Acute Coronary Syndrome Patients Demonstrate Higher Risk of Suicide

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The risk of suicide is higher in in patients with acute coronary syndrome compared with healthy individuals.
The risk of suicide is higher in in patients with acute coronary syndrome compared with healthy individuals.

The risk of suicide is increased in patients with acute coronary syndrome (ACS) compared with healthy individuals, according to results from a case-referent study published in the Journal of the American Heart Association.1

The researchers identified 41,050 individuals who committed suicide between 2000 and 2012 using the National Mortality Registry dataset maintained by the Department of Health of Taiwan. A referent group of 164,200 individuals was randomly matched to the cases of completed suicide by age, sex, and area of residence at a ratio of 1:4. In both the case and referent groups, there were 68.5% men and 31.5% women.

Among individuals in the case and referent groups, 1027 (2.5%) and 2412 (1.5%) had ACS. The prevalence of ACS was significant higher among those who committed suicide (odds ratio [OR]: 1.75; 95% confidence interval [CI], 1.62-1.88, P = .0022). After multivariable conditional logistic regression analyses took into account sex, age, and area of residency, the adjusted OR (aOR) decreased but remained significant (aOR: 1.15; 95% CI 1.05-1.26, P <.05.)

Those who were single, separated, divorced, or widowed were also at a higher risk of suicide.

The higher odds of suicide for patients with ACS continued to persist during all follow-up periods, but were especially elevated at time of initial diagnosis or between 0 and 6 months after hospital discharge (OR: 3.05; 95% CI, 2.55-3.65). In addition, the researchers observed a higher odds of suicide in patients who had more than 20 outpatient visits (aOR: 1.43; 95% CI, 1.36-1.51), more than 5 hospital admissions (aOR: 2.55; 95% CI, 2.21-2.94), and any emergency room visit (aOR: 3.08; 95% CI, 2.99-3.17).

In terms of other major comorbidities, cancer and chronic kidney disease were also associated with higher odds of suicide (aOR: 1.85; 95% CI, 1.74-1.96 and aOR: 1.24; 95% CI, 1.12-1.36, respectively). However, hypertension and dyslipidemia were associated with lower odds after multivariable conditional logistic regression analyses. Finally, patients with mood and psychotic-related disorders were at the highest odds of suicide among various psychiatric disorders.

Previous studies2-4 have reported an increased risk of suicide following myocardial infarction (MI)—even with or without psychiatric illnesses.

“Although integrating management of depression with cardiac rehabilitation makes good clinical sense, there is still enough evidence lacking on the effective identification and treatment of depression following MI,” the researchers concluded.

Future research should evaluate larger samples to confirm best practices in managing mental illness, particularly depression, to improve outcomes in patients with ACS.

Study Limitations

  • As all diagnoses, including suicide, were confirmed via administrative claims data, misclassification is possible.
  • Potential bias may exist because of unmeasured or unknown confounders.
  • This was a single-country study which limits the generalizability of the findings.
  • Event-free survival was not measured.
  • Data are retrospective and observational, and the relative effect size was small.

References

  1. Liu C-H, Yeh M-K, Wang J-H, Weng S-C, Bai M-Y, Chang J-C. Acute coronary syndrome and suicide: a case-referent study. J Amer Heart Assoc. 2016. doi:10.1161/JAHA.116.003998.
  2. Kishi Y, Robinson RG, Kosier JT. Suicidal ideation among patients with acute life-threatening physical illness: patients with stroke, traumatic brain injury, myocardial infarction, and spinal cord injury. Psychosomatics. 2001;42:382-390.
  3. Gradus JL, Qin P, Lincoln AK, et al. Acute stress reaction and completed suicide. Int J Epidemiol. 2010;39:1478-1484.
  4. Larsen KK, Agerbo E, Christensen B, Sondergaard J, Vestergaard M. Myocardial infarction and risk of suicide: a population-based case-control study. Circulation. 2010;122:2388-2393.
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