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

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.