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Research paper
Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis
  1. Francesco Bartoli1,
  2. Maurizio Pompili2,
  3. Nicoletta Lillia3,
  4. Cristina Crocamo1,
  5. Giuseppe Salemi3,
  6. Massimo Clerici1,
  7. Giuseppe Carrà1,4
  1. 1 Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
  2. 2 Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
  3. 3 Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
  4. 4 Division of Psychiatry, University College London, London, UK
  1. Correspondence to Dr Francesco Bartoli, Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy; f.bartoli{at}


Background A better understanding of the epidemiological impact of suicidal ideation after stroke is required to identify subjects needing personalised interventions.

Objective The aim of this meta-analysis was to estimate rates and correlates of suicidal ideation among stroke survivors.

Methods We searched via Ovid, Medline, Embase and PsycInfo from database inception until August 2016. Predefined outcomes were (1) rates of suicidal ideation based on random-effects pooled proportion and (2) relevant sociodemographic and clinical correlates, using random-effects odds ratio (OR) or standardised mean difference (SMD) for categorical and continuous variables, respectively.

Results Fifteen studies and 13 independent samples, accounting for 10 400 subjects, were included in meta-analyses. The pooled proportion of suicidal ideation among stroke survivors was 11.8% (7.4% to 16.2%), with high heterogeneity across studies (I2=97.3%). Current (OR=11.50; p<0.001) and past (OR=6.96; p<0.001) depression, recurrent stroke (OR=1.77; p<0.001), disability (SMD=0.58; p=0.01) and cognitive impairment (SMD=−0.22; p=0.03) were all associated with suicidal ideation. Moreover, suicidal ideation was less likely in stroke survivors who were married (OR=0.63; p<0.001), employed (OR=0.57; p=0.02) and had higher education levels (OR=0.55; p=0.002).

Conclusion Despite some limitations, this meta-analysis shows that about one out of eight stroke survivors has suicidal ideation. Thus, there is enough evidence to support the use of routine screening and early interventions to prevent and treat suicidal ideation after stroke, especially among subjects carrying specific correlates.


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  • Contributors FB had full access to the data set of this study and take responsibility for the integrity of data and the accuracy of data analysis. All authors made substantial contributions to the intellectual content of the paper.

    Conception and design: FB, NL, GC. Literature review: FB, MP, NL. Study protocol: FB, NL, CC, GC. Articles screening: FB, NL. Data collection and data set management: FB, NL, CC. Statistical analysis and interpretation of data: FB, CC, MP, GC. First draft of manuscript: FB, NL, CC, GC. Critical revision of manuscript: MP, GS, MC. Supervision: GC, GS, MC.

    All authors gave final approval for the final version of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed

  • Data sharing statement Data from single studies used for this meta-analysis are available on request.