Abstract 32: Post Stroke Suicide In Georgia, 2011-2018: Identifying High Risk Groups

Abstract

Background: Disability can impact stroke survivors’ quality of life and mental health and may lead to suicide. Identifying and treating people at risk is one of the strategies listed by the Centers for Disease Control and Prevention to reduce suicide. The objectives of this study were to estimate the burden of suicide among stroke survivors in Georgia, identify predisposing factors, determine when patients are more likely to die of suicide, and examine suicide circumstances. Methods: Clinically diagnosed ischemic stroke (IS) patients from the Georgia Coverdell Acute Stroke Registry were linked with the Georgia Violent Death Reporting System (GVDRS) and death data for a retrospective cohort study. We applied survival analysis to estimate the annual suicide rate and cox proportional hazard model to identify high risk groups for suicide among stroke survivors. For those who died by suicide, circumstances were analyzed descriptively. Results: A total of 68,122 IS patients, from 2011 to 2018, were included. The median follow-up period was 40 months, and 70 suicide deaths were observed with a suicide rate of 28.3/100,000 person-years. About two-thirds of the suicides happened within 2 years of the stroke incident. Whites (HR=3.4), males (HR=10.8), young adults (HR=2.8), patients with depression (HR=3.8), and those who left hospitals against medical advice (HR=5.6) were more likely to die by suicide compared to blacks, females, older adults, patients without depression, and those who were discharged home respectively. Depression was reported in 36% of deaths, of which 25% had a past medical history of depression at hospital admission for stroke or were discharged with an antidepressant prescription. Firearms were used in 86.4% of the suicides. Conclusion: Ischemic stroke survivors have a 30% higher risk of death by suicide compared to the general Georgia population. This increased risk is mainly among males, patients with depression, and those who left hospitals against medical advice. More than four out of five suicides are by firearm; therefore, it is reasonable to make screening for suicide and counseling on firearm safety for patients and caregivers be a part of the discharge process and post discharge follow-up.