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Tanji F, Iwasawa A. Association of Suicidal Ideation With Physical Health Conditions, Mental Health Conditions, and Multimorbidity and the Modifying Role of Emotional Social Support: A Cross-Sectional Study in Japan. J Prim Care Community Health 2024; 15:21501319241277112. [PMID: 39238263 PMCID: PMC11378242 DOI: 10.1177/21501319241277112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION It is unclear whether the risk of suicide differs among individuals with only physical health condition, those with only mental health conditions, and those with both types of conditions (multimorbidity) and how emotional social support modifies these associations. This study aimed to examine differences in the association of suicidal ideation with the presence of only physical health conditions, only mental health conditions, and multimorbidity and the modifying role of emotional social support in these associations. METHODS A cross-sectional survey was conducted between August and September 2023 in a Japanese rural town to collect data. The exposure variable was the health condition, and it was classified into 4 groups: disease-free, only physical health conditions, only mental health conditions, and multimorbidity. The outcome variable was suicidal ideation. The data collected were analyzed using multivariate logistic regression analysis and stratified analysis. RESULTS Suicidal ideation was found to have a significant positive association with the presence of only mental health conditions and multimorbidity. These associations remained unchanged in the absence of emotional social support. However, the odds ratio for the only mental health conditions group decreased in the presence of emotional social support, while the odds ratio for the multimorbidity group remained significantly higher. CONCLUSIONS Suicidal ideation is positively associated with the presence of only mental health conditions and multimorbidity, but emotional social support modifies only the association between suicidal ideation and the presence of only mental health conditions. These results suggest that it may be important to identify the type of social support one needs based on one's health condition to prevent suicide.
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Affiliation(s)
- Fumiya Tanji
- Akita University Graduate School of Health Sciences, Akita, Japan
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Atsushi Iwasawa
- Akita University Suicide Prevention Research Center, Akita, Japan
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Huang D, Zhong S, Yan H, Lai S, Lam M, Jia Y. Association between serum zinc levels and suicidal ideation in US adults: A population-based cross-sectional study. J Affect Disord 2023; 329:359-368. [PMID: 36801424 DOI: 10.1016/j.jad.2023.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Evidence suggests that the homeostatic disruption of zinc, copper, and selenium might contribute to the pathophysiology of mental disorders. However, the specific relationship between the serum levels of these trace elements with suicidal ideation remains poorly understood. This study aimed to investigated the association among suicidal ideation on serum levels of zinc, copper, and selenium. METHODS The cross-sectional study was conducted using data from a nationally representative sample of the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Suicidal ideation was assessed using Item #9 of the Patient Health Questionnaire-9 Items. Multivariate regression models and restricted cubic splines were performed and E-value was calculated. RESULTS A total of 4561 participants aged 20 years and older were analyzed, of whom 4.08 % had suicidal ideation. The serum zinc levels were lower in the suicidal ideation group than in the non-suicidal ideation group (P = 0.021). In Crude Model, the serum zinc levels were associated with a higher suicidal ideation risk in the second quartile compared with the highest quartile [odds ratio (OR) = 2.63; 95 % confidence interval (CI): 1.53-4.53]. The association persisted (OR = 2.35; 95 % CI: 1.20-4.58) after full adjustment, with E-value 2.44. A nonlinear relationship was observed between serum zinc levels and suicidal ideation (P = 0.028). No relationship was observed between suicidal ideation and serum copper or selenium levels (all P > 0.05). CONCLUSIONS Decreased serum zinc levels may increase susceptibility to suicidal ideation. Future studies are needed to validate the findings of this study.
