Suicidal drug overdose following stroke in elderly patients: a retrospective population-based cohort study

Abstract

PurposeThe purpose of this study was to investigate the incidence and risk of suicidal drug overdose (SDO) after stroke in older patients.MethodsWe enrolled patients aged 60–99 years who were diagnosed with new-onset stroke between 2002 and 2013 and age-, sex-, and index-year-matched controls who did not have stroke. Patients with a history of SDO before enrollment were excluded. Both groups were observed until December 31, 2013. The primary end point was the occurrence of newly diagnosed SDO. The cumulative incidence rates of the study and control groups were estimated using the Kaplan–Meier method. Furthermore, we used the Cox proportional hazards model to identify risk factors for SDO.ResultsWe selected 22,770 individuals. Among them, 11,385 were older patients (aged 60–99 years) who had newly diagnosed stroke and 11,385 were controls. Of the 22,770 individuals, 275 (1.21%) had SDO during a mean follow-up period of 5.33±3.30 years, comprising 191 (1.68%) from the stroke group and 84 (0.74%) from the control group. Older patients with stroke had a significantly higher risk of SDO than the controls (adjusted hazard ratio: 2.288, 95% confidence interval [CI]: 1.746–2.999, p<0.001). Moreover, in older patients with stroke, the risk significantly increased with the number of stroke events. Patients with depressive disorder or coronary disease had an increased risk of SDO. Additionally, benzodiazepines and anticoagulants were the two most commonly prescribed medications for SDO.ConclusionClinicians should be aware of the risk of SDO and risk factors in older patients with stroke. Psychological assessment and medication monitoring should be incorporated into current clinical diagnoses in neurology and treatments following stroke.

Increased Risks of Suicide Attempt and Suicidal Drug Overdose Following Admission for Head Injury in Patients with Depression

“…SDO is a nonviolent suicide method with a generally lower mortality rate than suicide by violent means. Because of the restricted access to firearms in most Asian countries, Asian patients may find it easier to attempt suicide through the nonviolent method of self-poisoning [26,27]. This study reminds us that self-poisoning with medical substances or tranquilizers is the most accessible method for attempting suicide in patients with depression and head injury.…”

Suicide Attempt and Suicidal Drug Overdose in Chronic Obstructive Pulmonary Disease Patients With or Without Depression

“…However, as a nonviolent method of SA, SDO is frequently noted in Taiwanese patients with COPD and depression. Although more than 95% of the people who attempt SDO could eventually survive in Europe (17), SDO causes considerable burden in Asian countries; hence, SA through SDO should be effectively prevented (18,19). Our results implied that COPD patients could be dangerously abuse prescribed medicines and tranquilizers for attempting suicide through overdose, especially when these patients have comorbid depression.…”

Increasing Risks of Suicide Attempt and Suicidal Drug Overdose After Head Trauma in Patients With Sleep-Disordered Breathing: A Population-Based Study

“…Fortunately, in Europe, more than 95% of people who attempt SDO would eventually survive ( 2 ). Although SDO is a non-violent suicidal method with a low mortality risk than the suicides through violent means, SA with SDO should be effectively prevented before a patient even attempts it, especially in Asian countries ( 15 , 16 ). This study evidenced the proportional increases in the risks of SA and SDO in the SDB and SBI cohorts.…”