Association between stroke history, depression, and suicidal ideation: National health and nutrition examination survey, 2011-2018.

Objective

Stroke patients often have mental health comorbidities such as depression and suicidal ideation. Stroke is a leading cause of long-term disability and is associated with increased risk of death, with mental illness playing a large role in this relationship. However, the impact of stroke on suicidal ideation among individuals with co-morbid depression is not well understood. We aim to determine if stroke in combination with depression was associated with a higher prevalence and severity of suicidal ideation.

Methods

We performed a retrospective cross-sectional study using data from the National Health and Nutrition Examination Survey, 2011-2018. All respondents were divided into four mutually exclusive categories based on their diagnosis of stroke and depression. Weighted prevalence estimates and 95% confidence intervals (CI) were reported across clinical and demographic categories. Multivariable logistic regression models were used to identify the independent association between stroke, depression, and suicidal ideation. Adjusted odds ratios (AOR) and a p-value of < 0.05 were used to determine statistical significance.

Results

The analytic sample included 19,397 participants, of whom 863 (4%) had a history of stroke. Depression was present in 154 (0.7%) participants with stroke and 2709 (11.6%) participants without stroke. The mean age of participants with stroke and depression was 59 years. This group was more likely to be female (64%), non-Hispanic White (67.7%), have more than a high school education (38.9%), and be overrepresented among those living at or below the federal poverty level (69.8%). Stroke was independently associated with an increased risk of suicidal ideation in those with depression (adjusted odds ratio [AOR] = 1.86; 95% CI: 1.21-2.85; p = 0.005) when compared to those with depression but without stroke. Living at or below the poverty level was also independently associated with increased suicidality risk (AOR = 1.39; 95% CI: 1.11-1.74; p = 0.005).

Conclusion

A history of stroke was found to significantly increase the odds of suicidal ideation in those with depression. These findings can help inform better integrative screening and treatment of mental health among stroke patients, especially those with co-morbid depression.