Meta-analysis of risk factors associated with suicidal ideation after stroke

Abstract

Background Over the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS. Methods We systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria. Results A total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration. Conclusion PSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).

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“…Suicide is the most serious consequence of depression, where the prevalence of depression is about 2 to 9% ( 23 ). A Meta-analysis showed that the type of mental disorder most strongly associated with suicide attempts was depressive disorder ( 24 ). According to Eriksons theory of psychological development, college students are at a critical stage of rapid physical and mental development and are vulnerable to psychosocial factors ( 25 ).…”

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“…Patients with PSD are at a higher risk of short-and long-term mortality (9,10). Additionally, PSD may be associated with a higher probability of cognitive impairment (11), an elevated risk of suicide (12), increased hospitalization costs (13), a greater risk of falls (14), and a lower quality of life than stroke survivors without PSD (15)(16)(17). Advanced age, female sex, history of depression, left hemispheric stroke, more severe disease, and genetic predisposition (e.g., apolipoprotein E) have been linked to the development of PSD (1).…”