Meta-analysis of risk factors associated with suicidal ideation after stroke: A focus on Asian populations
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
... ent 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 = 2693036) were included for meta-analyses. Of these studies, 7 reported 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 men, 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, alcohol consumption, low family income, depression, heart disease and sleep disorders were the important risk factors for the pathogenesis of suicide after stroke. When compared to PSS more than one year, the incidence of suicide within one year after stroke was more likely to be statistically significant. It was found that 4 out of every 1,000 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 Despite some limitations, we successfully identified the prevalence of PSS in Asian populations and the underlying risk factors. Based on the results of this meta-analysis, 4 out of every 1,000 stroke survivors committed suicide and the individuals with suicidal ideation tended to suicide within one year after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. In addition, stroke survivors with low household income had nearly double the risk of suicidal ideation, especially in Asian populations. Hence, targeting the identified risk factors may be helpful to improve stroke patient care and prevent suicidal ideation after stroke.(Registration No. CRD42019128813).