sociodemographic and clinical variables, including previous suicide attempt history, were assessed. Psychopathology, self-esteem, and self-perceived stigma were also measured using the Positive and Negative Syndrome Scale, the Rosenberg Self-Esteem Scale (SES), the Beck Depression Inventory (BDI), the Beck Hopelessness Scale, and the Korean version of the Internalized Stigma of Mental Illness scale (K-ISMI). Results: Of the total of 87 participants, 20 (23.0%) had attempted suicide. Patients with a history of suicide attempts had sig-nificantly higher scores on the BDI ( p =0.036) and K-ISMI ( p =0.009), and significantly lower scores on the SES ( p =0.001). Analysis of covariance revealed that the SES scores were significantly lower in patients with a history of previous suicide attempts than in those with no history, after controlling for K-ISMI and BDI scores ( p =0.039). Conclusion: Low self-esteem appears to represent a psychological dimension that is closely related to suicide risk. Therefore, clinical attention should be paid to the evaluation and enhancement of low self-esteem in schizophrenia patients with suicidality. A longitudinal prospective study is required to ascertain whether low self-esteem leads suicide attempts.