Strokes can be disabling, leaving survivors to confront many challenges during their recovery. Now, a new Asian study shows survivors are at higher risk for attempting suicide, especially if they are younger, less affluent and have a physically demanding job.
Researchers analyzed data from more than 2 million people in Taiwan between 2000 and 2010. They found that by the end of 2011, stroke patients were more than twice as likely to have attempted suicide as people who had not had a stroke.
The findings, published Wednesday in the Journal of the American Heart Association, mirror results of similar studies on Western populations.
The new study is significant because it is one of the few that focuses on the connection between stroke and suicide attempts in Asia, according to neurologist Dr. Bruce Ovbiagele, professor and chairman of neurology at the Medical University of South Carolina, who was not involved in the study.
The study found that 1,925 people—or 0.13 percent—of the more than 1.4 million Taiwanese who didn't have a stroke attempted suicide. That compared to suicide attempts among 2,140, or 0.3 percent, of 713,690 stroke patients.
Ovbiagele noted, however, that one of the study's weaknesses is that it doesn't discuss the severity of the strokes.
Among stroke patients overall, suicide attempts were more common among people who had their stroke before age 50, manual laborers and those earning a low income.
The high cost of recovering from a stroke may explain why low-income workers would be more likely to attempt suicide, according to the study.
"Health-related rehabilitation services are often insufficiently funded and provided in many respects, particularly in Asian and developing societies," the researchers wrote.
Ovbiagele said many stroke patients have lingering physical or psychological effects, which might especially depress a manual laborer who couldn't continue to work or a younger person facing a lifetime of limitations.
Doctors also aren't sure whether the stroke itself sets off a physical reaction that can lead patients to become depressed or suicidal.
"The biological mechanism by which individuals with stroke become more prone to depression and suicidal ideation is unclear, but likely involves changes in neurotransmitters, cortisol levels and cerebral blood flow," said Dr. Amytis Towfighi, a vascular neurologist at the University of Southern California's Keck School of Medicine.
"Post-stroke depression is complex and likely involves a combination of biological and psychosocial factors," said Towfighi, who chaired a committee that wrote last year's scientific statement from the American Heart Association about depression after stroke. She was not involved in the new study.
Regardless of the factors at play, post-stroke depression is vastly underdiagnosed, said Ovbiagele, who also coauthored the AHA statement and is chair of the American Stroke Association's International Stroke Conference 2018 program committee.
"The patient or caregiver often has to complain about it or the doctor has to routinely look out for it," he said. "Since a substantial number of stroke patients subsequently develop depression, ideally this would be an important issue for clinicians to think of and address in appropriate patients after a stroke."
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Tomor Harnod et al. Risk of Suicide Attempt in Poststroke Patients: A Population‐Based Cohort Study, Journal of the American Heart Association (2018). DOI: 10.1161/JAHA.117.007830