Background

Suicide constitutes one of the major public health problems in the USA. Physical illness has been demonstrated to be a significant risk factor for both suicidal ideation and suicide attempts. Mackenzie and Popkin (1987) reported that suicide risk is greater among patients with physical illnesses than among the general population. DeVivo et al. (1993) found that 6.3% of all deaths among patients with spinal cord injury (SCI) were caused by suicide and that persons with SCI were 4.9 times more likely to commit suicide than the general population.

Among patients with stroke, suicidal thoughts are relatively frequent but reports of completed suicides are relatively rare. Garden et al. (1990) reported on two patients who developed mood disturbance in the acute poststroke period and eventually committed suicide. Although neither patient openly expressed suicidal thoughts to staff or family members, risk factors such as depression, insomnia, and cognitive impairment, may have contributed to these suicides.

Suicidal thoughts after acute stroke

Our first investigation of patients with suicidal thoughts evaluated 301 patients with acute stroke in whom we had systematically asked them about the existence of suicidal thoughts or plans (Kishi et al. 1996a). Using the present state examination (PSE), a total of 20 patients (6.6%) reported that they had deliberately considered suicide and that these death wishes were not simply passive death wishes or fleeting thoughts (Fig. 19.1).