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Affiliation(s)
- Dong Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Hong Yan
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Meifong Lam
- Psychiatric service of the Centro Hospitalar Conde de São Januário, Macao 999078, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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Volz M, Ladwig S, Werheid K. Return to work and depressive symptoms in young stroke survivors after six and twelve months: cross-sectional and longitudinal analyses. Top Stroke Rehabil 2023; 30:263-271. [PMID: 35068384 DOI: 10.1080/10749357.2022.2026562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND While depression after stroke is common and stroke prevalence globally increases in working age populations, the role of return-to-work (RTW) in the pathogenesis of post-stroke depression (PSD) remains unclear. This study examined if RTW is linked to PSD within the first year after ischemic stroke, independently from established risk factors. METHOD Stroke survivors (n = 176) in their working age (<65 years) recruited from two rehabilitation clinics were assessed for established risk factors: pre-stroke depression, activities of daily living, stroke severity, cognitive impairment, and social support. RTW and depressive symptoms (Geriatric Depression Scale: GDS-15) were assessed six- and twelve-months post-stroke. Multivariate regression analyses were used to assess the cross-sectional and longitudinal relationship between RTW and GDS-15, while controlling for established PSD risk factors. RESULTS Successful RTW was independently associated with lower GDS-15 at both measurement occasions (p < .05), next to the absence of pre-stroke depression and higher social support. Stroke severity predicted GDS-15 at twelve months. The predictive value of six-months RTW for subsequent depressive symptoms beyond the influence of established risk factors was ß = -1.73 (p = .09). DISCUSSION RTW was independently associated with PSD in young stroke survivors within the first-year post-stroke, and exerted a (marginally significant) effect on subsequent depression. Our study highlights the relevance of RTW for young stroke survivors' PSD, beyond the influence of established risk factors. Further assessments examining to what extent fostering RTW contributes to mental well-being after stroke might be promising for PSD prevention, next to evident beneficial economic effects.
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Affiliation(s)
- Matthias Volz
- Department of Psychology, Universität Kassel, Kassel, Germany
| | - Simon Ladwig
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany.,Clinic of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Katja Werheid
- Department of Psychology, Universität Bielefeld, Bielefeld, Germany
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Kim J, Park EC. Associations of stroke with all-cause and cause-specific mortality: A population-based matched cohort study. J Public Health (Oxf) 2023; 45:66-74. [PMID: 35220438 DOI: 10.1093/pubmed/fdac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the specific associations between stroke and all-cause and cause-specific mortality among Korean adults. METHODS We used data extracted from the Korean National Health Insurance claims database from 2002 to 2013, including information on individuals with or without stroke aged 20 years and older. Patients with intracerebral hemorrhage, ischemic stroke or unspecified stroke were classified as stroke patients, while a reference population matched in terms of sex and age were also selected. The outcomes were all-cause mortality, natural causes of death (i.e. all natural causes, death by stroke and death by other diseases) and suicide. Survival analysis was performed using the Cox proportional hazards model. RESULTS Of the 73 150 eligible participants-including 14 630 stroke patients and 58 520 age- and sex-matched controls-11 121 (15.2%) died during the study period. Of them, 10 513 participants (94.5%) died of natural causes, including 1653 (14.5%) who died due to stroke and 8860 (79.7%) who died due to other diseases. Two hundred and fifty patients (2.2%) died by suicide. Stroke patients showed higher adjusted hazard ratios (HR) for all-cause (HR = 6.48, 95% CI, 3.87-10.86), all-natural-cause (HR = 2.68, 95% CI, 2.53-2.84), stroke (HR = 21.16, 95% CI, 17.49-25.61), other disease (HR = 1.69, 95% CI, 1.58-1.81) and suicide mortality (HR = 3.34, 95% CI, 2.24-4.98) than those without stroke. The effect size of stroke for suicide mortality was greater than that for other causes of mortality (except stroke mortality). CONCLUSIONS Stroke was associated with a higher risk of all-cause, natural cause and suicide mortality; stroke was more strongly associated with risk of suicide mortality than with any mortality for any other causes. From a policy standpoint, these results suggest the need for greater supportive care to prevent unnatural deaths among stroke patients.
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Affiliation(s)
- Juyeong Kim
- Department of Public Health, Sahmyook University, Seoul 01795, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 10711, Republic of Korea
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Muacevic A, Adler JR, Gutlapalli SD, Prakash K, Swarnakari KM, Bai M, Manoharan MP, Raja R, Desai A, Desai DM, Arcia Franchini AP. Poststroke Depression, An Underrated Clinical Dilemma: 2022. Cureus 2022; 14:e32948. [PMID: 36712776 PMCID: PMC9879592 DOI: 10.7759/cureus.32948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
It is known that the majority of patients are prone to develop depression following a stroke. Several biological factors, including the disruption of the hypothalamic and adrenal axis and changes in cortisol and interleukin 6 (IL6), are said to have an essential role in its development. Magnetic resonance imaging (MRI) scans point toward white matter lesions and lacunar infarcts as the primary pathological culprit. People affected by poststroke depression (PSD) are more likely to commit suicide or develop another ischemic event after the initial episode, which can likely increase the mortality related to PSD and stroke. Selective serotonin reuptake inhibitors (SSRIs) are the mainstay of treatment for PSD. However, it has a poor safety profile and is not very productive, making the use of SSRIs controversial, and further studies are required to prove its benefits concerning PSD. This literature review discusses the importance of PSD, how it impacts the quality of life of people affected by stroke, and its treatment.
