Depression and suicidal ideation in schizophrenia spectrum disorder: a cross-sectional study from a lower middle-income country

Research output: Contribution to journalArticlepeer-review


  • M Omair Husain
  • Imran B Chaudhry
  • Zainib Khan
  • Ameer B Khoso
  • Tayyeba Kiran
  • Paul Bassett
  • M Ishrat Husain
  • Nusrat Husain

Colleges, School and Institutes

External organisations

  • Greater Manchester Mental Health NHS Foundation Trust
  • Pakistan Institute of Living and Learning
  • Statsconsultancy Ltd
  • University of Manchester
  • University of Toronto
  • Ziauddin Hospital


OBJECTIVES: Depression has long been considered a significant feature of schizophrenia and is associated with more frequent psychotic episodes, increased service utilisation, substance misuse, poor quality of life and completed suicide. However, there is a distinct lack of literature on this comorbidity from low- and middle-income countries or non-western cultural backgrounds.

METHODS: This is a cross-sectional analysis of baseline data from a large randomised controlled trial, examining the prevalence of depression and suicidal ideation in patients with schizophrenia spectrum disorder. A total of 298 participants were recruited from inpatient and outpatient psychiatric units in Karachi, Pakistan. Participants completed the Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Euro Qol (EQ-5D) and Social Functioning Scale (SFS).

RESULTS: Data indicate that 36% of participants in the study were depressed and 18% endorsed suicidal ideation. Depression was associated with higher positive symptom scores and reduced quality of life, but no significant difference in negative symptoms and social functioning.

CONCLUSIONS: Depression and suicidal ideation are prevalent in Pakistani patients diagnosed with schizophrenia spectrum disorder. Evaluation of depressive symptoms in this group may help identify individuals at higher risk of completed suicide, allowing for targeted interventions to improve outcomes.Key pointsTo our knowledge, this is the first study describing the prevalence of depression and suicidal ideation in individuals with schizophrenia from Pakistan.Our data indicate that 36% of individuals with schizophrenia in our sample were depressed and 18% endorsed suicidal ideation.Depression in schizophrenia was associated with poorer quality of life and higher positive symptom burden.This study adds to the scarce literature from low- and middle-income countries where the burden of mental illness is great and where the majority of suicide deaths occur.Addressing social inequality, food insecurity, high rates of unemployment and low levels of literacy in these settings may have a profound effect on population mental health and suicide risk.


Original languageEnglish
JournalInternational Journal of Psychiatry in Clinical Practice
Early online date14 Jul 2021
Publication statusE-pub ahead of print - 14 Jul 2021


  • Schizophrenia, depression, low and middle income, psychosis Pakistan, suicide