No Increase in Suicide Risk Among Cardiopathic Patients

The association between heart diseases and suicide: a nationwide cohort study

OBJECTIVE

To assess the association between specific heart diseases and suicide.

DESIGN

Nationwide retrospective cohort study.

PARTICIPANTS

A total of 7 298 002 individuals (3 640 632 males and 3 657 370 females) aged ≥15 years and living in Denmark during 1980-2016.

MAIN OUTCOME MEASURES

Incidence rate ratios (IRR) with 95% confidence intervals. In multivariate analysis, we adjust for sex, period, age group, living status, income level, Charlson Comorbidity Index, psychiatric disorders prior to heart disease and self-harm prior to heart disease.

RESULTS

Excess suicide rate ratios were found for following disorders: heart failure (IRR: 1.48; 95% CI: 1.38-1.58); cardiomyopathy (IRR: 1.41; 95% CI: 1.16-1.70); acute myocardial infarction (IRR: 1.28; 95% CI: 1.21-1.36); cardiac arrest with successful resuscitation (IRR: 4.75; 95% CI: 3.57-6.33); atrial fibrillation and flutter (IRR: 1.42; 95% CI: 1.32-1.52); angina pectoris (IRR: 1.19; 95% CI: 1.12-1.26); and ventricular tachycardia (IRR: 1.53; 95% CI: 1.20-1.94). A higher rate of suicide was noted during the first 6 months after the diagnosis of heart failure (IRR: 2.38; 95% CI: 2.04-2.79); acute myocardial infarction (IRR: 2.24; 95% CI: 1.89-2.66); atrial fibrillation and flutter (IRR: 2.70; 95% CI: 2.30-3.18); and angina pectoris (IRR: 1.83; 95% CI: 1.53-2.19) when compared to later.

CONCLUSION

Several specific disorders were found to be associated with elevated rates of suicide. Additionally, we found temporal associations with higher suicide rates in the first time after diagnosis. Our results underscore the importance of being attentive towards psychological distress in individuals with heart disease.

Suicide deaths by intentional self-poisoning in people with cardiovascular disease

OBJECTIVE

We aimed to characterize self-poisoning deaths in people with cardiovascular disease (CVD) and compare to other suicide decedent groups.

METHODS

Suicide deaths by self-poisoning in people with CVD (n = 151) were compared to suicide deaths by other methods in people with CVD (n = 260) and suicide deaths by self-poisoning in people without CVD (n = 509). Sub-analysis of the CVD self-poisoning group compared people with depression and without depression. Toxicology reports were compared between intentional self-poisoning groups.

RESULTS

A higher proportion of suicide deaths were due to self-poisoning in the CVD group compared to the non-CVD group. People with CVD were less likely to have any identified stressor (excluding medical stressor) prior to dying from self-poisoning compared to those without CVD. Female sex, past suicide attempts, living circumstances, and comorbid substance abuse were each significantly associated with self-poisoning as the method of suicide in people with CVD. Opioid, any antidepressants, benzodiazepines, and tricyclic antidepressants (TCAs) were commonly identified as lethal in people with CVD. Compared to people in the CVD self-poisoning without depression group, people in the CVD self-poisoning with depression group were more likely to have lethal levels of TCAs.

CONCLUSIONS

Our findings characterize suicide deaths in people with CVD, and identified notable differences based on method of death and presence of depression.

Suicidal ideation among adults with cardiovascular disease: The National Health and Nutrition Examination Survey

OBJECTIVE

Previous studies have shown a possible link between cardiovascular disease (CVD) and suicidal ideation (SI). However, limited information exists regarding the association between different subtypes of CVD and SI and the role of depression.

METHODS

Data were used from the National Health and Nutrition Examination Survey for cycles 2009-2010 and 2011-2012. SI was assessed by item 9 of the Patient Health Questionnaire 9. Data regarding sociodemographic factors, and comorbid conditions were collected and examined as potential correlates. Logistic regression analyses were used to examine the relationship between CVD and subtypes and suicidal ideation.

RESULTS

Among a total of 11,678 participants, suicidal ideation was significantly higher among patients with CVD compared to participants without a history of CVD (5.4% vs 3.6%, P<0.001). A subset of patients with CVD with a history of congestive heart failure (CHF) and prior myocardial infarction (MI) had the highest percentage of SI (10.6%). The association between CVD and SI remained significant after adjusting for baseline characteristics and associated comorbidities including depression (OR 1.40, 95% CI 1.10-2.09, P=0.006).

CONCLUSION

CVD is an independent risk factor for SI. The identification of a subset of patients with CVD at greatest risk of SI underlines the importance of screening in this vulnerable population.

Suicide in males and females with cardiovascular disease and comorbid depression

BACKGROUND

Myocardial infarction (MI) has been associated with an increased risk of suicide, further increased among individuals with a comorbid psychiatric illness. A paucity of studies have examined details of suicide among individuals with cardiovascular disease (CVD) and comorbid depression. We aimed to compare demographic, clinical and suicide-specific characteristics between suicide victims with CVD with depression (CVD+D) and without comorbid depression (CVD-D).

METHODS

Coroner data on suicide decedents with CVD (n=413) occurring in Toronto, Canada from 1998 to 2012 were collected. Characteristics were compared between the CVD+D and CVD-D groups. Regression analysis examined for gender differences in these groups.

RESULTS

CVD+D subjects compared to CVD-D were more likely to have had a past suicide attempt (p=0.008), and to have experienced a bereavement (p=0.008) or financial stressor (p=0.005) in the past year. Each of these variables remained significantly associated with the presence of depression after the regression analysis. Within the CVD+D group, females were more likely to die from suicide by self-poisoning (p<0.0001) and males by shooting (p=0.001).

LIMITATIONS

Psychological autopsies were not available. The definition of CVD was broad and the accuracy of its diagnosis could not be confirmed.

CONCLUSION

Individuals with CVD+D who died from suicide had significant differences in clinical characteristics and specific stressors compared to those without depression. These data may help to better characterize suicide risk and prevention in this vulnerable population.

Risk of suicide and suicide attempts associated with physical disorders: a population-based, balancing score-matched analysis

BACKGROUND

The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders.

METHOD

Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3:1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1-90, 91-364, ⩾ 365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923).

RESULTS

Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03-1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71-9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73).

CONCLUSIONS

People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.