Jae Woo Choi1, Sang Gyu Lee2, Tae Hyun Kim3, Euna Han1. 1. College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea. 2. Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea. 3. Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea.
Abstract
OBJECTIVES: The present study evaluated suicide risk within 1 year after discharge among older adults with stroke as a function of depression onset. METHOD: We used the Korean National Health Insurance Service-Senior cohort data and included first discharged patients with a stroke as the principal diagnosis. The comparison group was selected by a 1:2 case-control propensity score matching for age, sex, Charlson comorbidity index, and diagnosis year between 2005 and 2012. Suicide deaths were measured by code for causes of death from Statistics Korea, and the main outcome was suicide death within 1 year following discharge. An adjusted hazard ratio (AHR) of suicidal risk was measured using a Cox proportional hazard model. RESULTS: In the total sample of 128 286 older adults (aged 63-114 years), the higher suicidal risk was examined for stroke patients vs the comparison group (AHR = 1.4; 95% confidence interval [CI], 1.1-1.8). Stroke patients with depression had an increased suicide risk (AHR = 2.9; 95% CI, 1.8-4.8) but only for poststroke depression (AHR = 4.1; 95% CI, 1.8-9.5). Pre and poststroke depression suicidality (AHR = 4.8; 95% CI, 2.1-11.1) was also higher when compared to stroke patients without depression. CONCLUSIONS: Poststroke patients are at increased suicidal risk during 1 year following discharge. Furthermore, patients who were diagnosed with depression after a stroke are more likely to commit suicide than stroke patients without depression. This suggests a necessity for early suicide preventive intervention for stroke patients while considering depressive symptomology.
OBJECTIVES: The present study evaluated suicide risk within 1 year after discharge among older adults with stroke as a function of depression onset. METHOD: We used the Korean National Health Insurance Service-Senior cohort data and included first discharged patients with a stroke as the principal diagnosis. The comparison group was selected by a 1:2 case-control propensity score matching for age, sex, Charlson comorbidity index, and diagnosis year between 2005 and 2012. Suicide deaths were measured by code for causes of death from Statistics Korea, and the main outcome was suicide death within 1 year following discharge. An adjusted hazard ratio (AHR) of suicidal risk was measured using a Cox proportional hazard model. RESULTS: In the total sample of 128 286 older adults (aged 63-114 years), the higher suicidal risk was examined for strokepatients vs the comparison group (AHR = 1.4; 95% confidence interval [CI], 1.1-1.8). Strokepatients with depression had an increased suicide risk (AHR = 2.9; 95% CI, 1.8-4.8) but only for poststroke depression (AHR = 4.1; 95% CI, 1.8-9.5). Pre and poststroke depression suicidality (AHR = 4.8; 95% CI, 2.1-11.1) was also higher when compared to strokepatients without depression. CONCLUSIONS: Poststroke patients are at increased suicidal risk during 1 year following discharge. Furthermore, patients who were diagnosed with depression after a stroke are more likely to commit suicide than strokepatients without depression. This suggests a necessity for early suicide preventive intervention for strokepatients while considering depressive symptomology.