Abstract P237: Stroke Survivors and Suicide: A Systematic Review and Meta-Analysis

Abstract

Background: People with neurological conditions are at a higher risk of suicide compared to the general population. Despite the known association of stroke with depression and suicidal ideation, it is unclear if stroke is associated with a higher risk of suicide. Methods: We systematically searched MEDLINE, Embase, PsycINFO, and Google Scholar from their inception to July 26, 2020 using keywords and database-specific subject. We independently adjudicated and selected observational studies that compared the risk of suicide in stroke survivors to a comparison group, consisting either of people without history of stroke or the general population. We evaluated study quality using the Newcastle Ottawa scale. Using random effects meta-analysis, we calculated the pooled adjusted risk ratio (RR) of suicide in stroke survivors, and separately calculated the pooled adjusted RR of death by suicide and suicide attempt. Using prespecified analyses, we explored study-level factors to explain heterogeneity. Results: We screened 4023 articles and included 23 studies, of fair quality, totaling over 2 million stroke survivors, of whom 5563 committed suicide. Compared to the non-stroke group, the pooled adjusted RR of suicide in stroke survivors was 1.73 (95% confidence interval, 1.54-1.95, I 2 = 93%), with a significantly (P=0.03) higher adjusted risk of suicide attempt (RR 2.09, 1.69-2.58) than of death by suicide (RR 1.61, 1.44-1.80). Observed heterogeneity could not be explained by pre-specified meta-regression and subgroup analyses. Conclusions: Stroke should be recognized as an independent risk factor for suicide. Comprehensive strategies to screen and treat depression and suicidal ideation in stroke survivors should be developed to reduce the burden of suicide in stroke survivors.