The Prevalence of Self-injurious Behavior in Patients With Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis

Abstract

Abstract Background and Hypothesis In patients with schizophrenia spectrum disorder (SSD), the lifetime prevalence of self-harm (SH) and non-suicidal self-injury (NSSI) is currently uncertain. The primary aim of this review was to provide a synthesis of the existing literature concerning the prevalence of SH/NSSI in individuals with SSD, and individuals at clinical high risk of psychosis (CHR-P). Secondary aims were to investigate methods, severity, and functions of self-injurious behavior in these populations. Study Design Studies quantifying the prevalence of SH/NSSI in individuals with SSD or at CHR-P were included in this review. MEDLINE, EMBASE, and PsycInfo were searched for eligible studies June 10, 2022 and systematically screened by two independent reviewers. Risk of bias was assessed using the Joana Briggs Institute Critical Appraisal Checklist for Prevalence Studies by two independent reviewers. A meta-analysis of the lifetime prevalence of SH/NSSI was conducted using generalized linear mixed model with the logit transformation. Study Results Thirty-two studies were included in this review (n = 15 440), 4 of which included individuals at CHR-P (n = 397). The meta-analysis showed a pooled lifetime prevalence of SH of 31.0% (95% CI: 22.1%; 41.6%) in individuals with SSD (n = 2822) and 39.7% (95% CI: 17.5%; 70.0%) in individuals at CHR-P (n = 397). These estimates should be interpreted with caution due to substantial heterogeneity. Cutting was the most frequent method of SH/NSSI and SH command hallucinations may be an overlooked cause of self-injurious behavior in these patients. Conclusions Self-injurious behavior is a highly prevalent, and possibly overlooked concern, in individuals with SSD and at CHR-P.