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Tang WK, Tsoi KKF, Chung CP, Kim JS. Risk of self-harm in post TIA patients: A population-based cohort study. J Psychosom Res 2022; 159:110937. [PMID: 35605442 DOI: 10.1016/j.jpsychores.2022.110937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether individuals who have experienced a transient ischemic attack (TIA) have an increased risk of self-harm behaviors. METHODS In this matched cohort study, we reviewed the electronic health records of all patients admitted for any reason to Hong Kong public hospitals between January 1, 1993, and December 31, 2019. We selected a post-TIA cohort consisting of 37,356 patients and a comparison cohort comprising 37,352 subjects. All participants enrolled in this study were followed up until a diagnosis of self-harm, death from other causes, or the end of 2020, whichever occurred first. Univariate Cox proportional hazards regression models were used to calculate the risk of self-harm since the onset of TIA. RESULTS Throughout the 27-year study period, the number of individuals exhibiting self-harm behavior in the TIA and comparison groups was 1031 (2.76%) and 512 (1.37%), respectively. The TIA group had a higher proportion of subjects with self-harm (χ2 = 178, p < .001). The incidence rates of self-harm were 33.94 and 19.27 per 10,000 person-years in TIA patients and comparators, respectively. Compared with the comparators, the adjusted hazard ratio for self-harm in TIA patients was 1.63 (95% confidence interval, 1.46-1.82). CONCLUSIONS TIA is associated with an increased risk of self-harm. Healthcare professionals should help identify patients at heightened risk and provide efficient and targeted prevention strategies for this population.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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Zhang S, Wang A, Zhu W, Qiu Z, Zhang Z. Meta-analysis of risk factors associated with suicidal ideation after stroke. Ann Gen Psychiatry 2022; 21:1. [PMID: 34986853 PMCID: PMC8734070 DOI: 10.1186/s12991-021-00378-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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).
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Affiliation(s)
- Shuangmei Zhang
- 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
| | - Anrong Wang
- Science and Technology Innovation Center Affiliated To Guangzhou, University of Traditional Chinese Medicine, Guangzhou, 510145, China
| | - Weifeng Zhu
- Department of Neurology, Affiliated Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, 510145, China
| | - Zhaoyang Qiu
- Department of Neurology, First College of Clinical Medicine Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Zhaoxu Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, 100044, China.
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Alias A, Bertrand L, Bisson-Gervais V, Henry M. Suicide in obstructive lung, cardiovascular and oncological disease. Prev Med 2021; 152:106543. [PMID: 34538370 DOI: 10.1016/j.ypmed.2021.106543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
Healthcare institutions face increasing demands stemming from the burden of noncommunicable diseases. The personal, social, financial and societal impact of these diseases are well-documented. However, the mental health concerns and trajectories of patients afflicted by chronic medical diseases have been under-recognized and are under-resourced. Despite that chronic diseases are associated with substantially increased risk of suicide, the medical world has largely failed to properly address suicide in the medically ill. Considering their high prevalence and mortality rate, this review article will highlight the mental health burden and suicide risk in obstructive lung, cardiovascular (including stroke) and oncological disease, in light of relevant data and conceptual models of suicide. Finally, general evidence-based suicide intervention strategies and potential selective adaptation of these strategies to the chronic medically ill patient populations and medical settings will be reviewed.
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Affiliation(s)
- Ali Alias
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Lia Bertrand
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St Joseph's Healthcare Hamilton, West 5(th) Campus, 100 West 5(th) Street, Hamilton, ON L8N 3K7, Canada.
| | - Vanessa Bisson-Gervais
- Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, 5100 de Maisonneuve Blvd. West, Suite 720, Montreal, QC H4A 3T2, Canada; Segal Cancer Centre, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada; Lady-Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada
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Comparative Analysis of Stroke Patients with and without Sequelae: A Cross-Sectional Analysis Using the KOREA National Health and Nutrition Examination Survey (2016-2019). J Clin Med 2021; 10:jcm10184122. [PMID: 34575233 PMCID: PMC8466602 DOI: 10.3390/jcm10184122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: We aimed to evaluate the association between sociodemographic factors and mental health problems and the sequelae of stroke in South Korea by analyzing the annual Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2016 to 2019. (2) Methods: Data were obtained from 32,379 participants who participated in the KNHANES (2016-2019). A total of 567 participants diagnosed with stroke were included in this study. Patients were divided into two groups based on the presence of sequelae: (a) stroke patients with sequelae (n = 227, 40.0%) and (b) stroke patients without sequelae (n = 340, 60.0%). (3) Results: Compared to stroke patients without sequelae, those with sequelae were significantly associated with sex (male, 61.2% vs. 47.6%, p = 0.002), household income (lower half, 78.9% vs. 67.4%, p = 0.005), owning a house (60.4% vs. 68.5%, p = 0.048), marital status (unmarried, 7.05% vs. 1.76%, p < 0.001), depression (13.2% vs. 7.35%, p = 0.045), suicidal ideation (6.17% vs. 3.24%, p = 0.010), and suicide attempts (2.64% vs. 0.88%, p = 0.012). (4) Conclusions: Our study showed that poor sociodemographic factors and mental health problems were significantly associated with sequelae from stroke. Clinical physicians should therefore carefully screen for depression and suicidality in stroke patients with sequelae, especially in those with poor sociodemographic factors.
