By Matthew E. Fink, MD

Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College

SOURCE: Vyas MV, Wang JZ, Gao MM, Hackam DG. Association between stroke and subsequent risk of suicide: A systematic review and meta-analysis. Stroke 2021;52:1460-1464.

The development of depression following stroke is common, and ranges from 28% to 35% in prospective cohort studies. Depression and low mood have been associated with suicidal ideation, but factors such as cognitive impairment and physical disability also may increase the risk of suicidal ideation in survivors of stroke.

Vyas et al conducted a systematic review of the literature to perform a meta-analysis of observational studies and determine the prevalence and risk of attempted suicide in patients who survive and recover from stroke. Using key words, they systematically searched multiple literature databases and selected observational studies that reported suicide attempts or deaths by suicide in stroke survivors. Then, the authors defined a comparison group consisting of people without a history of stroke or the general population. They used a random effects meta-analysis and calculated the pooled adjusted risk ratio of suicide in stroke survivors and calculated the pooled risk ratio of suicide attempt and death by suicide.

A total of 4,093 articles were screened with 23 studies of fair quality totaling more than 2 million stroke survivors. Of those, 5,563 attempted suicide or died by suicide. Compared to the non-stroke group, the risk ratio for suicide or attempted suicide in stroke survivors was 1.73, P = 0.03. The risk of attempted suicide was higher than death by suicide when compared to the non-stroke population. The investigators noted that in patients who were followed in cohort studies, the risk of suicide was lower for every one year of increase in follow-up.

Stroke should be considered a risk factor for suicide. Tactics to screen and treat depression and suicidal ideation should be an important component of long-term follow-up and care for stroke patients.