title: Poststroke suicide attempts and completed suicides: a socioeconomic and nationwide perspective.
abstract: OBJECTIVE
  We examined attempted and completed suicides after stroke to determine whether they were associated with socioeconomic status, other patient characteristics, or time after stroke.
  
  
  METHODS
  This nationwide cohort study included stroke patients from Riksstroke (the Swedish Stroke Register) from 2001 to 2012. We used personal identification numbers to link the Riksstroke data with other national registers. Suicide attempts were identified by a record of hospital admission for intentional self-harm (ICD-10: X60-X84), and completed suicides were identified in the national Cause of Death Register. We used multiple Cox regression to analyze time from stroke onset to first suicide attempt.
  
  
  RESULTS
  We observed 220,336 stroke patients with a total follow-up time of 860,713 person-years. During follow-up, there were 1,217 suicide attempts, of which 260 were fatal. This was approximately double the rate of the general Swedish population. Patients with lower education or income (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.11-1.68) for primary vs university and patients living alone (HR 1.73, 95% CI 1.52-1.97) had an increased risk of attempted suicide, and patients born outside of Europe had a lower risk compared to patients of European origin. Male sex, young age, severe stroke, and poststroke depression were other factors associated with an increased risk of attempted suicide after stroke. The risk was highest during the first 2 years after stroke.
  
  
  CONCLUSIONS
  Both clinical and socioeconomic factors increase the risk of poststroke suicide attempts. This suggests a need for psychosocial support and suicide preventive interventions in high-risk groups of stroke patients.
authors.affiliation: From the Department of Statistics, USBE (M.E.), and Department of Public Health and Clinical Medicine (E.-L.G., K.A.), Umeå University; and the Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden. marie.eriksson@stat.umu.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Eriksson
authors.affiliation: From the Department of Statistics, USBE (M.E.), and Department of Public Health and Clinical Medicine (E.-L.G., K.A.), Umeå University; and the Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden.
authors.forename: Eva-Lotta
authors.initials: EL
authors.lastname: Glader
authors.affiliation: From the Department of Statistics, USBE (M.E.), and Department of Public Health and Clinical Medicine (E.-L.G., K.A.), Umeå University; and the Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.affiliation: From the Department of Statistics, USBE (M.E.), and Department of Public Health and Clinical Medicine (E.-L.G., K.A.), Umeå University; and the Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Asplund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D012737:Sex Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
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