Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis.
A better understanding of the epidemiological impact of suicidal ideation after stroke is required to identify subjects needing personalised interventions.



The aim of this meta-analysis was to estimate rates and correlates of suicidal ideation among stroke survivors.



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.



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).



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.
Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
Francesco
F
Bartoli
Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy.
Maurizio
M
Pompili
Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
Nicoletta
N
Lillia
Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
Cristina
C
Crocamo
Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
Giuseppe
G
Salemi
Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
Massimo
M
Clerici
Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.|Division of Psychiatry, University College London, London, UK.
Giuseppe
G
Carrà
D000368:Aged; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016017:Odds Ratio; D012008:Recurrence; D013223:Statistics as Topic; D020521:Stroke / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D017741:Survivors / Q000523:psychology*
DEPRESSION; EPIDEMIOLOGY; META-ANALYSIS; STROKE; SUICIDAL IDEATION