Suicide after a stroke: a population study

Abstract

Study objective-To establish whether there are increased rates of suicide after a stroke and the degree to which any increase is related to gender, age at stroke, diagnosis, duration of hospitalisation, and time since stroke. Design-Cross linkage of national registers for hospitalisations and causes of death. Setting-The population of Denmark, 1979Denmark, -1993. Patients-A study cohort was defined comprising all 114 098 stroke patients discharged alive from hospital during the period 1979-1993. These patients were then screened in a register of causes of death over the same time period, and 359 cases of suicide were identified. Main results-Annual incidence rates, both observed and expected, together with standardised mortality ratios (SMR) were computed based on annual population and suicide statistics, stratified by age and gender. The overall annual incidence rate of suicide in the cohort was 83 per 100 000 per year compared with an expected figure of 45 (diVerence = 38, 95% CI = 27, 49). Correspondingly, SMR were increased for stroke patients. Across all age bands the SMR for mens was 1.88 (95%CI 1.66, 2.13) and for women 1.78 (1.48, 2.14). SMR were greatest (2.85; 2.17, 3.76) for patients under 50 years of age group and were least for patients 80 years or older (1.3; 0.95, 1.79). There was no clear relation to stroke diagnosis. Suicides were negatively related to duration of hospitalisation, being lowest for those hospitalised for more than three months (0.88; 0.65, 1.19) and highest for those hospitalised for less than two weeks (2.32; 1.92, 2.80). Survival analysis suggested that the risk for suicide is greatest up to about five years after a stroke. Conclusions-Stroke patients are at an approximately doubled risk for suicide. This risk is greater among younger patients and among patients hospitalised for a relatively shorter time. The risk appears to decline with time after a stroke, being greatest within the first five years. (J Epidemiol Community Health 2001;55:863-866) Depressive symptoms and clinical depression are not uncommon among stroke patients and the phenomenon of post-stroke depression is widely recognised.1-3 More seriously, suicide ideation and suicide attempts have also been reported. 4 Because of their relative infrequency however, completed suicides among stroke patients have generally only been reported among single case or small sample studies.5 A recent exception was a Danish study that reported on 140 suicides occurring among over 37 000 stroke patients across a 17 year period in one county of Denmark; measured against population statistics for suicide. Stenager et al 6 found that standardised mortality ratios were markedly increased for stroke patients, particularly among relatively younger patients and among women. The objectives of this study were to attempt to replicate these findings using a full national cohort of stroke patients and to consider the role of stroke morbidity and potential risk periods for suicide after hospital discharge. Methods DATA SOURCESPart...

Suicide in the United States End-Stage Renal Disease Program

“…These data are consistent with unadjusted data reported for kidney transplant recipients (14) and similar in magnitude to the risk for suicide associated with other chronic or debilitating illnesses, including HIV infection, chronic lung disease, and stroke (15)(16)(17). Suicide rates were uniformly increased in ESRD across most major demographic groups, with the exception of blacks and patients who were younger than 30 yr.…”

Poststroke suicide attempts and completed suicides

“…[4][5][6] The suicide risk is particularly high in patients who are relatively young. 4,5 In the general population, suicide rates vary with socioeconomic factors such as civil status, education, and income.…”

“…[4][5][6] The suicide risk is particularly high in patients who are relatively young. 4,5 In the general population, suicide rates vary with socioeconomic factors such as civil status, education, and income.7 After a stroke, existential distress might be prominent 8 and add to the direct biological effects of brain injury to cause depression.9 A Portuguese study of 177 stroke patients found that suicidal thoughts were more common among patients with a low level of education, 3 but there are no previous studies on how suicide attempts or completed suicides relate to socioeconomic factors in stroke patients.We aimed to study how major socioeconomic factors (education, income, civil status, and country of birth) are associated with suicide attempts and completed suicides in patients who have had a stroke. We also explored other factors associated with suicide attempts, including the time after stroke at which suicide risk was the greatest and what methods were used in the suicide attempts.…”

“…1 Having had a stroke increases not only the risk of suicidal thoughts [1][2][3] but also the risk of suicide. [4][5][6] The suicide risk is particularly high in patients who are relatively young. 4,5 In the general population, suicide rates vary with socioeconomic factors such as civil status, education, and income.…”

“…[4][5][6] The suicide risk is particularly high in patients who are relatively young. 4,5 In the general population, suicide rates vary with socioeconomic factors such as civil status, education, and income. 7 After a stroke, existential distress might be prominent 8 and add to the direct biological effects of brain injury to cause depression.…”