Advertisement

Wishing to die or self-harm after stroke: A planned secondary analysis of the AFFINITY Randomised Controlled Trial

      Highlights

      • Stroke is associated with increased risk of depression and of suicidal ideation and acts.
      • It is unclear if the routine use of antidepressants after a stroke decreases the cumulative prevalence of suicidal ideation.
      • This randomised controlled trial showed that the cumulative prevalence of recurrent wish to die or self-harm affected 2.5 % and 3.7 % of participants treated with placebo and fluoxetine, respectively, after 52 weeks of follow-up.
      • Routine daily treatment with fluoxetine for 26 weeks neither increases nor decreases the cumulative prevalence of suicidal/death ideation after 26 and 52 weeks.

      Abstract

      We investigated the cumulative prevalence of self-harm ideation among stroke survivors of the AFFINITY trial. We assessed these thoughts with the last item of the PHQ-9, and functional impairment with the modified Rankin Scale (mRS). Of 1221 participants (age 63.9 ± 12.3 years, 775 men), 11 reported wishing to die or self-harm at baseline. By week 52, 36 of 1159 surviving participants had reported wishing to die or self-harm. Treatment with fluoxetine for 26 weeks did not change the prevalence of these thoughts compared with placebo. Clinically significant symptoms of depression were present in 95 % of participants with recurrent self-harm thoughts.
      The study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12611000774921.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Eriksson M.
        • Glader E.L.
        • Norrving B.
        • Asplund K.
        Poststroke suicide attempts and completed suicides: a socioeconomic and nationwide perspective.
        Neurology. 2015; 84: 1732-1738
        • Vyas M.V.
        • Wang J.Z.
        • Gao M.M.
        • Hackam D.G.
        Association between stroke and subsequent risk of suicide: a systematic review and meta-analysis.
        Stroke. 2021; 52: 1460-1464
        • Affinity Trial Collaboration
        Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial.
        Lancet Neurol. 2020; 19: 651-660
        • Almeida O.P.
        • Hankey G.J.
        • Ford A.
        • Etherton-Beer C.
        • Flicker L.
        • Hackett M.
        • et al.
        Depression outcomes among patients treated with fluoxetine for stroke recovery: the AFFINITY randomized clinical trial.
        JAMA Neurol. 2021; 78: 1072-1079
        • Kaplan M.L.
        • Asnis G.M.
        • Sanderson W.C.
        • Keswani L.
        • De Lecuona J.M.
        • Joseph S.
        Suicide assessment: clinical interview vs. Self-report.
        J. Clin. Psychol. 1994; 50: 294-298