Increased Suicide Risk in Cardiovascular Disease With Highest Rates in Younger Patients

ischemic stroke
ischemic stroke
Patients with these cardiovascular diseases would benefit from early psychiatric help.

Suicide death rates in patients with cardiovascular diseases (CVD) peak early after diagnosis of acute myocardial infarction (AMI), ischemic stroke (IS), and hemorrhagic stroke (HS), according to the results of a study published in the Journal of Affective Disorders. However, in patients with chronic CVD with congestive heart failure (CHF) and pacemaker implantation (PMI), suicide death rates increase progressively over time.

Furthermore, patients with PMI, CHF, and IS had the highest association with psychiatric illness, while young or middle age patients with PMI had the highest suicide death rate.

Major physical illness increases the risk for depression and suicide. In patients admitted for chronic medical conditions such as diabetes and cancer, 20% to 30% develop an affective disorder. In patients with AMI, depression is common after the event but often goes unrecognized and untreated.

Victor Chien-Chia Wu, MD, of the division of cardiology at Chang Gung Memorial Hospital, Linkou Medical Center, in Taoyuan City, Taiwan, and colleagues used the Taiwan National Health Insurance Research Database (NHIRD) and Taiwan Death Registry (TDR) to retrieve data on patients with 1 of 5 CVDs — AMI, CHF, IS, HS, and PMI — between January 1, 2001 and December 31, 2015. The primary outcome was suicidal death. The investigators used the standardized mortality ratio (SMR) to compare the risk for death by suicide in the 5 CVDs with the general population.

The investigators found 212,206 patients with CHF, 178,894 with AMI, 475,359 with IS, 189,555 with HS, and 64,173 with PMI. Mood disorders were highest in patients with PMI, followed by patients with CHF, IS, AMI, and HS. Depressive disorders were highest in patients with PMI, followed by patients with CHF, IS, HS, and AMI.

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The suicide death rate per 100,000 person years was 59.6 in CHF, 44.6 in AMI, 57.6 in IS, 44.6 in HS, 54.0 in PMI, and 20.3 in the general population. In patients with CVDs, the suicide rate peaked between age 15 and 49, with the highest rate found in patients with PMI. In older patients with CVD, the suicide death rate was nearly half that of the younger age group. In contrast, in the general population the suicide death rate gradually increased with age. Using the SMR to compare risks for suicidal death, patients with CHF had the highest mean SMR, followed by patients with IS, PMI, HS, and AMI.

The investigators concluded that the acute nature of AMI, IS, and HS is associated with suicide death rates that peak early, while the chronic nature of CHF and PMI is associated with progressively increasing suicide death rates. The researchers suggest that these patients would benefit from early psychiatric help.


Wu VC-C, Chang S-H, Kuo C-F, et al. Suicide death rates in patients with cardiovascular diseases — a 15-year nationwide cohort study in Taiwan. J Affect Disord. 2018;238:187-193.