Suicide and suicidal behaviour are major problems in schizophrenia. Our aim was to review the recent literature on risk factors for suicide in schizophrenia from genes to clinical characteristics to identify different pathways leading to suicide and present a life-span developmental model for suicide in schizophrenia.

We performed a database search in four databases (Medline, PubMed, PsycInfo and Web of Science) with the keywords suicide AND schizophrenia. A comprehensive hand search was also performed.

There seem to be five main pathways for schizophrenia patients leading to suicide: First is comorbid depression that leads to suicide. Second, there is a group of patients with a difficult, chronic course of illness and many relapses and exacerbations. They lose their hope progressively over time. Third group comprises patients (mostly young males) with impulsiveness, dysphoric affect and substance abuse. Fourth is a relatively small but theoretically interesting and clinically important group of mainly young patients with high premorbid functioning and above average intellectual capacity. Fifth pathway, failure in treatment, comprises patients lacking social support whose treatment has failed. We also propose a life span model showing these five different pathways to suicide in schizophrenia.

There are different pathways leading to suicide in schizophrenia. These suicidal trajectories could be useful in clinical work when evaluating patients’ possible suicide risk and treating them. They might also provoke some further research ideas and hypotheses.