Abstract
BackgroundBoth apathy and suicide are common in poststroke patients. However, the association between poststroke apathy and suicide-related ideation (SI) in Chinese stroke patients is not clear and poorly understood. The aim of this study was to examine the association between apathy and SI in stroke.MethodsA cross-sectional study was conducted to investigate the association in 518 stroke survivors from Acute Stroke Unit of the Prince of Wales Hospital in Hong Kong. Geriatric Mental State Examination-Version A (GMS) and Neuropsychiatric Inventory-apathy subscale (NPI-apathy) were employed to assess poststroke SI and apathy, respectively. Patients’ clinical characteristics were obtained with the following scales: the National Institutes of Health Stroke Scale (NIHSS), the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale (GDS).ResultsThirty-two (6.2%) stroke survivors reported SI. The SI group had a significantly higher frequency of NPI-apathy than the non-SI group (31.2% vs 5.3%, p < 0.001). The SI group also had higher GDS scores (10.47 ± 3.17 vs 4.24 ± 3.71, p < 0.001). Regression analysis revealed that NPI-apathy (OR 2.955, 95% CI 1.142-7.647, p = 0.025) was a significant predictor of SI. The GDS score also predicted SI (OR 1.436, 95% CI 1.284-1.606, p < 0.001).ConclusionsThe current findings show that poststroke apathy is an independent predictor of SI 3 months after stroke. Early screening for and intervention targeting apathy through medication and psychological treatments may be necessary to improve stroke patients’ apathy and reduce SI.
Highlights
Both apathy and suicide are common in poststroke patients
Patients with spinal cord injuries who committed suicide were significantly more apathetic than their non-suicidal counterparts matched according to age and sex, and apathy was predictive of suicide [18]
Patients excluded from the study had higher National Institutes of Health Stroke Scale (NIHSS) scores (5.01 ± 5.10 vs 3.73 ± 3.55; p < 0.001)
Summary
Both apathy and suicide are common in poststroke patients. The association between poststroke apathy and suicide-related ideation (SI) in Chinese stroke patients is not clear and poorly understood. Apathy is a common neuropsychiatric syndrome following stroke (poststroke apathy) [8,9,10] It is defined as a combination of lack of emotion, interest, concern and motivation [11] manifesting in poor engagement with significant others and in social activities, and loss of pleasure and usual interests [12]. The prevalence of Apathy predicts suicide [18,19] in other disease affecting the central nervous system. Patients with spinal cord injuries who committed suicide were significantly more apathetic than their non-suicidal counterparts matched according to age and sex, and apathy was predictive of suicide [18]. We hypothesized that poststroke apathy would be associated with SI
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