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Jang J, Jung HS, Kim S, Lee KU. Associations between suicidal ideation and health-related quality of life among community-dwelling stroke survivors: 2013-2017 Korea National Health and Nutrition Examination Survey. Qual Life Res 2021; 31:403-412. [PMID: 34331196 DOI: 10.1007/s11136-021-02960-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The study aimed to identify differences between individuals with stroke and the general population regarding socioeconomic, mental health, and Health-related quality of life (HRQOL) factors, and associations among Suicidal ideation (SI), HRQOL, and mental health. METHODS Data of individuals with stroke (n = 592) and without stroke (n = 23,562) aged 20 or older from the 2013-2017 Korea National Health and Nutrition Examination Survey were analyzed. Chi-square tests examined differences in socioeconomic status, mental health, and HRQOL (EQ-5D) between groups. Independent associations between each EQ-5D dimension and SI were analyzed through multivariable logistic regression. RESULTS Individuals with stroke were more likely to have problems on all EQ-5D dimensions. Significant univariate associations were identified between four EQ-5D dimensions and SI among individuals with stroke. Pain/discomfort (odds ratio [OR] = 1.32; 95% confidence interval [CI], 1.01-1.75, p = 0.048) and anxiety/depression (OR = 4.66; 95% CI, 3.69-5.89, p < .0001) of the EQ-5D were associated with SI when adjusting for all socioeconomic variables; anxiety/depression (OR = 2.80; 95% CI, 2.18-3.60, p < .0001) was the only risk factor for SI after controlling for socioeconomic and mental health variables. CONCLUSION Individuals with stroke showed higher rates for problems on the EQ-5D, SI, and depression compared to the general population. They also demonstrated significant associations between SI and each EQ-5D dimension except physical activity, especially pain/discomfort and depression/anxiety. The study's findings can be referred to when predicting suicide risk in individuals with stroke by analyzing their EQ-5D scores.
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Affiliation(s)
- Jinyoung Jang
- Department of Public Health, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
- The Korean Association of Internal Medicine, Seoul, Republic of Korea
| | - Hyun-Sung Jung
- Department of Public Health, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
- Indoor Environment and Noise Research Division, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Kyoung-Uk Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Kim M, Lee YH. Comparison of Psychological Health Problems between Families Living with Stroke Survivors and the General Population in the Community. Chonnam Med J 2021; 57:118-125. [PMID: 34123739 PMCID: PMC8167444 DOI: 10.4068/cmj.2021.57.2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
This study aimed to identify and assess the differences in psychological health problems between families living with stroke survivors (FwSS) and the general population without stroke families (GwoSF). A total of 4,514 cases of FwSS were selected for analysis from the 2013 Korea Community Health Survey. In order to determine control groups in GwoSF, propensity scores were generated based on the sociodemographic characteristics of age, gender, residential region, marital status, educational level, monthly household income, and employment status. Each FwSS was matched to 3 controls of GwoSF (13,542 controls) using a greedy matching algorithm with 8 to 1 digit matching. After propensity score-matching, the proportion of usual stress (30.2% vs 24.6%), depressive mood (7.1% vs 6.1%), and suicidal ideation (13.0% vs 11.1%) in FwSS were all significantly higher than those in GwoSF (Ps<0.05). Compared to GwoSF, the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for psychological health problems in FwSS were calculated using multiple logistic regression analysis. The aORs for usual stress (aOR 1.32, 95% CI 1.21–1.42), depressive mood (aOR 1.14, 95% CI 0.99–1.31; borderline significance), and suicidal ideation (aOR 1.17, 95% CI 1.05–1.30) were significantly higher among FwSS than GwoSF. Moreover, the psychological health problems of FwSS were more evident in females than in males. This study shows that FwSS have poorer psychological health outcomes than GwoSF with similar sociodemographic characteristics. Community-based strategies and family support programs, especially for female family members of stroke survivors, are essential to improve the psychological health of stroke families.
