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Suicide in Stroke Survivors: Epidemiology and Prevention

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Abstract

Stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; however, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases suicide risk, especially among women and younger patients. The aim of the current review is to investigate the relationship between suicide and stroke in order to determine which stroke patients are at elevated risk for suicide. Moreover, we review the literature in order to provide pharmacological treatment strategies for stroke patients at high risk of suicide. We performed a careful search to identify articles and book chapters focused on this issue, selecting only English-language articles published from 1990 to 2014 that addressed the issue of suicide after stroke and its pharmacological management. We found 12 clinical trials that explored the relationship between stroke and suicidal ideation and/or suicidal plans and 11 investigating suicide as the cause of death after stroke. We identified stroke as a significant risk factor for both suicide and suicidal ideation, especially among younger adult depressed patients in all articles, providing further support for the association between post-stroke and suicidality. Suicide risk is particularly high in the first 5 years following stroke. Depression, previous mood disorder, prior history of stroke, and cognitive impairment were found to be the most important risk factors for suicide. Selective serotonin reuptake inhibitors (SSRIs) represent the treatment of choice for stroke survivors with suicide risk, and studies in rats have suggested that carbolithium is a promising treatment in these patients. Early identification and treatment of post-stroke depression may significantly reduce suicide risk in stroke patients.

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Conflict of Interest

Professor Pompili, Dr. Venturini, Dr. Lamis, Dr. Giordano, Dr. Belvederi Murri, Dr. Serafini, Professor Amore, and Professor Girardi have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 1035-1039, Via di Grottarossa, 00189, Rome, Italy

    Maurizio Pompili, Paola Venturini, Gloria Giordano & Paolo Girardi

  2. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Dorian A. Lamis

  3. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Genoa, Italy

    Gianluca Serafini, Martino Belvederi Murri & Mario Amore

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  1. Maurizio Pompili
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  2. Paola Venturini
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  3. Dorian A. Lamis
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  4. Gloria Giordano
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Correspondence to Maurizio Pompili.

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Pompili, M., Venturini, P., Lamis, D.A. et al. Suicide in Stroke Survivors: Epidemiology and Prevention. Drugs Aging 32, 21–29 (2015). https://doi.org/10.1007/s40266-014-0233-x

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  • DOI: https://doi.org/10.1007/s40266-014-0233-x

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