Poststroke suicide attempts and completed suicides: a socioeconomic and nationwide perspective

Abstract

Objective: We examined attempted and completed suicides after stroke to determine whether they were associated with socioeconomic status, other patient characteristics, or time after stroke.

Methods: This nationwide cohort study included stroke patients from Riksstroke (the Swedish Stroke Register) from 2001 to 2012. We used personal identification numbers to link the Riksstroke data with other national registers. Suicide attempts were identified by a record of hospital admission for intentional self-harm (ICD-10: X60-X84), and completed suicides were identified in the national Cause of Death Register. We used multiple Cox regression to analyze time from stroke onset to first suicide attempt.

Results: We observed 220,336 stroke patients with a total follow-up time of 860,713 person-years. During follow-up, there were 1,217 suicide attempts, of which 260 were fatal. This was approximately double the rate of the general Swedish population. Patients with lower education or income (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.11-1.68) for primary vs university and patients living alone (HR 1.73, 95% CI 1.52-1.97) had an increased risk of attempted suicide, and patients born outside of Europe had a lower risk compared to patients of European origin. Male sex, young age, severe stroke, and poststroke depression were other factors associated with an increased risk of attempted suicide after stroke. The risk was highest during the first 2 years after stroke.

Conclusions: Both clinical and socioeconomic factors increase the risk of poststroke suicide attempts. This suggests a need for psychosocial support and suicide preventive interventions in high-risk groups of stroke patients.

Figure 1. Proportion of patients attempting suicide after stroke

Estimated proportion of stroke patients attempting suicide (Cox survival regression). Cumulative number of events and number of patients at risk at 0, 1, 3, 5, and 10 years after stroke in different age groups.

Figure 2. Suicide incidence 1 year after stroke compared to the general Swedish population

Incidence of complete suicides 1 year after stroke per 100,000 person-years in men and women and different age groups compared to the general Swedish population, 2001–2011.