Abstract
Suicide is the leading cause of premature death among those with schizophrenia (Palmer, Pankratz, & Bostwick, 2005). Although suicide is avoidable, it has been challenging to identify individuals at risk. Given the myriad of challenges that individuals with schizophrenia face, they often heavily rely on family members for both instrumental and social support. Thus, family relationships are paramount to the well-being of individuals with schizophrenia. The present study assessed relationships between suicidal ideation (measured with the Brief Psychiatric Rating Scale; Ventura, Lukoff, Nuechterlein, Liberman, Green, & Shaner, 1993) and family-related factors including expressed emotion (EE; measured with the Five-Minute Speech Sample; Magaña et al., 1986) and family cohesion (measured with the Family Environment Scale; Moos & Moos, 1994). Links between suicidal ideation and cognitive insight (measured with the Beck’s Cognitive Insight Scale; Beck, Baruch, Balter, Steer, & Warman, 2004) were also examined. Using a sample of 196 patients with schizophrenia, results from regression analyses supported study hypotheses by indicating that greater family cohesion was associated with lower levels of suicidal ideation. Also, in line with expectations, analyses indicated that that greater caregiver criticism and emotional over-involvement may serve as a risk factor for suicidal ideation. Additionally, greater self-reflectiveness (a subcomponent of cognitive insight) was associated with higher levels of suicidal ideation. Finally, an integrated model including all variables found to be associated with suicidal ideation revealed that greater expressed emotion, less family cohesion and greater self-reflectiveness were all associated with general emotional distress (GED; measured with the depression, anxiety, and stress scale; Lovibond & Lovibond, 1995), but only expressed emotion and self-reflectiveness were fully mediated by GED in predicting greater suicidal ideation. These results highlight the potential protective and exacerbating role that caregivers may play in whether individuals with schizophrenia contemplate or attempt suicide.