Research report
Suicide after a stroke: a population study
T W Teasdalea, A W Engbergb
a Department of
Psychology, University of Copenhagen, Njalsgade 88, 2300 Copenhagen S,
Denmark, b Centre for
Medicine, Division of Stroke. Hvidovre University Hospital, Denmark
Correspondence to: Dr Teasdale (teasdale{at}psy.ku.dk)
Accepted for publication 30 May 2001
STUDY OBJECTIVE
To
establish whether there are increased rates of suicide after a stroke
and the degree to which any increase is related to gender, age at
stroke, diagnosis, duration of hospitalisation, and time since stroke.
DESIGNCross linkage
of national registers for hospitalisations and causes of death.
SETTINGThe population
of Denmark, 1979-1993.
PATIENTSA study
cohort was defined comprising all 114 098 stroke patients discharged
alive from hospital during the period 1979-1993. These patients were
then screened in a register of causes of death over the same time
period, and 359 cases of suicide were identified.
MAIN RESULTSAnnual
incidence rates, both observed and expected, together with standardised
mortality ratios (SMR) were computed based on annual population and
suicide statistics, stratified by age and gender. The overall annual
incidence rate of suicide in the cohort was 83 per 100 000 per year
compared with an expected figure of 45 (difference = 38, 95% CI = 27, 49). Correspondingly, SMR were increased for stroke patients. Across
all age bands the SMR for mens was 1.88 (95%CI 1.66, 2.13) and for
women 1.78 (1.48, 2.14). SMR were greatest (2.85; 2.17, 3.76) for
patients under 50 years of age group and were least for patients 80 years or older (1.3; 0.95, 1.79). There was no clear relation to stroke diagnosis. Suicides were negatively related to duration of
hospitalisation, being lowest for those hospitalised for more than
three months (0.88; 0.65, 1.19) and highest for those hospitalised for
less than two weeks (2.32; 1.92, 2.80). Survival analysis suggested that the risk for suicide is greatest up to about five years after a stroke.
CONCLUSIONSStroke
patients are at an approximately doubled risk for suicide. This risk is
greater among younger patients and among patients hospitalised for a
relatively shorter time. The risk appears to decline with time after a
stroke, being greatest within the first five years.
Keywords: suicide; stroke
© 2001 by Journal of Epidemiology and Community Health
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