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Affiliation(s)
- Mina Kim
- Department of Nursing, Graduate School, Chonnam National University, Gwangju, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.,Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
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Vyas MV, Wang JZ, Gao MM, Hackam DG. Association Between Stroke and Subsequent Risk of Suicide: A Systematic Review and Meta-Analysis. Stroke 2021; 52:1460-1464. [PMID: 33691505 DOI: 10.1161/strokeaha.120.032692] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Poor mental health and depression are well-recognized sequelae of stroke; however, the association between stroke and subsequent risk of suicide is unknown. METHODS We systematically searched MEDLINE, Embase, PsycINFO, and Google Scholar from their inception to September 15, 2020, using keywords and database-specific subjects. We independently adjudicated and selected observational studies that reported suicide attempts or death by suicide in stroke survivors and a comparison group, consisting either of people without a 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 suicide attempt and death by suicide. Using prespecified analyses, we explored study-level factors to explain heterogeneity. RESULTS We screened 4093 articles and included 23 studies of fair quality, totaling over 2 million stroke survivors, of whom 5563 attempted suicide or died by suicide. Compared to the nonstroke group, the pooled adjusted RR of suicide in stroke survivors was 1.73 (95% CI, 1.53-1.96, I2=93%), with a significantly (P=0.03) higher adjusted risk of suicide attempt (RR, 2.11 [1.73-2.56]) than of death by suicide (RR, 1.61 [1.41-1.84]). A longer follow-up time in cohort studies was associated with a lower risk of suicide (RR, 0.97 [0.95-0.99] for every 1-year increase). CONCLUSIONS Stroke should be considered as a 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.
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Affiliation(s)
- Manav V Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Canada (M.V.V., J.Z.W., M.M.G.)
| | - Jeffrey Z Wang
- Division of Neurology, Department of Medicine, University of Toronto, Canada (M.V.V., J.Z.W., M.M.G.)
| | - Meah M Gao
- Division of Neurology, Department of Medicine, University of Toronto, Canada (M.V.V., J.Z.W., M.M.G.)
| | - Daniel G Hackam
- Division of Clinical Pharmacology, Department of Medicine, Western University, Canada (D.G.H.)
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Opoku S, Eliason C, Akpalu A. Why Me?: A Qualitative Study on the Experiences of Young Stroke Survivors in the Accra Metropolis of Ghana, West Africa. J Patient Exp 2020; 7:1788-1796. [PMID: 33457644 PMCID: PMC7786678 DOI: 10.1177/2374373520967505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Young stroke survivors are affected gravely when diagnosed with stroke between the ages of 18 to 45 years. The psychological and social effects of young stroke require stringent coping factors geared toward recovery and regeneration of self. A qualitative exploratory design was used to explore coping experiences and purposive sampling technique was employed to recruit 10 participants. Data were collected using tape recorded interviews which lasted between 45 minutes to 1 hour 30 minutes and guided by a semistructured interview guide which was informed by the research objectives and literature review. Thematic content analysis was used to analyze the transcribed data and 6 themes namely: psychological disruption, disruption to social identity, spiritual practices and beliefs, self-determination, support, and herbal medicine were derived. These themes gave insight into how these young stroke victims experienced and coped with physical signs and symptoms which negatively impacted their activities of daily living and resulted in social isolation, fear, anxiety, depression, guilt, and suicidal ideations. Provision of continuity of care for young adults living with stroke is highly recommended.
