Patients at increased risk of suicide after a stroke

By Melanie Hinze
Patients who have had a stroke are at increased risk of suicide, according to the results of a meta-analysis published recently in Stroke.

The research involved an analysis of 23 observational, case-control, cohort or cross-sectional studies published in MEDLINE, Embase, PsychINFO or Google Scholar from their inception to September 2020. Just over half the included patients were female, and the average age was 63.5 years.

Among 2.15 million adult stroke survivors identified, 5563 either made a suicide attempt or died by suicide. The risk of suicide was lower with increasing follow-up time.

The study authors determined that the risk of suicide was 73% higher in stroke survivors compared with those in a nonstroke group, after adjusting for baseline differences. The risk of suicide attempt was more than doubled in stroke survivors, whereas death by suicide was 61% higher than in those who had not experienced stroke.

Dr Karen Borschmann, Stroke Research Fellow at the Florey Institute of Neuroscience and Mental Health and St Vincent’s Hospital, Melbourne, said that supporting the mental health of stroke survivors was an urgent issue.

‘Survivors of stroke report unmet needs relating to their mental health, with young stroke survivors being a particularly vulnerable group,’ she said.

‘When considering risk factors for suicide, including depression, unemployment, social isolation and chronic health conditions, people who have survived a stroke experience these factors at a much higher rate than the general population,’ she added.

‘In a recent national survey, we found that the majority of clinicians who responded reported that their stroke services were inadequate to address the complex long­ term health and social needs of stroke survivors.’

The study authors concluded that comprehensive strategies to screen and treat depression and suicidal ideation in stroke survivors should be developed to reduce the burden of suicide in this group of patients.

Dr Borschmann agreed, saying that supporting the mental health of stroke survivors requires adequate mental health screening and triage, holistic management, improved long­term service provision and ongoing communication between patients, their family and friends and trained health professionals.
Stroke 2021; 52: 1460-1464; doi: 10.1161/STROKEAHA.120.032692.