Suicide after a stroke: a population study

Study objective-To establish whether there are increased rates of suicide a fter a stroke and the degree to which any increase is related to gender, ag e at stroke, diagnosis, duration of hospitalisation, and time since stroke. Design-Cross linkage of national registers for hospitalisations and causes of death. Setting The population of Denmark, 1979-1993. Patients-A study cohort was defined comprising all 114098 stroke patients d ischarged alive from hospital during the period 1979-1993. These patients w ere then screened in a register of causes of death over the same time perio d, and 359 cases of suicide were identified. Main results-Annual incidence rates, both observed and expected, together w ith standardised mortality ratios (SMR) were computed based on annual popul ation and suicide statistics, stratified by age and gender. The overall ann ual incidence rate of suicide in the cohort was 83 per 100000 per year comp ared with an expected figure of 45 (difference=38, 95% CI=27, 49). Correspo ndingly, SMR were increased for stroke patients. Across all age bands the S MR for mens was 1.88 (95%CI 1.66, 2.13) and for women 1.78 (1.48, 2.14). SM R 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 t he risk for suicide is greatest up to about five years after a stroke. Conclusions-Stroke patients are at an approximately doubled risk for suicid e. This risk is greater among younger patients and among patients hospitali sed for a relatively shorter time. The risk appears to decline with time af ter a stroke, being greatest within the first five years.