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Affiliation(s)
- Sussana Opoku
- Department of Nursing, Narh-Bita College, Tema, Ghana
| | | | - Albert Akpalu
- University of Ghana, School of Medical Sciences, Accra, Ghana
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14
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Chen X, Zhang H, Xiao G, Lv C. Prevalence of suicidal ideation among stroke survivors: A systematic review and meta-analysis. Top Stroke Rehabil 2020; 28:545-555. [PMID: 33186090 DOI: 10.1080/10749357.2020.1846933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: The prevalence of suicidal ideation (SI) among stroke survivors has been the subject of several studies, but systematic review data regarding the prevalence of SI among stroke patients are still scarce.Objectives: To estimate the pooled prevalence of SI among stroke survivors.Methods: A comprehensive search strategy was established across the following electronic databases; Web of Science, PubMed, the Cochrane Library, Chinese Wanfang database and Chinese National Knowledge Infrastructure (CNKI). The 95% confidence interval (CI) given in each identified study was used to assess the outcomes. Cochran's Q test and I2 statistic were used to evaluate heterogeneity. The quality of the final evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We calculated the pooled prevalence of SI among stroke survivors before subgroup analysis and meta-regression was used to find the partial source of heterogeneity.Results: Twenty-one studies with a total of 17,189 participants were included in this study and the pooled prevalence of SI among stroke survivors was 12.25% (95%CI: 9.91-15.07%). Substantial heterogeneity was detected in the estimation of prevalence. The evidence was graded as very low for the overall outcome and the single item subgroup, while it was graded as low for the stable scale subgroup.Conclusions: This meta-analysis suggests a high prevalence of SI among stroke survivors. Routine screening of SI after stroke is needed to plan interventions aimed at reducing suicide risk.
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Affiliation(s)
- Xingxing Chen
- International Nursing College, Hainan Medical University, Haikou, Hainan, China
| | - Hua Zhang
- International Nursing College, Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
| | - Gui Xiao
- International Nursing College, Hainan Medical University, Haikou, Hainan, China
| | - Chuanzhu Lv
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
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15
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Choi JW, Lee SG, Kim TH, Han E. Poststroke suicide risk among older adults in South Korea: A retrospective longitudinal cohort study. Int J Geriatr Psychiatry 2020; 35:282-289. [PMID: 31859411 DOI: 10.1002/gps.5245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/24/2019] [Indexed: 11/11/2022]
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.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Sang Gyu Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
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16
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Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol 2019; 17:790-801. [PMID: 30129475 DOI: 10.1016/s1474-4422(18)30233-3] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 01/15/2023]
Abstract
Epidemiological evidence suggests that the incidence of ischaemic stroke in young adults (18-50 years) has increased substantially. These patients have a long life expectancy after stroke, and the costs of long-term care pose huge challenges to health-care systems. Although the current recommendations for treatment of young and old (>50 years) patients with stroke are similar, the optimal management of young adult patients with stroke is unknown. They are usually not included in trials, and specific subanalyses limited to young adult patients with stroke are usually not done, owing to lower incidence of stroke and lower prevalence of vascular risk factors in young adults. Progress has been made in identifying patients with a considerable risk of stroke occurrence, such as those with patent foramen ovale. Future prevention studies might result in a decrease in the incidence of stroke and its sequelae in young adults. The development of guidelines specifically devoted to the management of stroke in young adults will be an important step in achieving this aim.
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17
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Ojagbemi A, Bello T. Tedium vitae in stroke survivors: a comparative cross-sectional study. Top Stroke Rehabil 2019; 26:195-200. [PMID: 30890043 DOI: 10.1080/10749357.2019.1590971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Suicide is best studied by deconstructing the psychological experiences preceding suicidal death. We assessed the characteristics of tedium vitae (feeling tired of life) after first ever stroke in Nigerian survivors. METHODS Using the Schedule for Clinical Assessment in Neuropsychiatry, tedium vitae was assessed in 130 stroke survivors attending rehabilitation in a large Nigerian university hospital. Global cognitive and executive dysfunctions were evaluated, respectively, using the Mini Mental State Examination and the modified Indiana University Token test. All participants had their index stroke 3 to 24 months before recruitment into the study. We also examined a comparative group of 130 age, gender, and education matched apparently normal persons who were unrelated to the stroke survivors. Associations were explored using univariate and multivariate logistic regression analyses. RESULTS Tedium vitae was experienced by 16 (12.3%) stroke survivors compared with 5 (3.9%) in the comparative group (O. R = 3.5, 95% C. I = 1.3-9.9, p = 0.018). Among stroke survivors, those who were retired were more likely to experience tedium vitae (56.2%, p = 0.045). In analyses adjusting for the effect of systemic hypertension, cognitive dysfunction, retirement and marital separation, there was a 3.5-fold increase in the odds of experiencing tedium vitae after surviving a stroke (O. R = 3.5, 95% C. I = 1.1-11.6, p = 0.042). CONCLUSIONS Tedium vitae is a common suicidal experience after stroke and may be among the earliest perceptible pointer to impending poststroke suicide. It is easy to assess and may be less costly to obtain an adequate sample size in studies aiming to understand the phenomenon of suicide in the stroke population.
