Stroke survivors may be more likely to attempt or die by suicide than people who have not had a stroke, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. This study will be simultaneously published in the American Heart Association’s journal Stroke.
Rates of depression among stroke survivors range from 28% to 35%, and stroke is considered an independent risk factor for depression. Since depression after a stroke has been associated with increased suicidal thoughts, researchers sought to quantify and understand the risk of suicide after stroke.
“Recognizing that stroke may increase the risk of suicidal thoughts or suicide attempts will help stroke survivors, their families and health care professionals to identify and hopefully reduce these risks,” said study author Manav V. Vyas, M.B.B.S., M.Sc., clinical associate in neurology at the University of Toronto in Canada. “It is important we investigate this issue because nearly 15 million people worldwide have a stroke each year, of which approximately 10 million survive. Stroke survivors have physical and mental health consequences and may be more likely to attempt suicide or die by suicide.”
Researchers searched multiple international medical databases including MEDLINE, Embase, PsycINFO and Google Scholar from the inception of each database to September 15, 2020 using keywords and database-specific subject headings for stroke and suicide. They analyzed 23 published studies that included more than 2 million stroke survivors to examine the association between stroke and suicide. More than 5,500 of those survivors attempted suicide or died by suicide.
When researchers compared their analysis to suicide statistics among the general population, they found stroke survivors:
had a 73% higher risk of suicide;
were more than twice as likely to attempt suicide;
had a 63% higher risk of dying by suicide; and
had a diminished risk of suicide with time.
“We anticipated that the risk of suicide in stroke survivors would be high, but we were surprised that it was 73% higher,” Vyas said. “I hope that this study highlights the need to recognize the scale and impact of disability in stroke survivors and their potential influence on mental health status. Having a conversation about low mood or depressed feelings can be challenging for stroke survivors who are often unable to communicate due to the stroke, therefore, health care professionals should consider routine screening of all stroke patients for symptoms of depression and suicidal thoughts, among other mental health conditions.”
This study has a few limitations, including that it is observational and cannot conclude that stroke causes suicide. Another limitation is that some of the studies examined did not exclude people who had a history of attempted suicide prior to the stroke, which could have impacted the results.