Risk of Suicide After Aneurysmal Subarachnoid Hemorrhage: A Nationwide Study.

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-01-15 DOI:10.1212/wnl.0000000000213348

Aleksanteri Asikainen,Miikka Korja,Jaakko Kaprio,Ilari Matias Rautalin

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引用次数: 0

Abstract

BACKGROUND AND OBJECTIVES Although around one-third of survivors of aneurysmal subarachnoid hemorrhage (aSAH) suffer from anxiety and depression, studies focusing on suicide risk after aSAH are lacking. Thus, we aimed to investigate whether survivors of aSAH have an elevated risk of suicide death in comparison with the general population. METHODS Using 2 externally validated nationwide registers (Care Register for Health Care and Cause of Death Register), we identified all ≥15-year-old survivors of aSAH (alive 30 days after hospital admission) in Finland during 1998-2017 and followed these patients until death or the end of 2018. By calculating standardized mortality ratios (SMRs) with 95% CIs using the Mid-P exact test, we compared the observed suicide rates of survivors of aSAH with the expected rates based on the age-matched, sex-matched, and year-matched general Finnish population. RESULTS We identified 5,708 survivors of aSAH (59% female, median age 55 years) of whom 19 (5 female patients and 14 male patients) died by suicide during a total of 53,060 person-years (median 8.9 years) of follow-up. Of all deaths by suicide, 7 were caused by self-poisoning, 6 by hanging/strangulation, 3 by a firearm, 2 by jumping, and 1 by a sharp object. The observed rate of suicide was 35.8 per 100,000 person-years compared with the expected rate of 20.4 per 100,000 person-years resulting in an overall SMR of 1.75 (95% CI 1.09-2.69). The risk of suicide was especially high among 15-39-year-old female and male patients (72.5 per 100,000 person-years; SMR = 3.57 [1.31-7.92]) and during the first year after aSAH (81.2 per 100,000 person-years; SMR = 3.64 [1.16-8.77]), after which the risk attenuated. DISCUSSION Survivors of aSAH are at excessive risk of suicide death in comparison with the general population. Given that this risk seems to be the highest among young individuals and during the first year after aSAH, early assessment and management of psychological distress, especially in young survivors of aSAH may be warranted. Future studies should include detailed individual-level data on psychiatric comorbidities and aSAH-specific factors, as well as record both nonfatal and fatal suicide attempts.

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动脉瘤性蛛网膜下腔出血后的自杀风险：一项全国性研究。

背景和目的虽然动脉瘤性蛛网膜下腔出血（aSAH）的幸存者中约有三分之一患有焦虑和抑郁，但aSAH后的自杀风险研究缺乏。因此，我们的目的是调查aSAH幸存者的自杀死亡风险是否高于一般人群。方法使用2个外部验证的全国登记册（卫生保健护理登记册和死亡原因登记册），我们在1998-2017年期间在芬兰确定所有≥15岁的aSAH幸存者（入院后30天存活），并对这些患者进行随访，直到死亡或2018年底。通过使用Mid-P精确检验计算95% ci的标准化死亡率（SMRs），我们将观察到的aSAH幸存者自杀率与基于年龄匹配、性别匹配和年龄匹配的芬兰普通人群的预期自杀率进行了比较。结果：在53060人年（中位8.9年）的随访期间，我们发现5708例aSAH幸存者（59%为女性，中位年龄55岁），其中19例（5名女性患者和14名男性患者）死于自杀。在所有自杀死亡中，7人死于自毒，6人死于上吊/勒死，3人死于火器，2人跳楼，1人死于尖锐物体。观察到的自杀率为35.8 / 10万人年，而预期的自杀率为20.4 / 10万人年，导致总体SMR为1.75 （95% CI 1.09-2.69）。自杀风险在15-39岁的女性和男性患者中尤其高(每10万人年72.5人；SMR = 3.57[1.31-7.92])和aSAH后第一年(81.2 / 100,000人年；SMR = 3.64[1.16-8.77])，之后风险减弱。讨论与一般人群相比，aSAH的幸存者自杀死亡的风险过高。鉴于这种风险似乎在年轻人中最高，在aSAH后的第一年，早期评估和管理心理困扰，特别是在年轻的aSAH幸存者中，可能是有必要的。未来的研究应该包括详细的精神疾病合并症和asah特异性因素的个人水平数据，以及记录非致命性和致命性自杀企图。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.