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Affiliation(s)
- Akin Ojagbemi
- a World Health Organization (WHO) Collaborating Centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine , University of Ibadan , Ibadan , Nigeria
| | - Toyin Bello
- a World Health Organization (WHO) Collaborating Centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine , University of Ibadan , Ibadan , Nigeria
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18
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Tsai CH, Cheng WJ, Muo CH, Lin TL. Fractures as a suicidal behavior risk factor: A nationwide population-based cohort study. Medicine (Baltimore) 2019; 98:e14148. [PMID: 30653150 PMCID: PMC6370150 DOI: 10.1097/md.0000000000014148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study aimed to evaluate the association between fracture history and sequential risk of suicidal behavior.A total of 82,804 patients with fractures and 82,804 control subjects without fractures were matched. The influence of fractures on the risk of suicidal behavior-related hospital visit was analyzed using a Cox proportional hazards model.The overall adjusted hazard ratio (aHR) of suicidal behavior-related hospital visit was 2.21 in fracture cohort. The aHR declined from 2.90 at the 1-year follow-up to 2.00 after 5 years or more. In fracture patients, the risk of suicidal behavior-related hospital visit was higher at age <35 years, with comorbidities of stroke and sleep disorder. Patients with multiple fractures had a 1.69-fold risk.Fractures are an independent risk factor for suicidal behavior. Individuals aged younger than 35 years, with comorbidities of stroke and sleep disorder, and those who have suffered multiple fractures have elevated risk of suicidal behavior among subjects in the fracture group. Furthermore, this increased risk remained even after 5 years had passed since the fracture incident.
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Affiliation(s)
- Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital
- School of Medicine, China Medical University
| | - Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital
- Department of Public Health, China Medical University
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital
- Department of Sports Medicine, China Medical University, Taichung, Taiwan
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19
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Gender-specific factors related to suicidal ideation among community-dwelling stroke survivors: The 2013 Korean Community Health Survey. PLoS One 2018; 13:e0201717. [PMID: 30071085 PMCID: PMC6072110 DOI: 10.1371/journal.pone.0201717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/21/2018] [Indexed: 11/20/2022] Open
Abstract
We assessed gender-specific factors associated with suicidal ideation among community-dwelling stroke survivors. In total, 4,322 stroke survivors who participated in the 2013 Korean Community Health Survey were included in the final analysis. Sociodemographic information, socio-family relationships, health behaviors, health status, and suicidal ideation were assessed using a standardized questionnaire. On fully adjusted analysis, suicidal ideation among males was more common in those who were widowed, rather than married (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.03–2.47), those who rarely contacted neighbors (OR 1.50, 95% CI 1.10–2.06), current smokers (OR 1.54, 95% CI 1.03–2.29), and frequent drinkers (OR 1.54, 95% CI 1.05–2.24). Suicidal ideation among females was more common in older subjects, those with lower monthly household incomes, the unemployed (OR 1.75, 95% CI 1.21–2.53), and housewives/students (OR 1.46, 95% CI 1.06–2.03), those who rarely contacted friends (OR 1.43, 95% CI 1.12–1.82), and diabetics (OR 1.35, 95% CI 1.05–1.73). Perceived persistent high-level stress, depressive mood, poor self-rated health, and a diagnosis of depression were commonly associated with suicidal ideation in both genders. Gender differences should be considered by medical practitioners and community policymakers when seeking to prevent and manage suicidal ideation in stroke survivors.
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20
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Torrisi M, De Cola MC, Buda A, Carioti L, Scaltrito MV, Bramanti P, Manuli A, De Luca R, Calabrò RS. Self-Efficacy, Poststroke Depression, and Rehabilitation Outcomes: Is There a Correlation? J Stroke Cerebrovasc Dis 2018; 27:3208-3211. [PMID: 30078760 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The sudden live changes of stroke survivors may lead to negative psychological and behavioral outcomes, including anxiety and depressive mood, which may compromise the rehabilitation process. Some personality features, such as self-efficacy, could play an important role in mediating the degree of post-stroke depression. Aim of this study is to investigate the possible correlation between specific psychological dimensions, such as poststroke depression and self-efficacy, and rehabilitation outcomes. MATERIALS AND METHODS Thirty-eight patients, affected by stroke, completed a four-hour-daily training lasting up to 8 weeks, including traditional and robotic-assisted physiotherapy. Patients were assessed at admission (T0) and at the end (T1) of the motor training, by means of the Montgomery-Asberg Depression Scale, the General Self-Efficacy Scale, and the Functional Independent Measure. RESULTS We observed a significant T0-T1 difference in MADRS scores in patients with a better functional recovery (t = 5.76; P < .0001) and higher self-efficacy (t = 4.74; P < .001), but no significant T0-T1 difference in individuals without functional recovery (t = 1.21; P = .239) and low self-efficacy (t = 1.72; P = .103). CONCLUSIONS Our study shows that rehabilitation outcomes and self-efficacy may influence mood, but not vice versa. Thus, to potentiate self-efficacy in the rehabilitation setting may help clinicians in obtaining better functional outcomes, including depression reduction.
