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

Authors Chang CH, Chen SJ, Liu CY, Tsai HC

Received 19 November 2017

Accepted for publication 21 December 2017

Published 7 February 2018 Volume 2018:14 Pages 443—450

DOI https://doi.org/10.2147/NDT.S157494

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Prof. Dr. Roumen Kirov

Peer reviewer comments 2

Editor who approved publication: Professor Wai Kwong Tang

Chun-Hung Chang,1,2 Shaw-Ji Chen,3,4 Chieh-Yu Liu,5 Hsin-Chi Tsai6,7

1Brain Disease Research Center, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; 2Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; 3Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan; 4Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; 5Biostatistical Consulting Lab, Institute of Nursing-Midwifery, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 6Department of Psychiatry, Tzu-Chi General Hospital, Hualien, Taiwan; 7Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan

Purpose:
The purpose of this study was to investigate the incidence and risk of suicidal drug overdose (SDO) after stroke in older patients.
Methods: We 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.
Results: We 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.
Conclusion: Clinicians 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.

Keywords: stroke, older people, suicidal drug overdose

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