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Stroke Patients Have Twice The Risk Of Suicide

Depressed stroke patients are twice as likely to commit suicide and remain at risk for at least five years.

"This risk is greater among younger patients and among patients hospitalised for a relatively shorter time," find Dr Timothy Teasdale and colleagues at the Department of Psychology, University of Copenhagen, Denmark. This emerges from a cross-sectional study from Danish government registries of 114,098 stroke patients discharged alive from hospital during the period 1979-1993.

Researchers point out: "Depressive symptoms and clinical depression are not uncommon among stroke patients and the phenomenon of post-stroke depression is widely recognised. More seriously, suicide ideation and suicide attempts have also been reported.

"Because of their relative infrequency however, completed suicides among stroke patients have generally only been reported among single case or small sample studies. 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."

Diagnoses included in the current study were subarachnoid haemorrhage; intracerebral haemorrhage; cerebral ischaemia; precerebral arterial occlusion ; cerebral thrombosis; cerebral embolism; acute but undefined cerebrovasacular disease. A diagnosis of transient cerebral ischaemia was not included.

Dr Teasdale and colleagues said the expected death rate from suicide over the time of their study was 45 per 100,000 of the population. But, they found that among the stroke patients the figure was almost double at 83 per 100,000 of the population.

Men were more likely to commit suicide than women, a figure which is also true of the general population.

Dr Teasdale and colleagues also found that patients suffering a stroke before the age of 50 were three times as likely to commit suicide. Patients who had been in hospital for less than two weeks were also significantly more likely to commit suicide than those in hospital for more than three months after their stroke.

Researchers said the findings of a higher rate of suicide among stoke patients under the age of 50 might be because "the disabilities consequent upon a stroke are more disturbing for younger patients than for older ones, as they would entail a greater change in life style with, for instance, the loss of ability to work. This is also consistent with the greater risk of post-stroke depression at younger ages."

As for the lower rate among stroke patients who spent longer in hospital, the researchers continue, "this may come about because the increased handicaps associated with more severe stroke reduce the capacity to carry out so decisive an action as suicide. Such an interpretation would be consistent with a reported positive association between level of functioning and suicide risk in spinal cord injury patients."

Dr Teasdale and colleagues go on: "Although we have here emphasized the role of psychosocial consequences of stroke as causally implicated in the increased risks for suicide this should not be taken to discount possible neurochemical factors. A body of research has implicated the role of serotonergic dysfunction and also abnormalities of cortisol secretion in post-stroke depression."

They conclude that while the numbers of suicides in the study are comparatively low, "the clearly increased rates relative to the age and gender matched population serve to underline the clinical need to be sensitive to the potential development of severe adverse emotional reactions to stroke."
Journal of Epidemiology and Community Health. 2001; 55: 863-6.

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