Schizophrenia-related suicide mortality in the United States by sex, 1999–2023

PURPOSE: People with schizophrenia experience markedly elevated risk of suicide, yet national-level data on schizophrenia-related suicide mortality in the United States (US) remain limited. This serial cross-sectional, population-based study quantifies temporal trends in schizophrenia-related suicide deaths from 1999 through 2023 by sex. METHODS: We used final mortality data from the CDC WONDER Multiple Cause of Death database among US residents aged 15-74 years whose underlying cause of death was intentional self-harm or sequelae of intentional self-harm and whose death certificate listed schizophrenia, schizotypal disorder, or other delusional disorders as a contributing cause. Counts and mortality rates per 100,000 population were extracted and stratified by sex. Temporal trends were examined using joinpoint regression, with annual percent change (APC) estimated for each identified trend segment. RESULTS: From 1999 to 2023, there were 3507 schizophrenia-related suicide deaths, of which 76.7% were male and 23.3% were female. The overall mortality rate increased from 0.04 per 100,000 in 1999 to a peak of 0.09 per 100,000 in 2021, a 122% increase. Overall, joinpoint models showed a 2.4% annual increase from 1999 to 2016, followed by a 5.8% annual increase from 2016 to 2023. Among female decedents, rates rose from 1999 to 2012 (APC = 3.6%) and then stabilized. Among male decedents, rates increased gradually from 1999 to 2015 (APC = 2.4%) and accelerated thereafter (APC = 5.8%). CONCLUSIONS: Schizophrenia-related suicide mortality increased substantially in the US, particularly among male individuals in recent years. These findings underscore the need for enhanced suicide prevention and treatment efforts targeting individuals with schizophrenia.