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Younger age, lower education, income predict suicide among stroke survivors

Younger age, lower education level and income level increased risk for suicide among stroke survivors, according to study findings in Neurology.

“In the general population, suicide rates vary with socioeconomic factors such as civil status, education and income. After a stroke, existential distress may be prominent and add to the direct biological effects of brain injury to cause depression,” study researcher Marie Eriksson, PhD, of Umeå University in Sweden, and colleagues wrote.

To study associations between socioeconomic factors, suicide attempts and completed suicides among patients who have experienced stroke, researchers reviewed data from Riksstroke, a Swedish stroke register. The study cohort included 220,336 patients with intracerebral hemorrhage, ischemic stroke or unspecified stroke that were discharged from the hospital. Study participants were followed from January 2001 to December 2012.

During follow-up, there were 1,217 suicide attempts among 985 patients and 260 of them were fatal. Of these, 147 patients attempted suicide within three months after stroke and 44 attempted suicide while still in the hospital.

Young age was significantly associated with increased risk for suicide attempt. The youngest patients, aged 18 to 54 years, were 6 times more likely to attempt suicide vs. patients aged 85 years and older.

Men had an increased risk for suicide attempt (HR = 1.39) compared with women, but that was mediated by men’s younger age at stroke onset.

Stroke patients who lived alone, had primary or secondary education or low or middle income had an increased risk for suicide attempt compared with patients who cohabitated, were educated in university or had high income.

Approximately 82% of the original study cohort were included in follow-up three months after stroke. Of these, 284 patients attempted suicide within 1 year of experiencing stroke.

There were 260 complete suicides during the study period, indicating an incidence rate of 30 suicides per 100,000 person-years among stroke patients. This rate was significantly higher than the incidence rate for the general adult Swedish population, which was 16 suicides per 100,000 person-years.

“A major implication of this study is that although suicide attempts and completed suicides are relatively uncommon after stroke, subgroups of stroke patients at clearly elevated risk can be identified. Indicators of enhanced risk for suicide include not only clinical but also socioeconomic factors,” Eriksson and colleagues wrote. “In high-risk groups, there is reason to explore suicidal thoughts and behaviors and to specifically consider psychosocial support and suicide preventative interventions.” – by Amanda Oldt

Disclosure: Eriksson reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.