Zhang Shuangmei, Wang Anrong, Zhu Weifeng, Qiu Zhaoyang, Zhang Zhaoxu
Department of Rehabilitation, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China.
Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China.
Ann Gen Psychiatry. 2022 Jan 5;21(1):1. doi: 10.1186/s12991-021-00378-8.
Over the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS.
We systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria.
A total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration.
PSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).
在过去十年中，卒中后自杀（PSS）作为卒中的并发症之一，受到了越来越多的关注。卒中和自杀的发生率相对较高，尤其是在亚洲人群中。因此，迫切需要更深入地了解卒中后自杀的患病率及其流行病学影响。PSS的临床诊断和预防尚处于起步阶段，但在疾病的不同阶段导致PSS发生的危险因素仍大多未知。本荟萃分析旨在确定不同阶段和时间进程中PSS的发生率，并识别PSS的潜在危险因素。
我们系统检索了Cochrane图书馆、Embase、PubMed、中国知网和Web of Science数据库，检索时间从各数据库建库至2019年4月。筛选报告PSS危险因素的研究文章并纳入荟萃分析。根据预先设定的标准提取纳入研究的数据。
共纳入12项研究（n = 2,69叁,036）进行荟萃分析。其中，对7项报告自杀患病率的研究进行了荟萃分析。卒中后自杀意念率的合并估计值为12%，其可能受多种危险因素影响，包括性别、吸烟、抑郁、睡眠障碍、既往卒中史和家庭收入低。在亚洲进行的研究显示，与其他地区相比，自杀患病率更高（约15%）。吸烟、家庭收入低、抑郁、心脏病和睡眠障碍是PSS的重要危险因素。与卒中后1年以上的PSS相比，卒中后1年内自杀发生率在统计学上更可能具有显著性。发现每1000名卒中幸存者中有4人倾向于自杀。该荟萃分析结果显示，无论卒中病程如何，抑郁（OR = 2.32；p < 0.01）与自杀意念显著相关。
PSS是卒中的常见并发症之一。尽管存在一些局限性，但我们成功识别了卒中后与自杀意念相关的危险因素。值得注意的是，无论卒中病程如何，抑郁均与自杀意念显著相关。针对这一危险因素可能有助于改善卒中患者的护理，并预防卒中后自杀意念。未来将开展研究，以评估自杀意念或想法以及实际自杀未遂是否能强烈预测卒中后的自杀死亡（注册号：CRD42019128813）。