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Affiliation(s)
| | | | - Antonio Buda
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Luigi Carioti
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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21
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Chang CH, Chen SJ, Liu CY, Tsai HC. Suicidal drug overdose following stroke in elderly patients: a retrospective population-based cohort study. Neuropsychiatr Dis Treat 2018; 14:443-450. [PMID: 29445281 PMCID: PMC5808687 DOI: 10.2147/ndt.s157494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the incidence and risk of suicidal drug overdose (SDO) after stroke in older patients. METHODS We enrolled patients aged 60-99 years who were diagnosed with new-onset stroke between 2002 and 2013 and age-, sex-, and index-year-matched controls who did not have stroke. Patients with a history of SDO before enrollment were excluded. Both groups were observed until December 31, 2013. The primary end point was the occurrence of newly diagnosed SDO. The cumulative incidence rates of the study and control groups were estimated using the Kaplan-Meier method. Furthermore, we used the Cox proportional hazards model to identify risk factors for SDO. RESULTS We selected 22,770 individuals. Among them, 11,385 were older patients (aged 60-99 years) who had newly diagnosed stroke and 11,385 were controls. Of the 22,770 individuals, 275 (1.21%) had SDO during a mean follow-up period of 5.33±3.30 years, comprising 191 (1.68%) from the stroke group and 84 (0.74%) from the control group. Older patients with stroke had a significantly higher risk of SDO than the controls (adjusted hazard ratio: 2.288, 95% confidence interval [CI]: 1.746-2.999, p<0.001). Moreover, in older patients with stroke, the risk significantly increased with the number of stroke events. Patients with depressive disorder or coronary disease had an increased risk of SDO. Additionally, benzodiazepines and anticoagulants were the two most commonly prescribed medications for SDO. CONCLUSION Clinicians should be aware of the risk of SDO and risk factors in older patients with stroke. Psychological assessment and medication monitoring should be incorporated into current clinical diagnoses in neurology and treatments following stroke.
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Affiliation(s)
- Chun-Hung Chang
- Brain Disease Research Center, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Institute of Nursing-Midwifery, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Bartoli F, Pompili M, Lillia N, Crocamo C, Salemi G, Clerici M, Carrà G. Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis. J Neurol Neurosurg Psychiatry 2017; 88:498-504. [PMID: 28331011 DOI: 10.1136/jnnp-2017-315660] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/07/2017] [Accepted: 03/01/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND A better understanding of the epidemiological impact of suicidal ideation after stroke is required to identify subjects needing personalised interventions. OBJECTIVE The aim of this meta-analysis was to estimate rates and correlates of suicidal ideation among stroke survivors. METHODS We searched via Ovid, Medline, Embase and PsycInfo from database inception until August 2016. Predefined outcomes were (1) rates of suicidal ideation based on random-effects pooled proportion and (2) relevant sociodemographic and clinical correlates, using random-effects odds ratio (OR) or standardised mean difference (SMD) for categorical and continuous variables, respectively. RESULTS Fifteen studies and 13 independent samples, accounting for 10 400 subjects, were included in meta-analyses. The pooled proportion of suicidal ideation among stroke survivors was 11.8% (7.4% to 16.2%), with high heterogeneity across studies (I2=97.3%). Current (OR=11.50; p<0.001) and past (OR=6.96; p<0.001) depression, recurrent stroke (OR=1.77; p<0.001), disability (SMD=0.58; p=0.01) and cognitive impairment (SMD=-0.22; p=0.03) were all associated with suicidal ideation. Moreover, suicidal ideation was less likely in stroke survivors who were married (OR=0.63; p<0.001), employed (OR=0.57; p=0.02) and had higher education levels (OR=0.55; p=0.002). CONCLUSION Despite some limitations, this meta-analysis shows that about one out of eight stroke survivors has suicidal ideation. Thus, there is enough evidence to support the use of routine screening and early interventions to prevent and treat suicidal ideation after stroke, especially among subjects carrying specific correlates.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Nicoletta Lillia
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Salemi
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Division of Psychiatry, University College London, London, UK
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